Burns, cuts and small injuries
95 min
Two hosts talk the lesson through. The voices are synthetic; the script was written from this lesson and checked against it, and asserts nothing the lesson does not.
- Sequence first aid for a heat burn under US and UK guidance, including how long to cool it and what to cover it with, and explain why the two countries' cooling times differ
- Decide which burns need medical care under each country's guidance, and sequence first aid for chemical and electrical burns
- Describe first aid for a cut or graze, a nosebleed, something in the eye, a knocked-out tooth and an amputated part, and say when each needs help
Cooking Fundamentals lesson 2 ended at the burn, with the first response in both countries: the NHS's 20 minutes under cool running water and the American Red Cross's 5 to 20, water rather than ice, jewellery off, no butter and no plasters, cling film laid on rather than wrapped, and when to get help. This lesson adds why cooling works, why the two countries give different times, the child who gets too cold, the US cover, and how deep a burn has to go before it needs a doctor. Then chemicals and electricity, and the small injuries: the graze, the nosebleed, the grit in an eye, the knocked-out tooth, and the finger that's come off.
Most of these won't kill anyone. What you do in the first minutes still decides a lot: how deep a burn goes, whether a tooth can go back in, whether a surgeon has anything to reattach.
This course is education, not a certificate, and not medical advice about anyone's own situation. In an emergency, call your local emergency number first (911 in the US, 999 or 112 in the UK, 112 across the EU), put the phone on speaker, and do what the call handler tells you. Reading can teach you what to do and in what order. It can't teach your hands how hard to push or how a back blow should feel, so take a hands-on class with a manikin and an instructor, and practise between classes. Each instruction here names the guideline and year it comes from, and guidance changes.
Burns
Where the advice comes from
The US has a burns guideline, the AHA and American Red Cross's 2024 first aid guideline, which grades each step, while RCUK's 2025 first aid guideline has no section on burns.12 So UK advice here comes from the British Burn Association's first aid guideline, which UK burns specialists wrote, and from the NHS, St John Ambulance and the British Red Cross, with ILCOR's 2025 review over both.34567
Cool it, straight away
On the first step, every source with burns advice says the same thing: cool the burn with water, and start now.
- ILCOR: "We recommend the immediate active cooling of thermal burns using running water as a first aid intervention for adults and children (strong recommendation, very low–certainty evidence)."7 A thermal burn is one from heat: in the AHA's list, flames, hot liquids, hot surfaces and hot gases.1
- AHA/Red Cross 2024: cool immediately, preferably with clean running water (COR 1, LOE B-NR).1
- In the UK, the NHS, the British Burn Association, St John and the British Red Cross all start with cool running water, at once.4356
Why does it help? Several sources describe a burn as something that keeps going. St John says the longer the burning goes on, the worse the injury; the British Burn Association says prompt first aid prevents further tissue damage; the AHA says cooling to stop the burn has long been advised as essential first aid.531 The British Red Cross gives the payoff: cooling reduces pain, swelling and the risk of scarring, and the sooner and longer it's done, the smaller the injury's effect.6
The AHA's supporting text describes cooling with running water as established and beneficial with little risk of harm, and cites a pooled analysis of 7 observational studies (11,383 adults and children) in which immediate cooling was linked with less need for further care.1 In lesson 4's terms, ILCOR's strong recommendation on very low certainty evidence is no contradiction: the certainty describes the studies, not how sure the panel is that you should act.7
How long to cool
ILCOR's review compared burns cooled for 20 minutes or more with burns cooled for other lengths of time. Before reading on: what do you guess it found?
So the two countries were free to choose, and they chose differently.
| In the US | In the UK |
|---|---|
| The guideline: "It may be reasonable to cool thermal burns for 5 to 20 minutes." (AHA/Red Cross 2024, COR 2b, LOE B-NR) | The NHS: "Hold the burn or scald under cool running water for 20 minutes. Do this as soon as possible, within 3 hours of it happening." |
| The public page: the American Red Cross: "Place the burn site under clean, cool, running water for 5-20 minutes" | The other UK texts: British Burn Association: "Cool the burn immediately with cool running tap water for 20 minutes and within 3 hours of injury"; St John: "at least 20 minutes or until the pain feels better"; British Red Cross: "at least 20 minutes" |
| The reason given: ILCOR couldn't show a best duration, and leading international organisations recommend 5 to 20 minutes | The reason given: the British Red Cross says the sooner and longer the cooling, the less the burn's impact. The British Burn Association gives no reason for 20 minutes as a minimum or for the 3 hours; its reason for not going past 20 is hypothermia |
AHA/Red Cross 2024, section 9.8;1 American Red Cross, Burns;8 NHS, Burns and scalds;4 British Burn Association, 2018;3 St John Ambulance, Burns and scalds;5 British Red Cross, Burns.6
Read the two columns together and they overlap: 20 minutes sits inside the American range, at its top. What differs is whether shorter counts as enough. Neither side is wrong on the evidence ILCOR found, because ILCOR found nothing to settle it. Follow your own country's figure; both columns rule out skipping the cooling.
