Correspondence (letter to the editor): benefits of cooling are not known.

The benefits of cold water therapy in stopping a burn injury from penetrating deeper into the tissues has been shown in some animal models, but only if the proportion of body surface that was burnt was 1–5% and the treatment was initiated immediately. Waiting for only a few minutes after the trauma has been sustained immediately negates any beneficial effect. If the treatment is administered for too long or the temperature is too cold then the tissue necrosis will be more extensive. The authors recommend cooling the burnt skin surface for (20 to) 30 minutes; a time period that we think is very clearly too long. In our view, cold water therapy is a lay or first-aid measure. The first step to be taken by the ambulance services or the emergency physician should be to immediately cease the cooling or heat treatment. The German Society for Burn Treatment (www.verbrennungsmedizin.de) recommends cooling therapy with tap water only for small burns; we think it is contraindicated in patients with large surface burns. The recommendations from the Deutscher Feuerwehrverband (the German Fire Services Association) express similar sentiments (2). The statement that no guidelines are available for the nutrition of burned patients is incorrect. The European Society for Parenteral and Enteral Nutrition’s 2006 guidelines include such aspects and recommendations (3).