Should You Put Ice on a Burn? No, and Here’s What to Do Instead

Why ice makes it worse

The instinct is understandable. A burn is hot, ice is cold, cold must be better. It is not.

A burn is tissue damage that carries on after the heat source is gone, which is why cooling works at all. Ice does not stop that process gently; it causes a second injury on top of the first. Extreme cold constricts the blood vessels supplying the damaged area, cutting off the circulation that the tissue needs to survive, and can cause a cold injury in its own right. The practical result is a burn that ends up deeper, takes longer to heal and is more likely to scar.

NHS guidance is specific about what to use: cool running water. If there is no running water, cool bottled water or a wet towel will do. Nothing in that list is ice.

How long, really

Twenty minutes. This is the single most common thing people get wrong, and it is worth being blunt about, because the older advice of ten minutes is still repeated everywhere including by people who were trained years ago.

Twenty minutes under cool running water, started as soon as possible after the burn. It feels like a very long time when you are standing at a sink, and it is the part that does most of the good. Setting a timer is not excessive.

If you did not get to it immediately, cool it anyway. NHS guidance is that cooling should be done within three hours of the injury, so a burn that happened twenty minutes ago is still worth cooling properly.

What to do, in order

1. Stop the burning. Move the person away from the heat source, or the heat source away from them.
2. Cool it. Cool running water, 20 minutes. Not ice, not iced water.
3. Remove clothing and jewellery near the burn, including watches and rings, before the area swells. Do not remove anything that is stuck to the burn.
4. Keep the rest of them warm. Twenty minutes of cold water on a large burn can drop body temperature, which matters especially with children and older people. Use a blanket, keeping it off the burn itself.
5. Cover it. Once cooled, lay cling film over the burn. Do not wrap it around a limb, because the area swells and a wrap becomes a tourniquet. A clean plastic bag works for a hand or foot.
6. Treat the pain with paracetamol or ibuprofen if appropriate.
7. Get help if it meets any of the thresholds below.

Things not to put on a burn

Blisters should be left alone. Bursting one opens a sterile wound to infection for no benefit.

When to call 999 or go to A&E

NHS guidance is to get emergency help immediately for a burn that is:

• Very large or deep, roughly the size of the casualty’s hand or bigger
• On the face, genitals or bottom
• Caused by an acid or chemical, or by electricity

Also seek medical help for any burn on a baby or young child, any burn that goes all the way through the skin and looks white or charred, and any burn where the person has inhaled smoke or fumes. If you are unsure, NHS 111 exists for exactly this.

Chemical and electrical burns are different

Chemical burns need the substance removed before anything else. Brush off dry powder, remove contaminated clothing without dragging it over clean skin, and then flush with running water for considerably longer than 20 minutes. Take the container or the safety data sheet with you to hospital, because the treatment depends on the substance. If your workplace uses hazardous substances, that is squarely a COSHH matter and the assessment should already say what to do.

Electrical burns are the deceptive ones. The visible mark where the current entered and exited can be tiny or invisible while the damage runs deep through the tissue in between. Anyone who has had an electric shock needs medical assessment regardless of how the skin looks, and the first priority is always making the area safe before touching them. We set that out in electric shock first aid.

Burns at work

Burns are not a kitchen-only problem. Catering and hospitality see the most, but hot work, steam, chemicals, exhausts, hot oil, friction and electricity all produce them, and cement burns are a slow alkaline injury that people often ignore until the damage is done.

Three things worth checking in your own workplace:

• Is there running water within reach of where burns actually happen? Twenty minutes of cooling is a different proposition if the nearest tap is across a yard.
• Does your first aid kit reflect the risk? There is no legal list of contents. What goes in comes out of your assessment, which we cover in workplace first aid kit requirements.
• Does anyone actually know the 20-minute rule? This is the single most commonly misremembered piece of first aid there is.

Burns are taught on every first aid course we run, including the one-day Emergency First Aid at Work course. How much first aid cover you need in the first place comes out of your first aid needs assessment, not from a ratio someone told you.

If you want your team to know this properly rather than from memory, burns are covered on every first aid course we run. Call 0845 838 4643 or use the enquiry form on this page.