The American Red Cross page changed during 2026. In January it said "for 20 minutes", as late as May it said "Never use ice, ice water, or a freezing compress to cool a burn.", and by the end of August both lines had gone.8
Too cold: children, and big burns
Water on a burn can chill the whole person, and small children chill fastest.
In the US, the AHA/Red Cross guideline says to watch preadolescent children being cooled with running water for signs of hypothermia (COR 1, LOE C-LD). Its reason: children have more surface area for their size than adolescents and adults. In one study of 117 children cooled in a shower, 5 (4%) became hypothermic or visibly cold and shivering.1 The American Red Cross adds a warning for large burns, particularly in children.8
In the UK, the British Burn Association's line is "Cool the burn but warm the patient": cover the parts that aren't burned, and aim to complete 20 minutes, since cooling beyond that may cause hypothermia, especially in children, older people and large burns.3 St John says not to over-cool, which can be more serious in babies and older people.5 The British Red Cross says to aim a shower at the burn, not the whole body, and to avoid a cold bath.6
ILCOR's good practice statement is the same idea: watch young children being cooled for signs of too much body cooling.7 Cool the burn. Keep the rest of them warm.
No running water, and ice
If there's no running water, the UK pages name alternatives: cool bottled water or a wet towel (the NHS); cold milk or canned drinks (St John); milk, soft drinks or even beer poured over it (the British Red Cross); a cool wet compress changed often over 20 minutes (the British Burn Association).4563 The American Red Cross says a cool or cold compress.8
On ice, both countries start from the same place: running water first, and no bare ice on a burn. The British Burn Association and St John say no ice, and so does the American Red Cross page's own FAQ: "Should I use ice to cool the burn? No. Use water. Ice may further damage the skin."358 In the US, the AHA/Red Cross guideline adds one narrow exception: if clean running water isn't available, "it may be reasonable to cool superficial burns (with the skin intact) with ice wrapped in cloth" (COR 2b, LOE C-LD). Its supporting text limits that to 10 minutes, to prevent frostbite, and reports animal studies in which ice lowered the tissue temperature but did not speed healing.1 So wrapped ice is a US fallback for an unbroken, superficial burn with no water to hand.
Rings off, then cover it
Take off rings, watches and anything tight near the burn, early. The AHA/Red Cross guideline says to remove jewellery, belts and other tight items promptly (COR 1, LOE C-EO), and its reason is that burned tissue swells and a ring can then cut off the blood supply.1 St John: remove them "before the area begins to swell".5 The NHS, St John and both Red Crosses add the exception: leave anything stuck to the burn.4568
Then cover it, and here the countries use different materials.
| In the US | In the UK |
|---|---|
| AHA/Red Cross 2024: for a burn with intact skin or an intact blister, awaiting a professional, loosely cover it with a clean cloth or a non-sticking dry dressing (COR 2b, LOE C-EO) | Cling film laid over the cooled burn, not wrapped: "Do not wrap the cling film around it." (NHS); in lengthways strips (St John; British Burn Association), discarding the first two turns of the roll (St John); a clean plastic bag for a hand or foot (St John), or for any burn (British Red Cross) |
| American Red Cross: a clean, dry, non-adhesive dressing, laid on loosely | The British Burn Association: no cling film on the face |
AHA/Red Cross 2024, section 9.8;1 American Red Cross;8 NHS;4 St John;5 British Burn Association;3 British Red Cross.6
Each side gives its reasons. The AHA: a cover protects the wound and reduces pain without trapping heat.1 The British Red Cross: cling film won't stick to the burn, keeps it clean, and eases pain by keeping air off it.6 And St John on why it is laid on rather than wound round: the burned area needs room to swell.5
Two things the public pages rule out. No sticking plasters or adhesive dressings, which stick to the burn (NHS; British Red Cross; American Red Cross).468 And don't burst blisters; St John says doing so may cause infection.5 For pain, the AHA/Red Cross guideline says over-the-counter painkillers are reasonable (COR 2a, LOE B-NR), and the NHS names paracetamol or ibuprofen.14
Butter, and the question of creams
In the first minutes, nothing greasy. The British Red Cross: "No. Butter, cream or toothpaste will not cool the area." Oils "retain heat", toothpaste's menthol only feels cool, and anything put on a burn may have to be taken off in hospital, which hurts.6 The American Red Cross says greasy substances "seal in the heat".8 St John adds creams and gels to its list of things not to use.5
What goes on a small burn in the days after is where the texts part, and none explains why. In the US, the AHA/Red Cross guideline says petroleum jelly, honey or aloe vera under a non-sticking dressing may be reasonable on the open wound of a small partial-thickness burn looked after at home (COR 2b, LOE B-R), from studies that mostly used them daily until it healed; the American Red Cross page's FAQ says petroleum jelly doesn't relieve pain or help healing.18 In the UK, the NHS's advice while a burn heals is "do not put any creams, oils or butter on burns or scalds", but a moisturising emollient if the skin gets itchy and dry, asking a pharmacist what to use.4 That's after-care, past first aid, and a question for a pharmacist or a doctor.
