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26 July 2017

Clinical Update: Corrosive Attack

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Corrosive Attack – immediate action for first-aiders

This guidance will apply to all forms of irritant skin contamination.

There are lots of recommendations for alkalis, acids and other there are also companies producing agents claimed to minimise the effects of the chemicals, but this guidance is based on simple principles of:

Being safe

Dry decontamination

Immediate and prolonged irrigation with water

As soon as a casualty is identified, call for support and the other emergency services especially ambulance and fire & rescue
whilst ensuring that both the rescuer and the casualty are not at further risk of attack

DO NOT WORRY ABOUT THE TYPE & SPECIFICS OF THE AGENT INVOLVED AT THIS STAGE.

• Apply nitrile gloves and use eye protection if available

• Ensure that you are in a well ventilated area and ideally outside. If indoors, open doors and windows and consider moving outside as early as possible in case fumes are released during decontamination.

Self-aid decontamination.

• Try and calm the casualty, whilst encouraging them to
urgently remove contaminated clothing, trying to keep their hands of affected areas

• If there are two casualties they can help each other

• Place contaminated clothing into one area or a waste bin

• Jewellery must also be removed from the affected area
as corrosive agents can lie trapped underneath

• Any remaining powder on the skin should be brushed
off with clean clothes or paper towels

Water irrigation for at least 20 minutes.

• Corrosive liquids will continue to burn into the skin and will need copius irrigation with water. Alkali agents can be more difficult to wash off and can take longer than 20 minutes but the management of all agents is the same.

• Ideally the water should be lukewarm or cold and from a clean source. However, in an emergency use whatever water is available and do not delay looking for clean water.

• Large amounts of water will be required to ensure that irrigation continues for at least 20 minutes. This usually means getting urgent support from the Fire Service who can use water out of the appliance and then fresh water from the hydrants

• Always consider where the ‘run-off’ water, which may still contain high concentrations of agent, is going in terms of:
– avoiding washing onto clean uncontaminated areas
of the casualty
– forming pools that could affect others
– environmental pollution

• Try and get the contaminated part of the body as low as possible to avoid water running onto other areas. This also applies to the face, avoiding contamination from one eye to the other.

• The water should be free flowing from a tap our poured and not standing or pooled such as a bath or lake, unless they are the only options.

• A garden hose or fire hose are ideal, but the pressure should be kept low to avoid driving the agent deeper
into the skin and splashing yourself and others

• There is a risk of hypothermia where extensive burns are present, so luke-warm water may then help but is rarely available, but for most corrosive burns the area is small and we can avoid healthy skin being cooled.

• 20 minutes is a long time to irrigate the skin, but do not be tempted to stop earlier, unless the agent has been
confirmed clear with litmus paper/pH test strips (eg urine dip sticks). We are aiming for a neutral pH of 7.0.

• If burning continues after 20 minutes, then
continue irrigation

• Do not move to hospital too soon, as irrigation should
not be interrupted within the first 20 minutes and the hospitals will often not be prepared to provide ongoing irrigation as soon as the casualty arrives.

• Wherever possible, try to preserve the dignity of the
victim by moving onlookers and covering the casualty after decontamination with cling-film to the affected
areas and loose clothing or cover to unaffected areas.

The Eyes

The eyes are very susceptible to corrosive agents, but
once again, early and copious water irrigation can be very effective in protecting sight. A few key pointers will help
the first aider:

• If only one eye is affected then always irrigate away
from the unaffected eye

• The eyes must be opened during irrigation and the
lids retracted to ensure that all of the agent is washed away effectively

• At least 20 minutes of irrigation with water will
provide the best outcomes

Management of other agents

Questions are often asked about agents that release
heat in contact with water including:

– Sulphuric acid
– Phosphorous
– Metal elements eg sodium

Some agents have other serious side effects
and systemic toxicity including:

– Phenol
– Hydroflouric acid
– Chlorine

Research has shown, that all the special measures for these agents are rarely available and in practical terms offer no advantage of large volumes of water and therefore water remains the agent of choice for ALL contaminants.

Antidotes and Chemical treatments
eg Diphoterine

Several agents such as this have been promoted for
emergency management of corrosive liquid burns. They are claimed to provide immediate relief and improve
healing, but the evidence remains limited and anecdotal
at present. The agents are expensive and typically in
limited supply. However, they may have a practical role
to play where water supplies are limited, but the Fire Service can normally obtain emergency water supplies anywhere in the UK

Summary

Acid, alkali of corrosive attacks are increasing and although rarely fatal they are often mutilating and disfiguring with long terms scarring. Early and urgent first aid action can
dramatically reduce the severity of the injury and even
prevent scarring.

• Call for help and remember to call the Fire Service for
decontamination

• Protect yourself with distance, gloves and good ventilation

• Manage ALL agents the same way

• Encourage self-decontamination by removal of casualty clothing and jewellery

• Brush off other powder contamination with paper
or clean clothes

• Liquid of gel corrosive agents require water irrigation
for 20 minutes or more

• Decontaminate the face and eyes first

• Do not wash contaminant onto unaffected skin or the eyes

• Do not cut the time or move to hospital too soon as
this is the mainstay of treatment

• Specialist treatments and reversal agents have not
current value over copious water

• Preserve the warmth and dignity of the casualty
wherever possible