What is the immediate treatment for chemical burns?

Immediate Treatment for Chemical Burns

For chemical burns, immediate irrigation with clean running water for at least 15 minutes is the essential first step in treatment. 1, 2

Initial Management Algorithm

1. Safety First

   • Ensure personal safety before assisting the victim
   • Wear appropriate protective equipment if available 2

2. Dry Chemical Removal

   • For dry chemicals, brush off as much powder as possible before irrigation 1, 2
   • This prevents spreading of the contaminant when water is applied 2

3. Immediate Decontamination

   • Begin irrigation with clean running water immediately 1, 2
   • Continue irrigation for at least 15 minutes 1, 2
   • Remove all contaminated clothing, jewelry, and surrounding materials during irrigation 1, 2

4. Special Chemical Considerations

   • For hydrofluoric acid and phenol exposures, consult poison control for specific decontamination instructions 1, 2
   • Follow chemical-specific protocols when available 2

5. Eye Involvement

   • Keep eyelids open during irrigation if eyes are affected 2
   • Direct water flow from inner corner outward to prevent contamination of unaffected eye 2

When to Seek Advanced Medical Care

Activate emergency medical services immediately if:

• Respiratory symptoms are present 1, 2
• Systemic symptoms develop 1, 2
• Large areas are exposed to chemicals 1, 2
• Burns involve face, hands, feet, or genitalia 1
• Full-thickness burns are suspected 1

Common Pitfalls to Avoid

• Delaying irrigation: Do not delay irrigation to find "ideal" solutions; tap water is effective and readily available 2
• Insufficient irrigation time: The full 15 minutes is necessary regardless of symptom improvement 2
• Attempting neutralization: Do not attempt to neutralize acids with bases as this can generate heat and worsen injury 2
• Failing to remove contaminated clothing: This can trap chemicals against the skin and worsen outcomes 2
• Using high-pressure water streams: This can cause additional trauma 2

Evidence Strength

The recommendation for immediate irrigation with running water for at least 15 minutes is supported by Class 1, Level B-NR evidence from the American Heart Association 1, 2. Observational studies have shown that immediate irrigation within 10 minutes with a large volume of water for at least 15 minutes resulted in decreased degree of full-thickness burns, fewer full-thickness burns, and shorter hospital stays compared to delayed or insufficient irrigation 1.

While the optimal duration of irrigation may vary based on the specific chemical, location, size, and depth of the burn, the evidence strongly supports immediate and thorough irrigation as the cornerstone of chemical burn first aid.