Which burns need a doctor
The US guideline sorts burns by depth, and its background section says how to tell the first kind. A superficial burn is red and painful, with no blistering and no broken or loosened skin; the skin still works as a barrier. Partial-thickness and full-thickness burns destroy the outer layer of skin and injure the layers beneath, and both often need more treatment than first aid can give.1 By the guideline's own definition, then, a burn that has blistered is not superficial. The background doesn't say how to tell a partial-thickness burn from a full-thickness one, so this course doesn't try.
| In the US (AHA/Red Cross 2024) | In the UK (NHS) |
|---|---|
| Prompt evaluation by a health care professional for a full-thickness burn, or a partial-thickness burn larger than the person's palm or on the "face, hands, feet, or genitals" (COR 1, LOE B-NR) | Call 999 or go to A&E for a burn that is very large or deep; on the face, genitals or bottom; or caused by an acid, a chemical or electricity |
| Signs of smoke inhalation (facial burns, trouble breathing, singed nose hairs, soot around the nose or mouth): call EMS (COR 1, LOE C-EO) | NHS 111 if you're not sure what to do; "Call 111 if you need advice for a child under 5 years old." |
| American Red Cross page: go to hospital if a child has been burned or the burn blisters, among others | British Red Cross: always get medical advice for a baby or child |
AHA/Red Cross 2024, section 9.8;1 American Red Cross;8 NHS, Burns and scalds;4 British Red Cross.6
The AHA's yardstick is "the person's palm", so for a toddler it is a toddler's palm.1 Smoke changes the picture: the AHA's reason is that hot smoke can swell the airway fast, and that signs of inhaling it can also point to carbon monoxide poisoning, which lesson 2 met.1 And read the NHS 111 line for what it says. It sits under "not sure what to do", and tells parents of under-fives to phone rather than use 111 online.4 It is not a rule that every burned toddler gets a 111 call, though the British Red Cross does want medical advice for every burned child.6
A man burns the back of his hand on an oven shelf. It is red and blistered, about the size of a large coin, far smaller than his palm. He'd rather not bother anyone. What do the US guideline and the NHS page each say?
Show the answer
In the US, it has blistered, so by the guideline's definition it's past superficial, and it's on his hand: the AHA/Red Cross 2024 guideline sends a partial-thickness burn on the hands to a health care professional promptly whatever its size (COR 1, LOE B-NR). The American Red Cross page goes further: a burn to the hands is on its list for immediate emergency treatment and a 911 call, and it would send any blistered burn to hospital.18
In the UK, the NHS's 999 or A&E list names the face, genitals and bottom, not the hands, and a coin-sized burn isn't very large. So the NHS route is 111 if he is not sure.4
Chemical burns
A chemical keeps burning while it is on the skin, so the job is to get it off, fast, without getting it on you. The British Burn Association says how long the chemical stays in contact is a major factor in how severe the burn is.3 The AHA's supporting text cites a study in which people rinsed within 10 minutes, for at least 15, had fewer full-thickness burns and shorter hospital stays.1
Protect yourself first. Gloves (NHS), and an apron and eye protection if you have them (St John); the American Red Cross calls protective equipment critical.958 St John adds ventilating the room, and pouring the water away from yourself.5
Brush off anything dry, then water. The AHA/Red Cross guideline says brushing off a dry chemical before rinsing is reasonable (COR 2a, LOE C-LD), because some dry chemicals react with water, and the NHS, St John and the British Burn Association say to brush it off too.1953 Take off contaminated clothing and jewellery (AHA, COR 1, LOE C-EO), which the AHA says can otherwise trap the chemical against the skin.1 Then water, and a lot of it:
| In the US | In the UK |
|---|---|
| "Unless otherwise recommended by local guidelines or chemical-specific information, skin exposed to caustic chemical should be irrigated with running water for at least 15 minutes." (AHA/Red Cross 2024, COR 1, LOE B-NR) | NHS: "Put the affected area under cool or lukewarm running water or pour lots of water over it for about 1 hour." British Burn Association: "for at least 20 minutes", and on until the pain eases or a specialist sees them. St John: flood it "until the ambulance arrives" |
| Call EMS for breathing problems, symptoms elsewhere in the body, or a large exposure (COR 1, LOE C-EO); a poison centre can advise (COR 1, LOE C-LD) | NHS: call 999 if an acid or chemical is on someone's skin or in their eyes |
AHA/Red Cross 2024, section 8.2;1 NHS, Acid and chemical burns;9 British Burn Association;3 St John, Chemical burn.5
The spread runs from 15 minutes to about an hour, and the sources agree on the rest: start at once, use plenty of running water, protect yourself.
