Burns

The first-aid treatment for a burn is cool running water for 20 minutes, and it is one of the most clearly established facts in first aid. The reasons: it stops the burning process continuing into deeper tissue, it reduces pain, and there is evidence it reduces the need for grafting when started promptly. It must be running water, it must be cool rather than ice-cold, and it must be about 20 minutes — brief cooling does much less, and ice causes further tissue damage.

What not to do. Ice directly on the burn; butter, oil, toothpaste, egg white or any kitchen substance; and — a specifically documented harm — do not apply ice or cold water to a burn covering a large area or in a small child for prolonged periods, because hypothermia is a real risk. Do not break blisters.

After cooling. Cover loosely with cling film laid, not wrapped, or a clean non-adherent dressing. Keep it warm while the rest is being cooled in a large burn. Pain relief — paracetamol or ibuprofen at the proper dose.

Aloe vera has randomised trial evidence for burn healing, reducing healing time compared to a control in several small trials. It is applied after cooling, and a fresh leaf or a pure gel is preferable to a scented product. It is not a substitute for cooling.

Honey has trial evidence in partial-thickness burns and is used in some settings as a dressing. Medical-grade honey is the studied form.

Silver sulfadiazine, the traditional topical antibiotic, has been found in some trials to delay healing compared to modern dressings — another case of a familiar treatment being superseded.

Sunburn is a thermal burn. Cool it, drink fluids, take an anti-inflammatory early, and — the thing people get wrong — do not apply a topical anaesthetic containing benzocaine, which can cause a serious reaction, and do not apply greasy ointments that trap heat.

When a burn needs a hospital. Anything bigger than the palm of the person's hand; anything on the face, hands, feet, genitals or across a joint; any full-thickness burn (white, waxy, leathery, painless — the painless part is the worrying part); any chemical or electrical burn; any burn in an infant, an older adult, or a person with diabetes; and any burn with blackened or charred skin.