Management of a chemical injury

How to deal with a chemical injury or lesion

Emergency management and caring for a chemical injury

After receiving a chemical splash, any contaminated clothing and contact lenses must be carefully removed from the casualty, if safe to do so, and the affected tissues must be washed as quickly as possible.

Note: Contaminated clothing and contact lenses must not be allowed to be replaced - they should be carefully bagged for disposal. Clothing should be removed downwards, cutting shoulder seams if necessary, to avoid further contaminating the face and eyes.

Washing with water

Rinsing with water was the first protocol used for chemical decontamination and this dogma persists on the basis of arguments which are more practical than scientific, because of its general-purpose and non-toxic character and of its availability. It allows the chemical agent to be diluted and removed from the surface of the affected tissue and to be carried away by a mechanical washing effect.

However, there are limits to washing with water:

It does not act on the potentially Corrosive or Irritant nature of the chemical agent.
There is not a rapid return to a safe physiological state - the effect of carrying the chemical agent away is limited to surface tissue and has no effect on penetrated chemical.
Water favours the chemical agent’s penetration of the tissue (see publication: Prof. Schrage, Klin Monastbl Augenheilkd, 2004)
In order to obtain optimal results it is necessary to intervene ‘immediately’ according to the European Standard EN15154 (10 seconds according to ANSI Standard) after the splash. However, there is sometimes only partial effectiveness, in particular with concentrated corrosive chemicals.
Significant side effects such as secondary care and surgical intervention, often resulting in permanent disability or disfigurement and even fatalities, are regularly reported in the scientific literature.
Recent comparative studies have shown the possibility of improving on rinsing with water.

Increasing the chances of reducing injury

Improving on rinsing with water consists of finding other solutions without these limitations in order to increase the chances of the casualty being saved and experiencing minimum injury.

In order to accomplish this, Diphoterine® solution, an aqueous solution that contains an amphoteric and chelating molecule was introduced. The aim of the resulting solution is to prevent chemical lesions or to significantly lessen their severity.

Washing with Diphoterine® solution

Diphoterine® solution has been classified as a Medical Device according to the 93/42 CEE Directive. It acts on the chemical agent in order to stop or minimise the development of chemical lesions. It is classified IIa because it can be used on injured skin. (see publication: Dr Cavallini – Cavallini, Annals of Burns and Fire disasters 2004, vol XVII-2, 84-87 and Cavallini, European Journal of Anasesthesiology 2004, 21, 389-392)

The benefits of washing with Diphoterine® solution:

It stops the Corrosive and Irritant agent’s actions on the eye and skin due to its amphoteric and chelating properties.
It stops the chemical agent’s penetration of the tissue and carries the chemical away from the interior to the exterior of the tissue due to its hypertonicity.
It achieves a rapid return to a pH level between 5.5 and 9, reducing the risk of a chemical injury.
It has a prolonged intervention time compared to water (in the first minute following the chemical splash) with improved washing efficiency: the absence of after-effects, little or no need for secondary care and little or no loss of work.

Secondary treatment and caring for a chemical injury (lesion):

Once decontamination as part of Chemical Injury first aid is completed and has been effective, the chemical lesion no longer progresses. It is then possible to treat any damaged tissue in order to facilitate cicatrization.

If the chemical first aid product is toxic, this hazard can now be dealt with.

Chemical lesions may require secondary treatment and management by a physician.

The secondary treatment must be appropriate.
It must be specific to the chemical product involved.
It must be scaled depending on the lesion that has developed.

Chemical lesions are conventionally managed in hospital chemical burn treatment centers. The treatment is often similar to that required in the case of thermal acid burns, with a few differences:

Cicatrisation takes longer. Skin grafts take less time on chemical burns treatment than on thermal burns.