Exactly What to Do in an Acid Attack

Back in 2008, on a morning seemingly like any other, Hope Peralta left her Chicago apartment to go to work. As she was about to enter her car, someone yelled, "Hey!" Startled, she turned around to find a girl standing there with a bottle of acid saying, "This is for you," as the contents were released onto Peralta's face. Soon she was knocked down and the remaining acid was poured on her back.

As the acid corroded her skin, Peralta could only wonder if this was how she would die. And though she survived after a four-month hospital stay that included an induced coma, the life she returned to left her aghast. When Peralta finally saw herself in the mirror for the first time (her family had covered all the mirrors she had access to in the hospital) after returning home, she said, "This is not me. This is a monster."

The story above did not transpire in some foreign land where you might imagine acid attacks are endemic because of cultural or religious barbarism. It happened right here in America, in a neighborhood of Chicago. Similarly harrowing attacks have been noted in places as familiar as New York, Cleveland and Arizona.

Peralta's story teaches us that the face of an acid victim has no particular gender, religion or nationality. A readily available and inexpensive weapon of terror, acid has unraveled lives through its physical and psychological toll. But timely intervention is possible, and people's lives are salvageable.

Acid, which gained prominence in Europe during the Industrial Revolution due to its use in manufacturing processes, was first weaponized during the Victorian era in Britain. Its common use as a means to inflict gruesome trauma prompted the Reformers' Gazette, a Glasgow newspaper, to refer to it as a "stain on the national character."

As Ian Jack of the Guardian recently noted, "Only later in the last century did the crime begin to be associated with the developing rather than the developed world, as a function of male oppression and feudalism, rather than the green-eyed cruelty of richer societies."

Yet associations can be grossly misleading. Data from the Acid Survivors Trust International (ASTI), a UK-based campaigning group, reveals that incidents of acid attacks are scattered all over the globe—the UK, India, Colombia, Pakistan, Nepal, Bangladesh, Uganda and Cambodia. According to ASTI's executive director, Jaf Shah, the UK's recent spike in acid violence, in which two-thirds of the victims are male, gives it the highest number of reported attacks per capita in the world.

It's important to remember that the objective of acid crimes is hardly ever to kill the intended target. The assailant hopes to cause maximum physical disfigurement whose manifold effects can reverberate daily in the victim's life. Samir Hussain of the UK, who had acid splashed on him in 2015 after he left a movie theatre with a friend, later said, "I got a life sentence."

Just as urgent initiation of CPR can save the brain, the preservation of skin and vision hinges on time when acid is involved. Johann Grundlingh, a consultant emergency physician at Barts Health NHS Trust in London, recently penned an editorial for the British Medical Journal on how bystanders and health professionals can positively affect outcomes in acid attacks by responding swiftly. "Seconds can make a difference between being able to see or being blind for the rest of your life," he tells me.

As soon as a chemical like sulphuric acid hits the skin, a process called coagulation necrosis ensues. Accidental cell death occurs when the proteins in the skin are denatured by the caustic substance. In this acute window—essentially as immediately as possible after acid has touched skin—the damage must be contained.

Initial responders should ensure that they don't come in contact with the chemical by donning gloves. First responders usually have chemical resistant gloves available in prep for a possible acid attack but if rubber gloves are the only thing available for a bystander, it can be double or triple gloved. Next, contaminated clothing or jewelry should be removed and affected areas should be rinsed with copious amounts of cool tap water for ten to 20 minutes. This prevents protracted exposure to the acid and limits the long-term effects of scarring and need for surgical reconstruction.

Any amount of surgery spared is invaluable. As Julie Caffrey, interim director of the Johns Hopkins Adult Burn Center at Johns Hopkins Bayview Medical Center, noted, "We can do lots of surgeries to improve appearance, but we can never get back to normal. It will never be what it was before the area was injured."

Throughout these initial stages, vital signs such as breathing, heart rate and level of consciousness should be monitored. After the victim has arrived in the emergency room, further evaluation will be done to ensure stability and appropriate specialists like ophthalmologists, burns specialists or plastic surgeons will contacted. Beginning with the face and eyes, acid should continue to be washed off to halt any active tissue destruction.

The rage, resentment and vindictiveness that inspire acid violence are a toxic brew of human feelings that can cause upheaval in the life of someone who's attacked. As society grapples with this scourge through law enforcement, legislation and NGOs, this is a reminder of medicine's crucial role in the fateful first seconds of an attack. It's in this time that a life is saved and, most importantly, a person is preserved.

Jalal Baig is a hematology/oncology fellow at the University of Illinois at Chicago.

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