Burns, Cuts and Heavy Bleeding: The First Aid That Actually Works
Most first aid mistakes come from well-meant traditional remedies. The correct actions for burns and bleeding are simple, and doing them properly in the first minutes changes outcomes substantially.
Burns
The single most important action: cool running water for 20 minutes.
Not five minutes. Twenty. This is effective up to around three hours after the burn, so it is still worth doing even if there was a delay.
Cool running water, around 15°C, from a tap. Not ice, not iced water, which causes further tissue damage and dangerous cooling, particularly in children.
Twenty minutes of cooling reduces burn depth, reduces the need for skin grafting and reduces scarring. It is the highest-value thing a bystander can do.
Then:
- Remove clothing and jewellery from the area unless it is stuck to the skin, because swelling follows quickly
- Cover loosely with cling film laid flat, not wrapped around a limb, or a clean non-fluffy cloth. Cling film is ideal: sterile enough, non-adherent, transparent for assessment, and reduces pain
- Keep the person warm overall while cooling the burn, especially children, since large burns cause rapid heat loss
- Simple pain relief
Never put on a burn: butter, ghee, oil, toothpaste, egg white, ice, turmeric paste, soy sauce, or any ointment. These trap heat, introduce infection, and have to be painfully removed before the burn can be assessed.
Do not burst blisters. They are a sterile biological dressing.
Seek medical attention for:
- Burns larger than the palm of the person’s hand
- Any burn to the face, hands, feet, genitals, or across a joint
- Burns that go all the way around a limb
- Deep burns: white, leathery, brown or charred, or painless, since painlessness means nerve destruction
- All chemical and electrical burns
- All burns in infants, young children, older adults, pregnant women or people with diabetes
- Any suspicion of inhalation injury: burns around the mouth or nose, singed nasal hair, soot in the mouth, hoarseness, or a burn sustained in an enclosed space
Chemical burns: irrigate with copious running water for at least 20 minutes, longer for alkalis, which penetrate deeper. Remove contaminated clothing while protecting yourself. Do not attempt to neutralise with another chemical.
Electrical burns: ensure the power is off before touching the person. The visible skin injury is often trivial compared with the internal damage along the current path, and cardiac rhythm disturbance can occur, so medical assessment is required even when the person seems well.
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Bleeding
For most cuts:
- Apply firm direct pressure over the wound with a clean cloth or dressing
- Keep it there. Lifting to check is the commonest error; it disrupts the clot that is forming
- Elevate the limb above heart level if practical
- If blood soaks through, add another layer on top. Do not remove the first
- Once bleeding stops, clean with running water, dry the surrounding skin, and cover
For severe, life-threatening bleeding:
- Call emergency services immediately
- Apply firm, sustained, hard pressure directly on the bleeding point, using your hands if nothing else is available
- If bleeding from a limb cannot be controlled with pressure, a tourniquet is appropriate. Apply it high and tight above the wound, tighten until bleeding stops, which will hurt, note the time, and do not loosen it. Modern practice supports tourniquets for catastrophic limb bleeding; the older fear of inevitable limb loss was overstated
- Pack deep wounds that are not in the chest, abdomen or neck with gauze or clean cloth pushed firmly into the wound while maintaining pressure
- Keep the person lying down and warm, and watch for shock: pale, cold, clammy skin, rapid weak pulse, rapid breathing, confusion, thirst
Do not remove an embedded object. It may be the only thing limiting the bleeding. Pad around it and apply pressure either side.
Nosebleeds: sit upright, lean forward, and pinch the soft part of the nose just below the bony bridge continuously for 10 to 15 minutes without releasing to check. Leaning back sends blood into the throat and causes vomiting. Seek help if it continues beyond 20 minutes, is very heavy, follows a head injury, or the person takes anticoagulants.
Wound care afterwards
- Clean with running water; antiseptic solutions are not required for simple wounds and some delay healing
- Keep it covered and moist rather than letting it dry out, which produces better healing and less scarring
- Tetanus: check vaccination status, particularly for dirty wounds, puncture wounds, or anything contaminated with soil
- Seek medical care for: wounds that gape and may need closure, those on the face, deep puncture wounds, animal or human bites, wounds with embedded material, signs of infection with spreading redness, warmth, swelling, pus or fever, numbness or inability to move the part beyond the wound, and any wound in someone on blood thinners or with diabetes
Wound closure is time-sensitive. Cuts needing stitches are best closed within a few hours, so a gaping wound should not wait until the next day.
Animal bites
Higher infection risk than they look, particularly cat bites, which are deep punctures.
Wash thoroughly with soap and running water for at least 15 minutes, and seek medical assessment. Rabies is relevant in many regions for dog, cat, monkey and bat exposures, and post-exposure treatment is time-critical and highly effective. Do not wait to see whether the animal becomes ill.
The short version
For burns: 20 minutes of cool running water, nothing else on the skin, cling film to cover, and no ice. For bleeding: hard direct pressure maintained without lifting, add layers rather than replacing them, and use a tourniquet for uncontrollable limb bleeding. Most of the harm in both cases comes from traditional remedies and from checking too soon.