December 2, 2022

Dear Colleagues,

Welcome back to this week’s edition of Pharmacy Phriday.  Over the next couple of weeks, the focus of these articles will include suggested treatments for Hydrofluoric (HF) Acid exposures.  These treatments are often medications listed in the UH protocols but not necessarily provided in the UH drug boxes.  The provider may sometimes access these medications in first aid or medical treatment kits provided at various industrial sites using HF or on transport vehicles making deliveries of the product.

Hydrofluoric (HF) Acid is often referred to as HF to prevent confusion of the product with other acids such as Hydrochloric Acid (HCl).  HF is often used in industrial settings for purposes such as glass etching, metal cleaning, and electronics manufacturing, to name a few.  Hydrofluoric acid, in lower concentrations, can also be found in some commercial products such as rust removers, cleaners, and solvents and may be found in the residential setting.

Through pre-planning efforts, an agency should identify locations that frequently use or store the product.  Prevention of accidents and safety are important considerations with HF, and facilities using the product will often seek combined training with first responders.  Pre-planning and training should also stress that responses to these types of exposures are a hazardous material incident and proper caution, including safety and PPE for first responders, is a must.

HF exposure is different from other acids because the fluoride ion readily penetrates the skin seeking out calcium and magnesium, causing the destruction of deep tissue layers. The most severe pain associated with HF exposures is often from the hidden damage and is frequently described as being out of proportion to physical findings of any external burns.  Unlike other acid burns, which are rapidly neutralized, the injury process in HF exposures may continue for days if left untreated.  Skin contact with lower concentrations of HF may not cause immediate symptoms, delaying the recognition and treatment from an exposure.  In some cases, this delay could be up to 24 hours, so a thorough history of recent events and possible exposure could be extremely important.  

If the burns are promptly and properly recognized and managed, the results of treatment are generally favorable.  Treatment is directed toward binding the fluoride ions to prevent tissue destruction.  Some of the first aid treatments recommended by manufacturers of HF include rapid decontamination and dilution with water until a more definitive treatment is available.  Benzalkonium Chloride (Zephiran) is one of those more definitive treatments that can be started by EMTs if not already started by plant personnel that have been trained in the first aid of HF exposures. 

Zephiran is a commercially available disinfectant that is often stored on-site where HF is used or stored regularly.  In instances when these treatments have been started, they should be continued throughout transport to a medical facility.  If Zephiran or a Calcium Gluconate gel (another treatment discussed in an upcoming issue of Pharmacy Phriday) are not available, water irrigation should continue until one of these agents is available. 

An iced Zephiran soak is recommended when an extremity is involved and makes the practicality of a soak viable. Ice cubes are the preferred method to cool the solution, which also assists with pain relief.  In cases when the exposure is on a body part other than an extremity or a soak is impractical, towels soaked in the solution can be placed on the exposed area.  Towels should be changed or soaked with the additional solution every 2-4 minutes.  The success of this treatment is indicated by the relief of severe pain in the burned area. If the patient complains of discomfort due to chilling from the ice soak, the affected body part can be removed from the soak every 10-15 minutes to allow relief.  If pain from the burn site returns, the soak should be resumed. 

Zephiran is intended for external use only.  It should not be used around the eyes, on the face, around the ears, or in other sensitive areas due to its irritating nature.  In those cases, other methods of treating the burns can be provided.  In the next edition of the UH EMS-I Pharmacy Phriday, we will focus on those additional treatments.

As we close this edition, we draw your attention to the fact that from December 5-9, 2022, National Influenza Vaccination Week will be observed.  The purpose of the observance is to encourage everyone to protect themselves and their loved ones from the flu this season by getting a flu vaccine.  Have you gotten yours? It’s not too late!

Till next time, stay safe!

Sincerely,

The UH EMS-I Team

University Hospitals