Do not neutralise it. St John: "Never attempt to neutralise acid or alkali burns unless you are trained to do so."5 The British Burn Association's reason is that neutralising can set off a reaction that gives out heat and adds to the damage.3 The NHS says to put nothing on a chemical burn, skin creams or other chemicals included.9 The AHA names a few chemicals, such as hydrofluoric acid and phenol, that are best dealt with using something other than water, and its 15 minutes gives way to local or chemical-specific advice.1 The British Burn Association's list of things not to wash with water is longer: dry lime, phenols, muriatic acid, concentrated sulphuric acid and elemental metals.3 For those, tell the call handler what the chemical is; in the US a poison centre can advise (AHA, COR 1, LOE C-LD).1
A splash in the eye is the same idea, faster. In the US, the AHA/Red Cross guideline says to rinse immediately (COR 1, LOE B-NR) with "a copious amount of tap water for 15 minutes" unless local guidelines differ (COR 1, LOE C-LD).1 In the UK, St John says "at least 20 minutes", holding the eye under gently running water with the lids washed inside and out.5 Both say keep the run-off away from the other eye and from you.15
Electrical burns
Lesson 2's first rule decides this one: make sure the power is off before you touch anyone in contact with a supply (the American Red Cross; St John; the British Burn Association).853
Then cool it. In the US, the American Red Cross says at least 15 minutes.8 In the UK, the British Burn Association says 20 minutes, within 3 hours, once the electrical source is dealt with.3 And don't judge it by its size. The American Red Cross: "Even a small electrical burn can mean significant internal injuries." It says electricity can affect the heart and breathing, and to be ready for CPR and an AED.8 St John lists cardiac arrest among the signs after an electric shock.5 The NHS sends every electrical burn to 999 or A&E.4 Lessons 3 and 5 have the CPR and the AED.
The kettle
A friend knocks a just-boiled kettle and hot water runs over the middle of her forearm, a little above her watch. She's an adult, alone with you in the kitchen.
1. Water, now. Her arm under the cold tap, running (AHA/Red Cross 2024, COR 1; NHS).14 Nothing yet says emergency, so the phone can wait; the water can't.
2. The watch comes off, before the arm swells (AHA/Red Cross 2024, COR 1, LOE C-EO; St John).15 Her sleeve isn't stuck, so it's pushed up; if it were stuck, it would stay.
3. Keep going. In the UK, 20 minutes. In the US, somewhere from 5 to 20 (COR 2b).41
4. Look at it. A patch of red on the forearm, smaller than her palm, with two small blisters, so past superficial, and nowhere near her hand. The AHA/Red Cross guideline doesn't send it to a professional on size or place; the American Red Cross page would send her to hospital because it blistered.18 In the UK, the NHS says small burns can often be treated at home, with 111 if she's not sure.4
5. Cover it. Cling film laid lengthways in the UK; a clean, dry, non-sticking dressing, laid loosely, in the US. No plaster, no butter, and the blisters stay whole.4518
6. Painkillers if she wants them (AHA/Red Cross 2024, COR 2a; NHS).14
The tea
This one stops halfway for you. It is a cold evening in December. A two-year-old pulls a mug of tea off the table, and it soaks the front of her jumper. She's screaming. Her parent strips the jumper off (it is not stuck) and there's a red, blistering patch across her chest bigger than her palm.
What's the same in both countries: water on the burn now, clothing that isn't stuck off, an eye on her temperature, and a professional. What's different is the call. In the US, a blistered burn larger than her palm goes to a professional promptly (AHA/Red Cross 2024, COR 1, LOE B-NR), and the American Red Cross page lists burns in the very young among the signs that need emergency treatment, with a 911 call.18 In the UK, the British Red Cross says always get medical advice for a burned child, and the NHS sends a very large or deep burn to 999 or A&E, with 111 by phone for an under-five if you're unsure.64 The NHS page doesn't say how large is very large, so that judgement is the parent's. This parent, looking at a blistered patch across a toddler's chest, makes the emergency call, and gets water onto the burn with the phone on speaker.
Twelve minutes in, she's shivering and her lips look pale. Under your country's guidance, what do you do, and who decides?
