Modern concepts of treatment and prevention of chemical injuries.
Chemical injuries are commonly encountered following exposure to acids and alkali, including hydrofluoric acid, formic acid, anhydrous ammonia, cement, and phenol. Other specific agents that cause chemical burns include white phosphorus, elemental metals, nitrates, hydrocarbons, and tar. Even though there are more than 65,000 chemicals available on the market, and an estimated 60,000 new chemicals produced each year, the potential deleterious effects of these chemicals on humans are still unknown. The Superfund Amendments and Reauthorization Act contains extensive provisions for emergency planning and the rights of communities to know about toxic chemical releases. Since 1990, the Agency for Toxic Substances and Disease Registry (ATSDR) has maintained an active, state-based Hazardous Substances Emergency Events Surveillance (HSEES) system to describe the public health consequences risked by access to hazardous chemicals. Most chemical agents damage the skin by producing a chemical reaction rather than hyperthermic injury. Although some chemicals produce considerable heat as a result of an exothermic reaction when they come in contact with water, their ability to produce direct chemical changes on the skin accounts for the most skin injury. Specific chemical changes depend on the agent, including acids, alkalis, corrosives, oxidizing and reducing agents, desiccants, vesicants, and protoplasmic poisons. The concentration of toxic agent and duration of its contact primarily determine degree of skin destruction. Hazardous materials (hazmats) are substances that may injure life and damage the environment if improperly handled. HAZMAT accidents are particularly dangerous for responding personnel, who are in danger from the moment of arrival on the scene until containment of the accident. Consequently, the Superfund Amendment and Reauthorization Act mandates community preparedness for dealing with hazmat accidents. Paramedics and members of the hazmat response team (usually firefighters) must work together to identify toxic chemicals and assess hazardous environments. The contingency plan for hazmat management can be divided into two parts: initiation of the site plan and evacuation. In coping with hazmat incidents, two distinct goals must be achieved concomitantly. First, hazmats must be contained, fire and explosions must be extinguished, and the site eventually must be cleaned. Second, those exposed to hazmats must be treated at the scene of contamination as well as in the hospital and rehabilitation setting.
Edlich
Richard F
RF
Distinguished Professor Emeritus of Plastic Surgery and Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA. richardedlichmd@gmail.com
Farinholt
Heidi-Marie A
HM
Winters
Kathryne L
KL
Britt
L D
LD
Long
William B
WB
Werner
Charles L
CL
Gubler
K Dean
KD
D000143:Acids / Q000633:toxicity; D000468:Alkalies / Q000633:toxicity; D000641:Ammonia / Q000633:toxicity; D000818:Animals; D002057:Burns, Chemical / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D003666:Decontamination; D005126:Eye Burns / Q000139:chemically induced / Q000628:therapy; D005561:Formates / Q000633:toxicity; D015386:Hazardous Substances; D006801:Humans; D006838:Hydrocarbons / Q000633:toxicity; D006858:Hydrofluoric Acid / Q000633:toxicity; D006875:Hydrotherapy; D008670:Metals / Q000633:toxicity; D010636:Phenols / Q000633:toxicity; D010758:Phosphorus / Q000633:toxicity; D012867:Skin / Q000187:drug effects; D013638:Tars / Q000633:toxicity
D000143:Acids; D000468:Alkalies; D005561:Formates; D015386:Hazardous Substances; D006838:Hydrocarbons; D008670:Metals; D010636:Phenols; D013638:Tars; C030544:formic acid; D010758:Phosphorus; D000641:Ammonia; D006858:Hydrofluoric Acid