Burns, Chemical

Chemical injuries are commonly encountered following exposure to acids and alkali, including hydrofluoric acid (HF), formic acid, anhydrous ammonia, cement, and phenol. Other specific chemical agents that cause chemical burns include white phosphorus, elemental metals, nitrates, hydrocarbons, and tar.

Since World War II, the number of chemicals developed, produced, and used in the United States has increased dramatically. More than 65,000 chemicals are available on the market, and an estimated 60,000 new chemicals are produced each year. Unfortunately, the potential deleterious effects on human health of many of these chemicals are unknown. The Superfund Amendments and Reauthorization Act (SARA) contains extensive provisions for emergency planning and the rights of communities to be informed of toxic chemical releases.¹

In addition to individualized state health departments, the following 5 national sources provide information regarding death and injuries caused by chemical releases: National Response Center (NRC), Department of Transportation (DOT), Hazardous Materials Information System (HMIS), Acute Hazardous Events (AHE) Database, and American Poison Control Centers Association.²

Health departments from 5 states (Colorado, Iowa, Michigan, New Hampshire, and Wisconsin) evaluated 3,125 emergency chemical-release events involving 4,034 hazardous substances that occurred from 1990-1992. Of these events, 77% involved stationary facilities and 23% were transportation-related. In 88% of events, a single chemical was released. The most commonly released hazardous substances were volatile organic compounds (18%), herbicides (15%), acids (14%), and ammonia (11%). These events resulted in 1,446 injuries and 11 deaths. Respiratory irritation (37%) and eye irritation (23%) were the most commonly reported symptoms. Chemical exposures also can occur at home or as the result of an attack.

Many common products once believed to be innocuous (eg, cement, gasoline) are now regarded as potentially hazardous and as the cause of serious injury and illness. Exposure to these agents can be reduced significantly through educational programs, cautionary labeling of toxic products, and appropriate use of protective clothing.

When poison control centers identify new products that are toxic to skin, information is added to the regional poison information system to ensure that injured patients are given the benefit of new data. Concomitantly, this information is shared with the manufacturer and Consumer Product Safety Commission (CPSC) to recognize and address the problem nationally. For example, numerous cases of serious permanent injury and, occasionally, death caused by exposure to sulfuric acid drain cleaners have been recorded by the CPSC. As a result of this alarming problem, the CPSC currently proposes banning the sale of this product to consumers.