Show the answer
In the UK, the British Burn Association says to cover the parts that aren't burned and keep her warm, and the British Red Cross says to aim a low-pressure shower at the burn, not the whole body.36 None of the UK sources gives a rule for stopping early, so tell the call handler what you see, and let them decide.
In the US, the AHA/Red Cross 2024 guideline says to watch a preadolescent child for hypothermia (COR 1, LOE C-LD), and the American Red Cross page says to be alert for it, particularly in children.18 Twelve minutes is inside the 5 to 20 the guideline allows (COR 2b); neither US text says more than that, so tell the call handler what you see.
ILCOR's good practice statement is the same in both: watch a young child being cooled for signs of too much cooling.7 If you wrote "put her in a cold bath", the British Red Cross warns against that, for this reason.6
Cuts and grazes
Cooking Fundamentals sent the kitchen knife cut here. This section covers the small cut and the graze: pressure, cleaning, a dressing, and when it needs someone else. Bleeding you can't stop is lesson 9's, and the US guideline's wound recommendations cover superficial wounds only.
The first step is the same as lesson 9's: pressure. The NHS says to press on a wound that is bleeding a lot, with a bandage or a clean folded cloth such as a tea towel.10 If something is stuck in the wound, lesson 9's rule holds: leave it, press around it.
Once it's stopped, clean it. The AHA/Red Cross guideline's steps:1
- "Superficial wounds and abrasions should be thoroughly irrigated until there is no obvious debris or foreign matter in the wound." (COR 1, LOE C-EO)
- "It is reasonable to use running tap water or sterile saline solutions for wound irrigation instead of antiseptic agents such as povidone-iodine." (COR 2a, LOE B-R)
- "It is reasonable to cover clean superficial wounds and abrasions with an occlusive dressing to promote wound healing." (COR 2a, LOE B-R)
The NHS agrees in plainer words: "Clean the wound by rinsing it with bottled or tap water, or by using sterile wipes." Then pat it dry and "put on a sterile dressing or a plaster."10
On tap water rather than antiseptic, the AHA's supporting text is frank: no trial has compared cleaning a wound with tap water against not cleaning it, but wounds rinsed with tap water get infected about as often as those rinsed with sterile saline, and adding povidone-iodine has not shown a benefit.1 Its examples of occlusive dressings are film, petroleum jelly and hydrogel dressings, and it says these heal better than dry ones.1
When a cut needs someone else:
| In the US (AHA/Red Cross 2024) | In the UK (NHS) |
|---|---|
| A bite from an animal or a person, or saliva in the wound: evaluated "in a medical facility as soon as possible" (COR 1, LOE C-EO) | Urgent GP or 111 if "you were bitten by a person or a wild or stray animal"; if the wound has soil, pus or body fluids in it, or is still dirty after cleaning; if it is larger than about 5 cm (2 in); or if you feel unwell or feverish |
| Redness, swelling, foul-smelling discharge, more pain, or fever: take off the dressing, look, and get medical care (COR 2a, LOE C-EO) | Urgent GP or 111 if "a cut is swollen, red and getting more painful or pus is coming out of it" |
| The guideline's wound section covers superficial wounds only | 999 or A&E if "you have a cut and cannot stop the bleeding", "the blood comes out in spurts and is bright red and hard to control", you lose feeling or movement near it, it's a bad cut on the face or the palm, the wound is very large or deep, or something is stuck in it |
AHA/Red Cross 2024, Table 42;1 NHS, Cuts and grazes.10
The NHS page also says to raise a bleeding hand above your head, which none of the resuscitation guidelines includes; lesson 9 has the detail.10
Nosebleeds
Sit down, lean forward, pinch the soft part of the nose, and wait longer than feels natural.
