Vitriol – The Treatment of Acid Burns and ASTI

I owe the Acid Survivor’s Trust International (ASTI) an apology.

You see, I didn’t think my article through. I made the same mistake as the people who tried to bully Melody and utilised ASTI’s name and works to argue against the bullying.

They deserve better than that.

I have had the pleasure of working with the Acid Survivor’s Trust International. ASTI, for those who are unaware is a medical charity from the UK who’s role in fighting the menace of vitriolage is from the reconstruction and rehabilitation standpoint.

I have said before. In South Asia, vitriolage is a perfect crime. A cup of liquid flung into the face of the victim in a crowded area and the perpetrator melts into the crowd. People are more interested in the victim.

In a situation where a person is burning in front of you, do you worry about the person or do you seek out the perpetrator?

ASTI is about reconstruction. ASTI helps rebuild the lives of women through plastic surgery. The scars will never ever go completely away.

I have a tiny acid scar on my hand. I accidentally broke my glove while treating the victim of an acid attack  some of the stuff got onto my thumb. It’s a callus of rough dead skin.

The Samaritan who brought her in though. His hands were covered in burns. He grabbed her and tried to clean the acid off and kept doing so despite the pain. He may have saved her eyes. And considering how it hurt, I can only imagine how much it hurt him. Ironically  it didn’t hurt her because the damage was extensive and deep. The acid had burnt out her pain receptors.

The last time I wrote about acid attacks a fair few people asked me how they should treat it in a first aid situation. Here is the thing. In most of the west acid attacks are a thankful and happy rarity. But they do happen and should you wish to learn? Follow these Basic Steps.

1. Be SAFE

This is a British Acronym.

Shout for Help/Assess/Free From Danger?/Evaluate

This is vital. There is no point in responding to any emergency situation half-arsed and poorly.

2. One of the major reasons why some of the damage in Asian countries is severe is the unwillingness to do this.

Strip. Everything covered in acid must be removed unless the item of clothing is adherent to the skin. Prolonged Contact  = More Damage. Clothes, Jewellery and Hats.

When the lady on my train yesterday had a Grand Mal seizure, to me the greatest thing I was worried about was her striking her head on a seat or lashing out and breaking a leg or an arm. I placed people in the way to get hit instead since  bruises heal but broken bones are painful. But in this all there was one woman who kept trying to adjust the sari of the victim. In her mind the “honour” of the woman was more important. I had to cut her blouse loose in a “chaste way”. (it’s called a skin incision. You concertina cut the blouse around the back this will expand and loosen it. One vertical cut from the top and two from the bottom and you have turned a tight fighting supportive part of the sari into something loose and better for breathing).

But many people don’t realise this even in the west. The patient’s life and later prognosis is helped by quick removal of the acid covered medium.

3.  This is the most important step. You need to wash the patient constantly in clean water. The used water must be removed and more replaced repeatedly. The ideal is for 30 to 40 minutes and running water is ideal. The water MUST be at room temperature.

4. Neutralise the acid with a solution of weak alkali. It’s a simple and elegant solution and distilled water and baking soda are good enough for the job. Mineral water and baking soda can do the trick too. The water MUST be clean.

5. Bring the bagged clothing to the hospital. And do so safely. Remember my scar and remember the acid is still active.

6. Superficial burns present with more pain than deep ones.

7. Remember speed of response is vital. The faster treatment is started, the faster you get the acid off the victim and the faster you get the victim from the setting to the hospital the better the morbid prognosis. Acid burns are not aimed at killing the victim so much as destroying their life and many a patient has been saved by simple and elegant first aid from much worse.

Do it well, do it good, speed will come on it’s own. And remember to keep it simple and safe.

And ASTI do some phenomenal work. I have seen their slide shows and met some of their phenomenal staff including the rather amazing Fiona Procter. These are her photos and there is a trigger warning. Many of these are pictures of people undergoing treatment after a tragedy.

Fiona’s photos encouraged me to actually put effort into expanding the clinic’s specific equipment list to handle such a case. Well it really meant keeping baking soda on hand since we have a running water system for the treatment of OPC poisoning but it was something we thought about.

Seeing people like her expand the care of acid burns and provide technology and expertise for reconstruction is great.

And let us NEVER forget the staff on the ground who coordinate and who often go unnoticed and unsung but who still fight against this horrific practice. There are cultural and religious issues which make this crime so common. Many victims are burned simply for their looks (because they are attractive) and because they may have spurned the advances of a man. Many victims from Muslim communities suffer worse burns due to the hijab and burkha as those absorb the acid and since many people won’t dare remove it. Many of the attacks are honour attacks. There is a definite gender ratio with more women being attacked than men. There are so many issues here and it is such a multi-factorial crime. ASTI are more catered to the care of the victims irrespective of these and that is incredibly vital to giving back these people’s lives.

We can so a lot.

Remember my dictim. Donate Time, Money and Skill where needed. ASTI do accept donations but if you cannot? Spread the word. I do not know any specific charity that is aimed specifically at helping the victims of vitriolage except for ASTI.


  1. Pen says

    In case you didn’t realise (how could you, nobody said anything), I think some of us did actually get the point the first time round. I, for one, noted the ‘weak alkali’ thing, just in case. It should be common sense really, at least to someone with a basic science education, but I found it a worthwhile reminder. Also the ‘don’t rip the person’s clothes off with your bare hands’. OK, that’s right, even if it is a natural thing to do.

    The work the ASTI are doing sounds amazing, I can’t even begin to imagine.

    Sometimes, I like to speculate about the cultural aspects of violence – which mean I estimate my chances of having to deal with the aftermath of an acid attack as low, but higher than zero, whereas, you know, the wrong end of half a beer bottle might be more prevalent. I don’t yet have anything intelligent to say on the subject.

    I can’t really remember who Melody what’s-her-name is, to tell you the truth.

  2. Samsara says

    “When the lady on my train yesterday had a Grand Mal seizure, to me the greatest thing I was worried about was her striking her head on a seat or lashing out and breaking a leg or an arm.”
    “But many people don’t realise this even in the west. ”
    Funny that.
    I was in a vehicle accident in Haryana where the Scorpio I was in rolled 3 times.
    Luckily I was wearing my seatbelt, but my head & neck were a mess.
    When I finally got to the hospital I was put in a private room & began to have a Grand Mal seizure.
    The physician & nurses attending me decided it was best to run out of the room & lock the door behind them.
    I awoke jammed head down between the gurney & wall crumpled in a heap.
    Nothing broke but I spent 1/2 an hour trying to figure out where the hell I was & who I was til my husband came & enquired as to where I might be & someone finally checked on me.
    Never go to the hospital alone in India.
    That’s all I’m sayin’


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