20CRW: A Low-Resource Concept for Burn First Aid

First aid recommendations for burn injuries are not standardized around the world, and there exist a variety of conflicting guidelines. We discuss the rationale of implementing 20 min of cool running water (20CRW) within 3 h of burn injury as standard burn first aid. Animal models and human data in both adults and children have shown that 20CRW is optimal in reducing scar tissue formation and improving tissue reepithelialization. 20CRW within 3 h of injury can be implemented in urban, rural, and wilderness settings with minimal equipment or training, although some austere environments may pose challenges. We advocate incorporating 20CRW as a standard component of burn first aid, first-responder protocols, and wilderness medical training curricula wherever feasible.