| In the US (AHA/Red Cross 2024) | In the UK (NHS; St John) |
|---|---|
| What to do: "A person experiencing epistaxis should sit with their head slightly forward with their nostrils pinched for 10 to 15 minutes." (COR 1, LOE C-LD), pinching the "lower third or soft portion of the nose" | What to do: the NHS: sit, lean forward, "pinch your nose just above your nostrils for 10 to 15 minutes". St John: pinch the soft part for 10 minutes, then up to "two further periods of 10 minutes" |
| When to get help: not stopped "after 15 minutes of continuous manual pressure", or lightheaded (COR 1, LOE C-EO); after an injury, with signs of a brain injury, an obviously misshapen nose, or signs of a broken facial bone (COR 1, LOE C-EO) | When to get help: NHS: A&E if it lasts longer than 10 to 15 minutes, seems excessive, makes you vomit swallowed blood, followed a blow to the head, or with weakness, dizziness or trouble breathing. St John: 999 if severe or lasting "more than 30 minutes" |
| On blood thinners: seek care unless it has stopped (COR 2a, LOE C-LD) | On blood thinners: NHS: see a GP about a nosebleed if you take a medicine such as warfarin |
| Ice: "The usefulness of cryotherapy (ice) for managing epistaxis in the first aid setting is unknown." (COR 2b, LOE C-LD) | Ice: NHS: an ice pack on the top of the nose "may help", but "the evidence to show it works is not very strong" |
AHA/Red Cross 2024, section 9.11;1 NHS, Nosebleed;11 St John, Nosebleed.5
The American Red Cross's own nosebleed page, as archived in February 2026, said to pinch for at least 5 minutes and check, then 5 more: shorter than the 2024 guideline it co-wrote.12
The AHA's supporting text gives the reasons for both steps: pinching the soft part of the nose helps the blood clot, and leaning forward stops blood going into the airway, which can cause trouble breathing, or the stomach, which can cause vomiting.1 St John on the old habit: "Do not tell them to lean their head back as this could cause the blood to trickle down the back of their throat and block the airway."5 Afterwards, St John says to avoid blowing the nose, so the clots aren't disturbed.5
Something in the eye
Do not rub it (AHA/Red Cross 2024, COR 1, LOE C-EO). The AHA says rubbing may make a scrape on the surface of the eye, or a wound that has gone into it, worse.1
Dust, grit or an eyelash, blown in: let tears wash it out, or rinse with tap water or eyewash (COR 2a, LOE C-EO).1 St John's method is to rinse with clean water poured from the inner corner of the eye, and if that fails, lift the speck off the surface with the damp corner of a clean tissue.5
Get care at once (AHA/Red Cross 2024, COR 1, LOE C-LD) for an eye hit at speed, as by grinding, nailing or machinery; anything sharp or metal that went in; a pupil out of shape, bleeding or lost sight after an injury; a feeling that something's still there after rinsing; or discomfort linked to a contact lens, which comes out.1 Don't try to remove anything embedded (St John).5 To stop fingers getting at it, the countries use different covers. In the US, the AHA suggests taping a hard eye shield, "paper cup, or plastic cup over the eye" (COR 1, LOE C-EO).1 In the UK, St John covers it with a clean eye pad.5 A chemical splash is the chemical burns section above.
A knocked-out tooth
Only a permanent tooth goes back. The AHA/Red Cross guideline: "primary teeth (also known as deciduous teeth or baby teeth) are not typically replanted", and the NHS: "Do not put a baby tooth back in as it could damage the tooth growing underneath."113
For an adult tooth, both countries say try to put it back, and quickly: hold it by the crown, the white part that sticks out of the gum, not the root (NHS); push it back into the socket (AHA/Red Cross 2024, COR 1, LOE C-EO; NHS); and see a dentist now (AHA/Red Cross 2024, COR 1, LOE C-EO).131 The details differ:
- In the US, rinse a dirty tooth briefly, "(<10 seconds)" (AHA/Red Cross 2024, COR 1, LOE C-EO), and bring the tooth to the dentist if it didn't go back.1
- In the UK, rinse it gently "in milk, saline or saliva", have them bite gently on a clean cloth to hold it in, and get an emergency dental appointment, or 111 if you can't get one (NHS).13
The AHA gives the reason for the hurry: the tooth's chance is best if it goes back at once, and out of the mouth the aim is to stop it drying and to keep alive what it calls the periodontal ligament cells, because keeping them alive improves the chances that the tooth takes when it's put back.1
If it won't go back in, it has to travel in something. Of milk, tap water and cling film, which do you guess the US guideline ranks highest, and which does it call harmful?
Show the answer
Cling film ranks highest of the three; tap water is the harmful one. The AHA's supporting text reports two studies in which tap water harmed those cells.1
The whole US ranking:
| The AHA/Red Cross 2024 ranking | Grade |
|---|---|
| First choice: Hanks Balanced Salt Solution (a buffered salt solution, in ILCOR's words), oral rehydration salt solution, propolis, pre-made rice water, or wrapping in cling film | COR 2a, LOE C-LD |
| Second: cow's milk, or the person's own saliva | COR 2b, LOE C-LD |
| Third: probiotic media, egg white, almond milk | COR 2b, LOE C-EO |
| Never: "An avulsed permanent tooth should not be stored in tap water." | COR 3: Harm, LOE C-LD |
The guideline's storage table also lists another person's saliva as a third-line option, ungraded, and warns of the infection risk.1 ILCOR suggests Hanks' solution, propolis, oral rehydration solutions or cling film over cow's milk, and milk over tap water (weak recommendation, very low certainty).7
In the UK, the NHS names milk or saliva, and says to spit into a container for the saliva.13 So milk is a sound choice in both countries; the US ranks a few things above it. Keeping the tooth in the injured person's mouth is a choking risk for a young child or a confused person, the AHA notes.1
An amputated part
The bleeding comes first: RCUK 2025 starts its section by sending you to its life-threatening bleeding steps, lesson 9's subject.2
Then ILCOR's 2025 good practice statements, which are new: send the part "as soon as possible, preferably to the same health care facility as the injured person", and cool it "without freezing".7 RCUK 2025 gives the steps:2
- Wrap the part in a sterile dressing or clean cloth moistened with saline or water.
