Water is the most effective first aid in an acid attack, say experts dealing with acid burns, which is the most common form of chemical burns in India.
Depending upon the concentration of acid used -- almost always against women -- it starts eating away the skin tissues within seconds and, in extreme cases, can even expose the bones.
Wash the affected area with running water.
"Pour water for 15-20 minutes or as long as it takes to wash off the chemical. The longer the acid stays on the skin, the chemical will continue burning and damaging the tissues," says Dr Mahesh Mangal, senior consultant for plastic and cosmetic surgery at Sir Ganga Ram Hospital.
If the eyes are affected, continue pouring water into them until the chemical is washed away.
The biggest misconception people have is that an acid attack victim needs to be taken to a hospital with burns treatment facility.
"Any hospital equipped to deal with emergency cases can treat acid burns. The primary aim is to prevent infection and save the victim's life and vision. Reconstructive surgeries come into picture much later," says Dr Sanjay Dhawan, director, department of ophthalmology, Fortis Memorial Research Institute.
Stabilising an acid attack victim takes 12-24 hours. First, the fluid and electrolyte loss is replenished by giving intravenous fluids; then antibiotics are used to prevent infection. The next step, a couple of days later, is to surgically remove the dead tissues.
"It takes a couple of days to assess the actual depth of wounds around the face, neck and chest area and hands and arms. Dead tissues don't heal and leave behind scars. After removing those, we use skin grafts to cover the exposed areas," Dr Mangal says.
The first phase of reconstructive surgery is started six weeks to a few months after injury.
Depending upon how severe the wound is, a person may require 10-15 surgeries, sometimes even up to 50, spanning years. Each reconstructive surgery costs from Rs 50,000 to Rs 2 lakh.
"The priority is to repair functional areas, like nose, lips and eyes. It isn't possible to restore the face to its original form; we manage to salvage 50 per cent of it at most to make it possible for the victim to negotiate life," Dr Mangal adds.
The scars, though, always remain.
"Restoring complete vision is also not possible in most cases. So the attempt is to restore whatever vision is left and repair eyelids to prevent dry eyes," Dr Dhawan says.
Another integral aspect to the treatment is psychological counselling to deal with post-traumatic stress syndrome. "Ideally, counselling must start immediately after the life-saving procedure to help the victim through an extreme phase of hopelessness.
A lot of courage needs to be built even to face the several phases of treatment," says clinical psychologist Pulkit Sharma, Imago- centre for Self.
The final step is the termination of counselling for the victim to move on which can, unfortunately, take years.