Acid attacks have a relatively long history. They are considered to be a modern phenomenon, but in reality they are a re-discovered attack methodology. They became ‘fashionable’ in the late 19th Century, when vitrioleuse or acid throwers, were in the newspapers. Largely women that had been jilted or spurned by their male ‘admirers,’ they sought revenge by throwing acid in the face of the man or his new paramour. It became an attack of the weak against the strong and fascinated enough people to become fin de siècle art that would eventually be sold in Walmart (https://www.walmart.com/ip/La-Vitrioleuse-Vintage-Poster-artist-Eugene-Grasset-c-1894-9x12-Art-Print-Wall-Decor-Travel-Poster/101745471).
The allure of acid attacks can also be found in the 1930s criminal underworld. It is a significant plot device in Graham Greene’s Brighton Rock (https://www.litcharts.com/lit/brighton-rock/terms/vitriol) but it is only in the past couple of decades that it has really become fashionable again. As opposed to a weapon for the weak, it has now become another device for the subjugation of women and is frequently used in ‘honour attacks’ (https://indicanews.com/2020/01/10/india-reports-300-acid-attacks-in-a-year/). In addition to these it has also been used in countries like the UK by criminals in petty robberies. Gun laws in the UK are such that it is difficult to do a ‘stick up’ for someone’s mobile phone, so the ability to threaten or maim with a small quantity of acid has become relatively common (https://www.standard.co.uk/news/crime/london-is-acid-attack-hotspot-of-western-world-with-victims-as-young-as-10-a4222921.html).
As such there is an urgent need to be able to improve the response to these, especially in terms of healthcare and first response. Professor Robert Chilcott, of the Centre for Research into Topical Drug Delivery and Toxicology at the University of Hertfordshire, has been tasked with trying to find improvements in decontamination of victims. “Last year, there was a 40% increase in the number of recorded cases of acid attacks. All the evidence that we have and most of the available guidance says if you have nothing else, do dry decon but ideally wet decon. There was no evidence to back that up, so we thought let's use our abilities to get to the bottom of this. We did a mechanistic study to start with, where we exposed skin for different times to sulfuric acids to see what the damage would be. We started off with 30 minutes and after that’s there's not much left of the skin. So, we went to 15 minutes and got exactly the same results, and then 10 minutes, and then five minutes… eventually we got down to about 10 seconds.”
“The window of opportunity for decon for sulfuric acid is extremely small. It's less than 10 seconds and that's the time that would take to find a bottle of water and take the lid off. We did find that if you can do it either immediately or within that 10 second timeframe, you can significantly reduce damage, but it's a significant reduction of a huge amount. It looks like dry decon is contraindicated for this particular application as it removed the skin, so we need to treat it with a degree of caution. What you're actually doing, however, is removing the dead tissue, a process known as debridement. A lot of burns studies have shown debridement might actually be therapeutic, but we can't say for definite whether this is true because our test system is basically dead skin that can't rejuvenate itself in any way. To take this research forward, we'd have to move into an animal model or a very advanced 3-D cell culture level.”
As you might imagine there is a lot of concern over using animal models in a study that is going to cause distress and would be hugely expensive. Currently no funding organisation has stepped up to do that. Considering how much acid there is used not only in academia but also in commercial applications it is surprising that there hasn’t been a bespoke product designed for this that could be re-purposed for paramedics. An impregnated blotter that can be quickly applied to the area and start to neutralise the acid. Professor Chilcott said not, that the speed of response in areas where exposure was likely meant that simple solutions were appropriate. “You'd be as well off with a bottle of saline, which is standard issue to paramedics, rather than a bespoke system; and it's a lot cheaper! You don't need something fancy with nano particles and ultra-absorbent polymers in order to get rid of what you can from the skin surface when you can just rinse it through with water. We're going to have to do more work on this, but we were moving towards the idea that if somebody has been splashed with acid you could use your clothes to try and remove as much as you can, while you're trying to find a source of water. We did do some studies with clothing, and we find that if you rub early enough, you can significantly reduce the overall injury by using clothing.”
The UK guidance for acid attacks (and other situations) is remove, remove, remove (https://naru.org.uk/remove-remove-remove-refreshed-ior-messaging-is-released-by-naru/) and as the individual disrobes there would likely be unaffected areas of the clothing that could quickly be used to dab away the acid. This could also, however, move the acid to unaffected areas of skin and burn them. Does Professor Chilcott see this use of clothes to reduce contaminations as something that is promoted to the general public or to trained paramedics? “When we've finished the study, we'll be in a better position to make recommendations to the UK government on the current data. We may suggest that, if you have nothing else, use unaffected areas of clothing, because then at least you're doing something rather than nothing. Given the extreme timescales that the acid is causing the damage, rather than wait 20 seconds to get water, if you can remove most of it with clothing you'll be doing a better job than waiting around.”
The extremely short response times will inevitably mean that immediate first aid will have to be given by the general public. As such there is little that can be expected in terms of specialist training or equipment. Considering the pain of the attack it is also going to be difficult to approach the victim and get to the affected area to provide assistance. Decontamination of acid attacks is going to remain problematic, and likely to have to shift towards specialised medical response rather than first response. Meanwhile Professor Chilcott and his team are looking at using their new exposure facility, which allows training and testing for a variety of climates and response to acid attacks will have to wait for a game changer.