How burns and scalds are treated, and when they need A&E, 999 or NHS 111

What is the difference between a burn and a scald, and how are they sized?

Burns are skin damage from dry heat such as fire or a hot object, and scalds are skin damage from hot liquid or steam. NHS-linked guidance describes a minor burn as affecting the outer layers of skin, which look red or pale pink, slightly swollen and painful. Deeper burns that cause white or charred skin are described as needing emergency assessment. A burn the size of the person's hand or bigger is described by the Healthier Together service as an emergency. Blistering at the burn site is also listed as a reason to seek urgent help for a child.

What first aid does the NHS describe?

The NHS describes cooling the burn with cool or lukewarm running water for 20 minutes, starting as soon as possible after the injury. Clothing or jewellery near the burn is described as taken off, but anything stuck to the burnt skin is left in place because removing it could cause more damage. After cooling, the NHS describes covering the burn with cling film laid in a layer over it, rather than wrapped around a limb. NHS 111 Wales adds that a clean, clear plastic bag can be used for a burn on the hand. For a child, the NHS describes keeping the child warm and avoiding ice or very cold water, which can make the wound worse.

What should be avoided, and what helps with the pain?

The NHS says never to use ice, iced water, or any cream or greasy substance such as butter on a burn. Blisters will burst naturally, and the NHS advises against bursting them because this can cause infection. For pain, the NHS suggests paracetamol or ibuprofen, following the maker's instructions on the packet. It adds that children under 16 should not be given aspirin.

Which burns need A&E or a 999 call?

The NHS says to call 999 or go to A&E for a burn that is very large or deep. The same applies to a burn on the face, genitals or bottom, and to a burn caused by an acid, a chemical or electricity. The NHS also says not to drive to hospital, and to ask someone else to drive or to call 999 for an ambulance. NHS treatment guidance also says to go to A&E if someone has been injured on purpose or if that is suspected. Healthier Together guidance adds burns on the neck, hands, feet or any joint to the list needing urgent assessment. Breathing in smoke can cause delayed symptoms such as coughing, a sore throat, difficulty breathing or singed nasal hair, and these still need A&E. Where a burn is smaller and less deep, the NHS says it can often be treated at home.

What about chemical and electrical burns?

For a chemical burn, the NHS acid and chemical burns page lists calling 999 first. It then describes removing contaminated clothing, brushing off dry chemicals and flushing the area with cool or lukewarm running water for about an hour. The NHS says treatment for these burns happens in hospital, where painkillers, antibiotics and fluids into a vein may be given. A burn caused by electricity is also in the NHS list of burns needing 999 or A&E. Burn network guidance gives longer rinsing times for some chemical burns, so the duration is not the same in every source.

What about children and babies?

For a child, the NHS describes putting the burn or scald under cool running water for 20 to 30 minutes straight away. It then says to see a GP, or go to a minor injuries unit or A&E, depending on how severe the burn or scald is. Where there is no running water, the NHS child page describes using cold water or another cool fluid such as milk.

How does a burn heal, and what are the signs of infection?

The NHS says how long a burn takes to heal depends on how serious it is and how it is treated. Minor, superficial burns usually close in about two weeks, while deeper burns can take months or longer. The NHS advises urgent medical advice from a GP or NHS 111 if the wound has not healed after two weeks. The NHS Recovery page lists a wound that becomes painful or smelly, a high temperature, or a dressing soaked with fluid as other reasons for urgent advice. Hospital patient leaflets add spreading redness, swelling, warmth and discharge as possible signs of infection. The South West Burns Clinical Network says a burn not healed in this time can carry a risk of sepsis.