- Put it in a clean, watertight bag or container.
- Put that inside another bag with ice or ice water; without ice, a cooler or instant cold packs.
- No direct contact with ice, no freezing. Label it with the person's name and the time.
- It travels with the person, to the same hospital.
ILCOR's reasons: replantation success depends on time, and cooling without freezing may improve the outcome, the more so when transport is long; only 35% of patients with a traumatic amputation reach the emergency department with the part properly preserved.7 The AHA/Red Cross 2024 guideline has no section on amputated parts, so ILCOR's statement is the international text for both countries.17
What people get wrong
"Butter, toothpaste or ice on a burn." Water. Butter and oils hold the heat (British Red Cross; American Red Cross); ice may damage the skin (American Red Cross; St John), and the British Burn Association rules it out, with one narrow US fallback.68531
"Pop the blister." Leave it whole (NHS; St John).45
"Wrap it tightly in cling film." Lay it on. It needs room to swell (St John).5
"A small electrical burn is a small injury." It may not be (American Red Cross); the NHS sends all of them to A&E or 999.84
"Neutralise an acid with an alkali." Water. Neutralising can give off heat and add to the burn (British Burn Association).3
"Tilt the head back for a nosebleed." Forward, and pinch (AHA/Red Cross 2024; NHS; St John).1115
"Put a knocked-out tooth in a glass of water." Tap water harms it (AHA/Red Cross 2024, COR 3: Harm). Milk, saliva, cling film or a rehydration solution.113
"Put a baby tooth back in." No: it can damage the adult tooth beneath (NHS).13
Practice
Take 20 minutes. Run cool water from the tap over the inside of your own unburned forearm for 20 minutes, the UK's figure and the top of the US range, so you know what the longest time either country asks for feels like. Set a timer and do not stop early. Stop at once if your arm aches, goes numb or you start to feel cold, and don't do this if you have a condition that affects your circulation or your skin's feeling. Do not do it on anyone else, and never on a child.
While the water runs, work through this table aloud. For each, say: hospital or emergency call now; see a doctor, dentist or 111; or look after it at home. Then say which body's rule you used.
| The injury | |
|---|---|
| A | An adult's grazed knee with grit in it, bleeding a little |
| B | A bite from a stray dog on a man's hand, two punctures, barely bleeding |
| C | A barbecue flare-up has reddened a woman's face, and her nose hairs are singed |
| D | An adult's nosebleed, in the US, still going after 15 minutes of continuous pinching |
| E | A sliver of metal from an angle grinder has gone into a man's eye |
| F | A deep cut across the palm of a hand; pressure has stopped the bleeding |
| G | A four-year-old's front baby tooth, knocked out whole in a fall |
| H | A splash of oven cleaner on an adult's forearm |
At the end, note how long 20 minutes felt, and whether you'd have stopped sooner if it had been a real burn.
Compare your table with these.
Show the answer
A. Home: rinse until no grit is left (AHA/Red Cross 2024, COR 1, LOE C-EO), cover it; the NHS says GP or 111 if it's still dirty after cleaning.110
B. A doctor, soon: bites go to a medical facility as soon as possible (AHA/Red Cross 2024, COR 1, LOE C-EO); the NHS says urgent GP or 111 for a bite from a stray animal.110
C. Emergency call: signs of smoke inhalation call EMS (AHA/Red Cross 2024, COR 1, LOE C-EO), and the NHS sends face burns to 999 or A&E.14 Cool the face with water while you wait; no cling film on a face (British Burn Association).3
D. Medical attention: not stopped after 15 minutes of pressure (AHA/Red Cross 2024, COR 1, LOE C-EO).1
E. Care at once: an injury at speed from grinding (AHA/Red Cross 2024, COR 1, LOE C-LD). Don't rub, don't remove it, tape a cup over the eye.15
F. In the UK, A&E: the NHS lists a bad cut on the palm.10 In the US, the guideline's wound recommendations cover superficial wounds only, and this course did not read the American Red Cross's wounds page, so it has no US rule to give you here.
G. Don't put it back: it is a baby tooth (NHS; AHA/Red Cross 2024).131 The NHS's emergency-dentist line covers anyone who has knocked out a tooth, so a dentist, soon; the AHA's recommendations cover permanent teeth only. If you said "push it back in", that's the trap.
