Acid attacks: treating the physical and psychological scars

Hospitals are treating an increasing number of people who have been attacked with acid, after an alarming rise in cases. Nurses play a vital part in helping victims overcome the devastating results.

Hospitals are treating an increasing number of people who have been attacked with acid, after an alarming rise in cases. Nurses play a vital part in helping victims overcome the devastating results

A victim being doused with water by a firefighter after an acid attack
in east London in July. Picture: London News Pictures

Hospitals are treating an increasing number of people who have been attacked with acid, after an alarming rise in cases. In London, where the majority of these attacks have occurred, the number in 2016 was up 74% on the previous year, with more than 450 incidents.

There were 114 attacks in the first four months of 2017 in the capital. Twenty people were injured when a corrosive substance was sprayed on people at a nightclub in east London in April.


increase in acid attacks in London last year

UK charity Acid Survivors Trust International says such incidents often have devastating effects on victims. Acid burns the skin and flesh, and can expose and damage bones. Survivors can have permanent disfigurement and may need many surgical procedures.

The experience can leave victims socially isolated and traumatised, and have a major impact on their mental health, the charity says.

The rise in cases means that an increasing number of nurses, especially those in emergency departments, burns units, general practice and mental health, may care for those affected by such injuries.

But specialist burns nurses stress that despite the rise in incidence these remain relatively rare events, particularly outside London.

Response kits

Across London, police officers are being issued with 1,000 acid attack response kits. Rapid response police cars will now carry the kits, which include protective gear and five-litre bottles of water, it was announced in late July. London Fire Brigade will respond to incidents along with police, to provide large volumes of water rapidly where needed. Pouring water over a victim can help prevent further damage to skin, but speed is critical.


people were injured in a single acid attack at a London nightclub

Catherine Mitchell, a burns clinical nurse specialist at Chelsea and Westminster Hospital NHS Foundation Trust, the only major burns unit in London, says it is ‘brilliant’ that police cars will be carrying water.

She says the unit has noticed a small increase in victims of attacks, but that only serious cases are admitted to the unit. Some victims are treated for less serious burns at local emergency departments.

As with any burns, the wounds are potentially life changing, she says, and eye injuries from the corrosive substance are relatively common.

Ms Mitchell says any nurse who sees a victim of an attack can take instant action to improve the patient’s outcomes. ‘There are very simple steps that people can take to make a difference.’

‘Whether it is acid or alkali, remove any contaminated clothing, while not putting yourself at risk. Where possible use cool running water, and if that is not possible, bottled water or buckets of water, to copiously irrigate the affected areas for at least 15 minutes.

Speedy irrigation

‘Take special care to protect the eyes, so if it the substance is in someone’s hair irrigate away from the eyes. If the chemical has affected the eyes, then irrigate the eyes directly. Then call for help. Lots of irrigation and the speed of irrigation is key.

‘Anyone at the scene or emergency department nurses should find out, if possible, what the chemical is. That is hard in acid attacks, but it is useful to know.’

A 2015 study published in the journal Scars, Burns & Healing found that victims in the UK were mostly young men, assaulted by male perpetrators. Three quarters of the 21 attacks considered in the study, carried out by St Andrew’s Centre for Plastic Surgery and Burns in Chelmsford, Essex, took place on the street, with acid the most common substance used, followed by alkali and then bleach. The majority of victims were white and the patients were in hospital for up to 41 days.

British Burn Association executive committee member Krissie Stiles, a burns care adviser at the Queen Victoria Hospital in East Grinstead, West Sussex, says the long-term care and psychological support needed by victims varies widely.

Restoring confidence

The wounds are treated the same as thermal burns, with skin grafts used where necessary and care provided by a multidisciplinary team including surgeons, physiotherapists, occupational therapists and nutritionists.

She says psychologists are an essential part of the team. Some patients will need ongoing support after their physical wounds have healed to deal with the trauma of the attack, while others will be able to move on without this support. Their families will often also need support, she says.

‘We want to get patients back to their normal lives,’ Ms Stiles says.

‘The vast majority of injuries from attacks are on the face and hands, which will tend to require quite a lot of looking after from a psychosocial and mobility point of view. We do everything possible with scar management and input from therapists to ensure that the patients feel confident when they walk out of the unit.’

Katie Piper: resilience and support for others

Katie Piper, a survivor of a devastating acid attack, has called for rules to be tightened on the sale of corrosive substances.

In 2008, a man threw sulphuric acid in her face. She was blinded in one eye and suffered severe, permanent scarring to her face, chest, neck, arm and hands and damage to her throat due to swallowing acid.

In an open letter to the journal Scars, Burns and Healing in July, she said she had since undergone more than 250 operations as well as hours of psychological therapy.

Improving outcomes

Ms Piper, who set up the Katie Piper Foundation to improve outcomes for burns survivors, wrote: 'The issue of penalties for carrying corrosive substances needs to be addressed and restrictions on the sale of corrosive substances need to be looked at seriously and methodically through a scientific and well-resourced approach that leads to swift action.

'For acid attack survivors, the aftermath is a life sentence.’

The government is currently reviewing existing laws related to acid attacks, the response of police, sentencing, how people access harmful products and the support offered to acid attack victims.


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