Alkaline Degreaser Splash: Eye and Forearm in a Workshop
You are the first aider in a small engineering workshop. A 34-year-old worker was decanting a drum of industrial alkaline degreaser when a hose slipped. Liquid splashed his right eye and the inside of his right forearm. He is in significant pain, holding his eye, and cannot open it. He wears a soft contact lens in that eye. There is a burn on the forearm roughly the size of his hand, with chemical still visibly wet on the skin. The workshop has a sink with running cold water, but the eye wash station was removed last month and not replaced. Another worker has started dabbing at the eye with a paper towel. The man is shouting that he wants to go home and wash it himself. The drum's label is legible but nobody has brought the safety data sheet.
1. What are your immediate priorities in the first minute, and why does the nature of the chemical change the urgency?
Read the worked answer
First, stop the other worker dabbing the eye - wiping spreads the chemical across the cornea and can cause an abrasion. Second, keep the casualty on site: dilution is the treatment, and letting him leave to wash at home risks permanent eye damage. Third, start irrigation now.
The chemical matters: alkalis are more destructive than acids because they penetrate tissue and cause liquefactive necrosis, so damage continues long after the splash. That makes irrigation time, not transport time, the priority. Send someone to phone 112, ask for the chemical's name and the safety data sheet, and have the wet sleeve cut off rather than pulled over the injured hand and eye.
Do not attempt to neutralise the chemical with anything, and do not apply ointments or drops - those only delay irrigation and can worsen injury.
2. Describe how you irrigate the eye, how long for, and what you do about the contact lens.
Read the worked answer
Position him so the affected eye is lower than the other, then irrigate with cool running water from the inner (nasal) corner outwards so contaminated water does not run into the good eye. Hold the lids apart gently if he will tolerate it, and let him blink as the pain eases. Irrigate for at least 20 minutes for an alkali - longer than for most acids - and keep going during transport if you can, recording the start time.
Remove the soft contact lens only if it comes out easily: a soft lens can trap chemical against the cornea, so removal is desirable, but do not delay or interrupt irrigation to dig for it. If it will not come out, leave it and let the hospital remove it; irrigation continues either way. Note in your handover that a lens was present and whether it was removed.
3. How do you manage the forearm burn and arrange transfer, and what must you avoid?
Read the worked answer
Brush off any dry chemical first - not relevant here because it is liquid - then irrigate the forearm copiously with running water for at least 20 minutes. Do not neutralise the chemical, do not apply butter, creams, oils or ice, and do not burst any blisters that form. Remove his watch and rings before swelling starts.
After irrigation, cover the burn loosely with cling film laid in strips along the limb, not wrapped around it. A circumferential wrap can swell and act as a tourniquet on a limb.
He needs hospital assessment: a chemical eye injury plus a hand-sized chemical burn both warrant 112 transport, and he should not drive himself or be sent home. Continue irrigating the eye while waiting if it gives relief. Hand over the chemical name and concentration, time irrigation started and total duration, whether the lens was removed, and any other injuries.