Burns outdoors can happen in seconds. Knowing what to do next can make a significant difference.
All perfectly normal parts of being outdoors.
Until something goes wrong.
Burns and scalds are injuries we often associate with the kitchen or workplace, but they present a particular problem outdoors. You may be miles from help, carrying limited first aid equipment and, importantly, have a limited supply of clean water.
So what should you actually do if someone is burned while camping, hiking or travelling in a remote environment?
Burns and scalds outdoors
A burn is usually caused by dry heat, such as fire, a hot stove or hot cookware. A scald is caused by hot liquid or steam.[1]
Around a campsite, both are possible.
Common causes include knocking over a camping stove, spilling boiling water, picking up hot cookware, falling against a campfire, hot embers, steam and clothing catching fire.
Prevention is obviously better than treatment. Put stoves on stable ground, keep cooking areas away from where people are walking and think carefully about where you place pans of boiling water.
Children and camp cooking deserve particular attention.
First things first: stop the burning
Before reaching for the first aid kit, stop whatever is causing the injury.
Move the casualty away from the heat source. If clothing is on fire, extinguish the flames. Remove hot or wet clothing, jewellery and other items close to the burn where possible.
Don't pull away material that is firmly stuck to the skin.
With a scald, remember that clothing soaked in hot liquid can continue holding heat against the skin, so removing it promptly – provided it isn't stuck – is important.
Then start cooling.
Cool the burn for 20 minutes
Current UK guidance recommends cooling a thermal burn with cool running water for 20 minutes, as soon as possible. Cooling can still be beneficial if started within three hours of the injury.
Twenty minutes can feel like a very long time when you're sitting beside a tent on a cold hillside.
But it matters.
Cooling removes heat from the tissues and helps limit progression of the burn injury.
Don't use ice or iced water. Extreme cold can cause vasoconstriction, potentially worsening tissue injury, as well as increasing the risk of hypothermia.
And remember an important principle:
Cool the burn. Keep the casualty warm.
Cover and insulate the unaffected parts of the casualty while cooling the burn. This becomes particularly important with children, older casualties, larger burns and cold or exposed environments.
But what if you've only got two litres of drinking water?
This is where outdoor first aid becomes different from first aid in a classroom.
At home, running a tap for 20 minutes is easy.
Halfway through a mountain day, at a wild camp or travelling somewhere remote, water may be one of your most valuable resources.
The preferred treatment remains cool running water for 20 minutes. But if your water supply is limited, the British Burn Association recommends applying a cool water compress using a clean, wetted, lint-free cloth and changing it frequently over the 20-minute period.
Why frequently?
Because a wet cloth sitting against warm skin will itself warm up and become less effective.
If you have sufficient water, pouring or gently flowing water continuously over the burn is preferable.
Does the water have to be drinking water?
Ideally, use clean potable water.
But this creates an interesting problem in remote environments.
What happens when the only water available isn't drinking quality?
More recent British Burn Association discussion of burn cooling specifically recognises that the absence of a clean water source should not necessarily prevent timely and effective cooling. Water of varying quality may have to be considered when clean water isn't available.
That doesn't mean automatically putting a burn into a stagnant muddy puddle.
It means making a sensible risk assessment.
A clear flowing water source presents a very different proposition from obviously stagnant or contaminated water. If carried clean water or filtered water is readily available, use it.
But don't lose sight of the immediate problem: heat continuing to damage tissue.
Outdoor first aid is often about balancing risks rather than waiting for perfect conditions.
What about burn gels?
Burn dressings and hydrogel products are common in first aid kits, which can give the impression that they replace water.
They don't.
British Burn Association guidance states that evidence for hydrogel effectiveness is limited.
If suitable water is available, water remains the priority.
This is worth remembering when building an outdoor first aid kit. Carrying a large burn dressing doesn't compensate for understanding how to manage the injury.
After cooling: cover the burn
Once adequately cooled, protect the burn.
Cling film is useful because it's clean, non-adherent and is generally available where there is cooking.
But don't wrap it around a limb.
Instead, lay separate sheets loosely over the burn and gently crimp them underneath. This allows room for the injured area to swell without the cling film becoming constrictive.
For hand burns, I carry small freezer bags in my own kit. They're lightweight, take up virtually no space and can be slipped loosely over the hand after cooling. That's particularly useful outdoors, where hands are an obvious place for burns from stoves, cookware and campfires.
Don't burst blisters and don't remove clothing burnt into the wound.
