C hemical burns are produced when the skin is exposed to a corro- sive material, such as an acidic or alkaline substance. Exposure to a variety of common substances can lead to an injury; this article will cover several of the more common chemicals that pose risks to the patient. Caustic substances that have capacity to cause burns can range from non- lethal capsaicin-based sprays used by law enforcement to commonly available chemicals found in households, industrial settings and construction work sites. One critical aspect to always consider when responding to a patient with a known or suspected chemical burn is the risk of exposure to the responder by the same causative agent. Several of the agents most closely asso- ciated with war and terrorism are caustic chemicals that result in burn injury. The prevention and management of chemical burns are prominent features in current efforts to curtail the impact of weapons of mass destruction (WMD). 3–6 In the after- math of the 9/11 attacks, 7 WMD became and remains a central focus of the U.S. Department of Homeland Security (DHS) in its efforts to coordinate and develop overall disaster preparedness and plan- ning. For medical disaster planning and preparedness, the U.S. Department of Health and Human Services’ (DHHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) and its Hospital Preparedness Program (HPP) 3,5,8–10 have also developed a focus to include weapon- ized chemical agents. Aside from national security threats however, the widespread day-to-day use of chemicals in households and industry, 11,12 can lead to serious chem- ical burn injuries. Regardless of intention to injure or instill fear 13–16 or if due to acci- dental exposure, chemical burns can be difficult to manage and create an ongoing danger to the responders. 17 Assessment and Triage The first steps of the assessment are to limit ongoing injury and determine the extent of exposure. These steps can be simplified to: strip, flush and cover the area. If it appears clothing is adhering to the injury site, then flush the area with By Randy D. Kearns, DHA MSA NREMTP-ret., Charles B. Cairns, MD, FACEP, FAHA, James. H. Holmes IV, MD, FACS, Preston B. Rich, MD, MBA, FACS, & Bruce A. Cairns, MD, FACS CHEMICAL BURN CARE: A Review of Best Practices Chlorine gas in a high concen- tration, saturated the clothing of this patient. Chemical burns were found in locations where the clothing was the thinnest and offered the least protection. Great risk and potential for injury is present when dealing with chemical burns, for patients and providers 40 MAY 2014 | EMSWORLD.com