You may know that immersing a new burn in cool running water is highly effective first aid, but do you know how long to hold it under the tap? It might be much longer than you thought – 20 minutes, according to a recent research paper out of Australia co-authored by Shriners Children’s Northern California burn physician Tina Palmieri, M.D. The new paper shows that cool running water on a burn provides more than pain relief. It also helps prevent some of the damage to the skin and underlying tissues. What’s more, you have up to three hours to get the benefit of the running water treatment, so there is ample time to react.
A look at the evidence
While Dr. Palmieri’s group’s paper was unable to establish a statistically significant reduction on ICU admissions, it did find a strong benefit on the other outcomes investigated, including a reduction in burn depth, decreased need for skin grafting, a shorter re-epithelization (resurfacing of the wound) time and less need for any surgical treatment for wound management.
For their paper, Dr. Palmieri and the group evaluated seven studies with the requisite quality and data for a meta-analysis. Those studies had a total population of 11,383 patients, of whom 50% received cool running water first aid for 20 minutes. Among the studies, findings included the following:
- One study reported a 31% decrease in the likelihood of pediatric hospitalization.
- One pediatric study reported a 63% decrease in the likelihood of a full thickness wound depth at the first dressing change.
- Pooled results from three studies showed a 46% decrease in the likelihood of the need for skin grafting.
- In two studies, the likelihood of needing any kind of surgical treatment, including grafting, debridement, etc., was 36% lower.
- Taken all together, the studies suggested that the average re-epithelization time was reduced from 14 days to 13 days. (Shriners Children’s burn surgeons suggest that when a burn re-epithelizes within 14 days, it won’t scar, but any longer than that, it will.)
“The review demonstrated that 20 minutes of cool running water first aid was associated with substantial improvements to patient morbidity, including significant reductions in burn wound temperature and depth, hospital admissions, skin grafting or other surgical intervention requirements and infection rates,” the study conclusion said. “Moreover, from a practical sense, cool running water first aid is mostly accessible, simple and can be applied by conscious patients, bystanders and pre-hospital responders.”
While it is not definitively known why the water helps, it is thought the coolness alleviates pain somewhat and reduces the temperature of the wound, which may suppress some histamine release, a triggering factor in causing inflammation and swelling.
Are there occasions you shouldn’t take the time to run under cool water? Yes, Dr. Palmieri said.
“If a burn is more than roughly five palm prints in size, you should seek immediate medical attention,” said Dr. Palmieri. “But, if it is less than that, keep the burn under cool running water for 20 minutes” and then seek additional treatment as necessary.
Moving past barriers
While this recommendation is practical and feasible almost anywhere, it’s not especially easy. “Twenty minutes can seem an eternity when you need to stay under the water and not move. Twenty minutes is hard to do,” Dr. Palmieri said. “You have to actually time it.”
The American Burn Association (ABA) has recommended running burns under cool water for five minutes, but neither the ABA nor the Centers for Disease Control and Prevention (CDC) have adjusted their recommendation to 20 minutes. Dr. Palmieri says the groups have been reticent because there hasn’t been a definitive, randomized, prospective trial – only case-report studies. Dr. Palmieri thinks both organizations should begin to recommend running for the faucet or hose based on the accumulating evidence.
For more information about fire safety and burn prevention, visit beburnaware.org.
After First-aid Action, Firefighters Recommend Shriners Children’s
Ayden, who was 10 at the time, was standing next to his father, Ravin, a chef, in a makeshift kitchen at an outdoor event. Suddenly, a gust of wind blew a tent into the cooking station and sent boiling water and hot food onto Ayden’s legs and feet.
Luckily for Ayden, four off-duty firefighters had arrived at the event just minutes earlier. The firefighters immediately sprang into action. One quickly disinfected the large kitchen sink so they could treat Ayden’s burns with water, another called for help, and the others grabbed their first-aid supplies. The team worked quickly to triage Ayden’s burns with bandages and water.
In that moment, Ayden’s parents faced a difficult choice. They could transport Ayden by ambulance to the nearest emergency room or they could bring him themselves to UC Davis, close to Shriners Children’s Northern California.
“The firefighters strongly recommended that Ayden go to Shriners Children’s,” said Ayden’s mom, Ashlee. “They all told us we must go there.”
Ashlee and Ravin put Ayden in the car and raced to UC Davis, where he was later transferred to Shriner’s Children’s. Ayden was treated for second- and third-degree burns for several days. He had follow-up care for months following his injury, including skin graft surgery.
“Everyone from the doctors, nurses and child life specialists did everything they could to make Ayden feel as comfortable as possible,” said Ashlee.
Today, Ayden is a typical 12-year-old boy and is back to doing what he loves: playing drums, competing in sports and hanging with his friends. Ashlee credits Shriners Children’s, and the amazing firefighters who sent him there, for his recovery.