An acid attack inflicts an immediate and devastating chemical burn, where the corrosive substance rapidly penetrates and destroys biological tissue. The speed of the damage is dependent on the type of acid, its concentration, and the duration of contact with the skin. Unlike thermal burns, chemical injuries can continue to cause cellular destruction for hours after the initial exposure, making the first moments following the attack profoundly important. A rapid, decisive, and informed response is the single most significant factor in minimizing the severity of the injury and preserving function.
Immediate First Aid Response
The first priority is to call for emergency medical help immediately while simultaneously initiating decontamination. Chemical exposure on the skin demands an aggressive and uninterrupted flushing protocol to dilute the acid and remove it from the tissue. The promptness of this action directly correlates with the final outcome, as studies show that irrigation within the first few minutes can significantly reduce the depth of the burn injury.
Contaminated clothing must be removed swiftly and carefully to prevent the chemical from continuing to soak into the skin or spreading to unaffected areas. It is important to cut away clothing rather than pulling it over the head, especially if the chemical is on the torso or head. Jewelry should also be removed from the affected limbs, as swelling will begin quickly and make removal difficult later.
The affected area must be flushed with copious amounts of cool or lukewarm running water for an extended period, ideally 20 to 30 minutes. Continuous irrigation is the most effective way to halt the chemical reaction and reduce the tissue’s temperature. The water should be allowed to run off the wound without pooling or contaminating other parts of the body.
Attempting to neutralize the acid with household substances like baking soda or an alkali solution is a dangerous mistake. This can create an exothermic reaction, generating heat that causes a secondary thermal burn and worsens tissue damage. After the flushing is complete, the burn should be covered loosely with a clean, non-fluffy cloth or plastic wrap to protect the open wound from infection.
Specific Care for Sensitive Areas
Exposure to the face often affects the eyes, constituting a severe ocular emergency requiring specialized flushing techniques. The eye must be continuously irrigated for at least 20 minutes using a gentle stream of clean, lukewarm water. It is necessary to hold the eyelids open during this process, as involuntary spasms will attempt to keep them closed, trapping the acid inside the eye.
If only one eye is contaminated, position the head so the water flows away from the unaffected eye, preventing cross-contamination. Flushing should be maintained even during transport to the medical facility until a healthcare professional takes over. If the acid was sprayed or ingested into the mouth, the victim should rinse the oral cavity immediately with water.
The victim should drink small amounts of water or milk to dilute the corrosive substance in the esophagus and stomach if a chemical has been swallowed. However, vomiting must never be induced, as the chemical would cause repeated severe burns to the lining of the throat and mouth on its way back up. Ingestion carries a high risk of systemic toxicity and requires immediate professional monitoring.
Professional Medical Intervention
Upon arrival at the medical facility, the initial focus of the emergency staff is to stabilize the patient and continue decontamination. Medical personnel assess the burn severity by determining the depth (superficial, partial-thickness, or full-thickness) and the extent, measured as a percentage of the Total Body Surface Area (TBSA). This assessment guides the fluid resuscitation protocol, administered intravenously to counteract burn shock and prevent organ damage.
Beyond the visible injury, chemical burns carry a risk of systemic toxicity as the chemical is absorbed into the bloodstream. Medical teams monitor for electrolyte disturbances, such as hypocalcaemia and hyperkalaemia, which can lead to cardiac arrhythmias. Blood gas analysis is performed to detect any acid-base imbalance resulting from the exposure.
Pain management is initiated immediately, often requiring strong opioid analgesics to manage the profound pain associated with deep tissue destruction. Non-viable tissue, or eschar, is surgically removed in a process called debridement to prevent infection and promote healing. Patients with extensive or deep chemical burns are typically transferred to a specialized burn unit for comprehensive, multidisciplinary care.
Recovery and Long-Term Healing
Once the acute phase has passed, the long-term journey focuses on minimizing scarring and restoring function. Wound care management involves meticulous hygiene and the application of specialized dressings, such as those impregnated with silver, to prevent bacterial colonization and infection. Antibiotic ointments like Silvadene or Bacitracin may be used to protect the fragile healing tissue and promote a clean wound bed.
To manage excessive scar tissue (hypertrophic scarring), custom-fabricated pressure garments are prescribed. These tight-fitting garments, made of elastic Lycra fabric, must be worn for 16 to 23 hours a day, applying pressure over 15 millimeters of mercury to flatten and soften the scars. Silicone gel sheets and scar massage are also employed to improve the pliability and coloration of the healed skin.
Physical and occupational therapy are integral to the rehabilitation process, working to prevent contractures and restore mobility, especially in joints and facial features. Therapists use exercises, splinting, and positioning to maintain the maximum possible range of motion as the wounds contract during healing. For many survivors, multiple reconstructive surgeries are necessary to release contractures, restore facial symmetry, or perform skin grafting.
The psychological impact of an acid attack is profound, often leading to post-traumatic stress disorder, depression, and social anxiety due to visible disfigurement and trauma of the assault. Counseling, psychotherapy, and peer support groups are necessary components of long-term recovery to address the loss of identity and facilitate social reintegration. Comprehensive recovery requires sustained emotional and informational support alongside physical rehabilitation.