First aid cooling for burn injuries improves re-epithelialisation rates and reduces scarring. The objective of this research was to explore and describe barriers and facilitators to the provision of optimal first aid for acute burn patients in the prehospital setting. Emergency medical service (EMS) clinicians in Queensland were invited via email to participate in a survey designed to assess experience, knowledge, and attitudes regarding provision of optimal burn first aid in the prehospital setting (N = 4500). Barriers and facilitators to administering optimal first aid in the prehospital environment were assessed via two open-ended questions with free-text response boxes. An inductive approach to qualitative content analysis was used to analyze free-text data. In total, we included 326 respondents (7.2% response rate). Responses (n = 231) regarding barriers to first aid were classified into 12 categories, within five overarching dimensions. The most common of these was identified as pain. Similarly, free text responses (n = 276) regarding facilitators of burn first aid formed eight dimensions with 21 subcategories – most commonly fast and effective pain relief. Factors influencing burn first aid provision in the prehospital setting were wide-ranging and varied, with pain identified as the most prominent.