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Water Is Not The Only Solution

In February 2019 the Faculty of Pre-Hospital Care and the British Burn Association issued a revised consensus for the Pre-Hospital management of burns.

For ocular and dermal splashes of irritant and corrosive chemicals the consensus advises the use of amphoteric solutions for first line decontamination.

“For chemical burns, amphoteric solutions are likely to be safe and as/more effective than alternative irrigation solutions, therefore the use of an amphoteric solution is recommended”

It also goes on to state with regard to irrigation:

“In the absence of amphoteric solutions irrigation should be performed with Hartmann’s or Normal Saline solutions. If neither would be available irrigation with tap or bottled water”

By looking at the mechanisms of a chemical injury we can understand why these recommendations have been made.

When corrosive or irritant chemicals contact the skin or eyes they will begin to penetrate. The speed of the penetration will depend on a number of factors including the type, the concentration and the temperature of the chemical. Following penetration the aggressor of the chemical will react with the components of the body tissue causing the chemical lesion due to the destruction of cells.

From this we can begin to understand that our first aid measures need to stop or reduce this penetration to reduce the severity of the injury. Traditionally we have managed this by irrigation with ‘copious’ amounts of water. This serves to mechanically remove the chemical from the surface of our skin and eyes and to dilute the chemical to reduce its ability to penetrate. This process has its limitations:

  • Water has no ability to act on the irritant or corrosive nature of the chemical agent
  • There is no rapid return to a safe physiological state. The effect of carrying the chemical away is limited to the surface of the tissue only
  • Irrigation must start immediately — EN15154 standard (ANSI standard recommends 10 seconds)
  • Large quantities of water are required — EN15154 standard recommends 60l of water per minute for 15 minutes ie 900l of potable water
  • Water is hypotonic to the body so can actually assist the penetration of chemicals due to osmosis — known as the wash-in effect.

Despite following these current protocol,s the requirements for secondary care, surgical care and fatalities are still reported in scientific literature.

Diphoterine® is an amphoteric chelating agent developed by toxicologists at Prevor for first aid management of chemical splashes to skin and eyes. Diphoterine® has three proven mechanisms:

  • Mechanical washing — to remove surface chemical
  • Chelation — to attract and bind the aggressive chemical molecule to quickly return the tissue to a safe physiological state. The Diphoterine® molecule is polyvalent and is able to chelate the aggressor of each of the six chemical groups that can cause a chemical injury: Acids, Bases, Oxidising Agents, Reducing Agents, Chelating Agents and Solvents
  • Hypertonicity — to create a reverse flow away from the tissue. (Opposite to the wash-in effect)

Using the benefits that Diphoterine® offers we can stop the progression of the chemical lesion — thereby limiting or preventing injury. The additional benefits of the functionality of Diphoterine® are:

  • the ability to extend the window to commence irrigation
  • a more comfortable rinsing process and a reduction in hypothermia risks
  • smaller volumes of liquid required due to the active washing capabilities
  • a reduction in pain due to the chelation of the chemical aggressor
  • safer first aid due to non-corrosive run-off
  • portable, autonomous, maintenance free, first aid management of chemical injuries

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