H. Gloves, contaminated clothing off, running water: at least 15 minutes (AHA/Red Cross 2024, COR 1, LOE B-NR), about an hour (NHS), and in the UK a 999 call (NHS).19 In the US, EMS for trouble breathing, symptoms elsewhere in the body or a large exposure, and a poison centre can advise.1
Take 5 minutes. On a card small enough for a sports bag or a first aid kit, write the knocked-out tooth steps for your country, in your own words: which teeth, how to hold it, how long to rinse, back in the socket, what it travels in if it won't go back (in your guideline's order), and who to call. Put the card in the bag.
Where to learn with your hands
How cold is cool, how loose is loose for cling film, how to hold an eye open for rinsing: a class with an instructor settles these faster than a page, and lesson 16 lists where to find one. In between, the British Red Cross and the American Red Cross each publish a free first aid app with step-by-step advice and quizzes.614 This course read the apps' pages, not the apps, and hasn't watched the British Red Cross's burns video against the advice above, so it is not embedded.
Connections
Cooking Fundamentals lesson 2 gave the kitchen burn its first response in both countries; this lesson added the reasons, the depth rule, the child who gets too cold, and chemical and electrical burns. Lesson 2's power-off rule opened the electrical burn, and its carbon monoxide warning came back with smoke. Lesson 4's grading key read ILCOR's strong recommendation to cool. Lesson 9's pressure and embedded-object rules carried over to the ordinary cut, and its bleeding steps come before an amputated part.
Lesson 11 turns to bones, joints, the head and the spine, where an open fracture is also a wound, and a blow to the head is also one of the NHS's reasons to take a nosebleed to A&E.
Go deeper
- British Burn Association, First Aid Clinical Practice Guidelines, 2018, two pages, free. The UK's specialist statement on heat, chemical and electrical burns. "Cool the burn but warm the patient" is the line to remember.
- Hewett Brumberg and colleagues, 2024 AHA and American Red Cross Guidelines for First Aid, Circulation, free. Sections 8.2 and 8.3 (chemicals), 9.3 (wounds) and 9.8 to 9.11 (burns, teeth, eyes, nosebleeds) are each a page, and the supporting text is where the reasons are.
- British Red Cross, First aid for burns, short, with an FAQ that answers the butter, ice and shower questions in plain words.
Sources
- E. K. Hewett Brumberg, M. J. Douma, K. Alibertis and colleagues, "2024 American Heart Association and American Red Cross Guidelines for First Aid", Circulation 150, 2024, e519 to e579. **Read level: full, direct, from the Internet Archive capture 20260502024223**, with Tables 37, 38, 42 and 47 to 51 read from the publisher's images. Sections 8.2, 8.3, 9.3 and 9.8 to 9.11, their recommendations, grades and supporting text, re-read from the same capture on 2026-09-25.
- Resuscitation Council UK, 2025 Resuscitation Guidelines: First aid, 27 October 2025 . Read level: full, direct.
- K. Stiles and N. Goodwin for the British Burn Association, First Aid Clinical Practice Guidelines, April 2018 . Read level: full, direct.
- NHS, Burns and scalds, last reviewed 31 March 2026 . Read level: full, direct.
- St John Ambulance, Burns and scalds, Severe burn, Chemical burn, Electrocution, Nosebleed and Eye injury pages, clinically reviewed 28 April 2025 . Read level: full, direct, all six pages.
- British Red Cross, First aid for burns, undated . Read level: full, direct. Also its first aid apps page, full, direct.
- T. Djärv, M. J. Douma and colleagues for the ILCOR First Aid Task Force, "2025 International Consensus on First Aid Science With Treatment Recommendations", Circulation 152, 2025. **Read level: full, direct, from the accepted manuscript on ilcor.org**; the burn, tooth and amputation passages quoted here checked word for word against the typeset text.
- American Red Cross, Burns, undated . Read level: full, direct (live page, 2026-09-24), and the January 2026 version through the Internet Archive capture 20260117094816. On 2026-09-25 the live site showed a maintenance page, so it was re-read from the capture 20260918081041.
- NHS, Acid and chemical burns, last reviewed 5 June 2024 . Read level: full, direct.
- NHS, Cuts and grazes, last reviewed 2 April 2026 . Read level: full, direct.
- NHS, Nosebleed, last reviewed 5 December 2023. **Read level: full, direct**.
- American Red Cross, Nosebleeds, undated . Read level: full, direct (live page, 2026-09-24); the pinch times given here are from the Internet Archive capture 20260219001333, read on 2026-09-25 while the live site was under maintenance.
- NHS, Knocked-out tooth, last reviewed 6 February 2025 . Read level: full, direct.
- American Red Cross, mobile apps page. **Read level: page full, direct.**
Check your understanding
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