Whatever you use, don't apply it tightly and allow for swelling.
Cool first. Cover second.
How serious is the burn? Think SCALD(E)
Treating the burn is only part of the problem.
You now need to decide what happens next.
A useful way of assessing a burn is SCALD(E):
S – Size
How much of the casualty has been burned?
A small splash to a finger is very different from boiling water being tipped across someone's thigh or torso.
C – Cause
What caused it?
Flame? Boiling water? Steam? Hot metal? Electricity? Chemical?
The mechanism can tell you a lot about the potential injury.
A – Age
Who is your casualty?
Children and older people can be particularly vulnerable to burns and to complications such as hypothermia during cooling.
L – Location
Where is the burn?
Burns involving areas such as the face, hands, feet, major joints or genital area warrant particular concern.
A hand burn may also have significant practical consequences outdoors. If the casualty can't grip a walking pole, use their hands effectively or manage equipment, can they actually self-evacuate?
D – Depth
What does the burn look like?
Is the skin simply red and painful?
Are there blisters?
Are there pale, mottled, waxy or charred areas?
Don't assume that the most painful burn is necessarily the deepest. Very deep burns can damage nerve endings and may actually be less painful.
E – Environment
This is the outdoor bit.
Where are you?
A relatively small burn ten minutes from a road is very different from the same injury six hours into a mountain journey.
Consider:
Distance from definitive medical care
Available communications
Weather
Temperature
Shelter
Available water
Ability to keep the casualty warm
Terrain
Time of day
Ability of the casualty to walk or self-evacuate
Resources available within the group
The injury hasn't changed.
But the situation has.
That's why environment belongs in an outdoor assessment of burns.
When should you get help?
Large, deep or otherwise significant burns require medical assessment. Burns involving certain areas, including the face and genitals, and electrical or chemical burns also require urgent assessment.
In the outdoors, I'd add another question:
Can we safely manage this casualty where we are?
SCALD(E) can help you make that decision.
If you're concerned about the Size, Cause, Age, Location or Depth of the burn – or the Environment makes continued management difficult – your threshold for seeking professional advice or evacuation should fall.
Depending on the situation, that might mean contacting 999 or 112, NHS 111 where appropriate, seeking medical advice or beginning an evacuation.
In a remote environment, make that decision early.
Poor communications, difficult terrain and worsening weather can turn a straightforward evacuation into something much more complicated.
Don't forget hypothermia
Imagine someone spills boiling water across their leg while camping on a cold evening.
You remove their wet clothing and start cooling the burn.
Correct.
But now they're sitting outside, partly undressed, wet and losing heat.
Treat the whole casualty, not just the burn.
Insulate them from the ground. Protect them from wind and rain. Cover unaffected areas and monitor them.
Cool the burn. Warm the casualty.
Prevention is part of first aid
Some of the best outdoor first aid happens before anyone gets injured.
Set up cooking areas carefully.
Keep stove fuel and naked flames separated.
Keep children away from stoves and boiling water.
Think about where people are going to walk before putting a stove down.
And before lifting a pan of boiling water, decide exactly where you're going to put it.
It sounds obvious.
Most safety advice does – until somebody knocks the stove over.
Outdoor first aid isn't about carrying a huge medical kit.
It's about understanding the problem, knowing your priorities and being able to adapt when the perfect equipment isn't available.
For an outdoor burn:
Stop the burning. Cool for 20 minutes. Keep the casualty warm. Cover the injury. Assess using SCALD(E). Decide whether you can safely manage the casualty or need to evacuate.
And if your water supply is limited?
Use what you have intelligently.
Because in the outdoors, the textbook answer and the resources available to you aren't always the same thing.
That's why good outdoor first aid training isn't simply about learning procedures.
It's about learning to make good decisions when things don't go to plan.
Be Adventure Ready.
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References
1. NHS. Burns and scalds. NHS. Guidance on immediate cooling, covering burns and indications for seeking medical assistance.
2. British Burn Association. First Aid Clinical Practice Guidelines. Pre-Hospital Special Interest Group. Guidance on stopping the burning process, 20-minute cooling, management where water supply is limited, prevention of hypothermia and covering burns.
3. British Burn Association / Emergency Management of Severe Burns. EMSB Course Manual, UK Edition. Guidance on burn cooling, effectiveness of running water compared with wet towels and prevention of hypothermia.
4. British Burn Association. Saving Lives Is Not Enough. 2024. Discussion of pre-hospital burn management and water strategies, including circumstances where clean potable water is unavailable.
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