Acid attacks are a medical emergency and a crime at the same time. What happens in the first few minutes can decide how much permanent damage is done. What happens in the hours after can decide whether the person responsible is ever held accountable. Knowing these steps once, before you ever need them, matters more than any first-aid course you could look up in the moment.
The First Response: Water, Immediately
The single most important thing to know is this: get water on the injury right away, and keep it running.
A tap, a shower, a hose, a bottle, whatever is closest. Don't wait for someone to tell you what to do, and don't wait to find the “correct” solution, because plain water already is the correct solution. Pour it over the affected area and keep pouring.
If the eyes are affected, this matters even more than the skin does. Hold the eyelids open gently, even though it will hurt, and let the water run from the inner corner of the eye outward so it doesn't carry acid into the other eye. The longer acid sits on the eye, the deeper the damage goes, so those extra seconds of forcing the eyes open are worth it.
If You're a Bystander: What to Do, Safely
If you're near someone who has just been attacked, your first job is to help without becoming a second casualty. Acid doesn't stop being dangerous once it's off the original victim. It can still be on the ground, on their clothes, or in the air as fumes, and it can burn you too if you're not careful.
Protect yourself first. If you have gloves, use them before touching the person or their clothing. If you don't, try to avoid direct contact with the acid itself, and use whatever's on hand — a jacket sleeve, a plastic bag, a cloth — as a barrier if you need to touch anything wet or affected. Don't lean directly over pooled acid on the ground, since fumes can affect your eyes and airway too.
Get everyone clear of the danger first, moving the injured person, and yourself, away from any acid still on the ground or in the air.
Call for help immediately, and name someone specifically. If other people are around, point at one person and tell them directly to call an ambulance. Don't just shout for someone to help, because in a crowd, everyone assumes someone else will act, and often nobody does. Naming one person breaks that pattern.
Start pouring water on the injury right away, using whatever clean water is nearest, without waiting for paramedics to arrive.
Help remove contaminated clothing carefully. Cut it away rather than pulling it over the head, and put on gloves first if you can. If clothing is stuck to the skin, don't rip it off, since it will tear the skin away with it. Keep it wet instead and let medical staff handle the rest.
Take off nearby jewellery, since rings, earrings, and watches can trap acid against the skin even after the initial rinse.
If it's safe, note what the acid was — a container, a bottle, a smell — without touching it yourself. This helps both doctors and police later.
It's normal to freeze in a moment like this, and it's important not to let panic overrun your body. Survivors have described bystanders standing frozen and unsure while a family member was the one who finally stepped in and acted. If you feel yourself freezing, the fastest way through it is to do the next physical thing in front of you: put on gloves if you have them, get water moving, call out to one specific person for help.
The First Hour: Getting to Proper Care
Keep water running on the skin for at least 20 minutes, and on the eyes for at least 15 to 20 minutes, longer if the chemical is alkaline. Don't stop just because the person seems calmer, since calm doesn't mean the chemical is gone. It can still be working under the surface even after the pain eases.
Once irrigation has had its full effect, get to a hospital, and be deliberate about which one. Research from Pakistan's National Burn Care Centre has found that many burn patients outside major cities lose critical time because they're first taken to a nearby general facility that isn't equipped for burns, and only reach a proper burns unit after a second referral and a longer journey. If you have any choice in the matter, head straight for a hospital known to have a burns unit, even if it means passing a closer one, since a delayed but correct transfer is often worse than a slightly longer trip taken immediately.
If there's any difficulty breathing or the throat feels tight, especially after a burn near the face or neck, go straight to emergency care without waiting for irrigation to finish. That's one of the only situations in this guide where you shouldn't wait at all.
The First 24 Hours: What Family Can Handle
Once the person is at the hospital, there's a lot a family member or friend can do without getting in the way of medical staff. Handling this while treatment is underway means less falls through the cracks later, when everyone is more exhausted and less clear-headed.
On the medical side, ask about referral to a specialist burns unit or eye specialist rather than accepting general emergency treatment alone, and ask about a tetanus booster, since it's routine but easy to forget in the chaos. Over the following day, watch the wound for spreading redness, increasing pain instead of decreasing, pus, or new dark patches, since any of these need urgent medical attention rather than a wait-and-see approach.
On the legal side, ask for a medico-legal certificate at the first hospital visit, since this officially documents the injury and matters a great deal if the case goes to court later. Keep the person's clothing without washing it, and put it in a bag separately. Take photos of the injury and, if it's safe to do so, the scene itself. Report the attack to the police as early as possible. In Pakistan, acid attacks are a criminal offence under Section 336-B of the Penal Code, carrying sentences of up to life imprisonment, and delayed reporting is one of the most common reasons these cases become harder to prosecute later. Don't wait until things settle down to make the report.
On the emotional side, shock, confusion, and panic in these first hours are normal, for the survivor and for you. This isn't the moment to process everything that happened. It's the moment to get through it, one practical step at a time. There will be time later for the harder emotional work, and support for that exists when you're ready for it.
What to Avoid
A few instincts feel helpful in the moment but actually make things worse. Here's what not to do, and why.
Don't reach for toothpaste. Observations from Pakistan's National Burn Care Centre have found that toothpaste is the single most common home remedy people in Pakistan actually turn to after a burn, more than any other household substance. It's an understandable instinct, since it feels cooling on contact, but it does nothing to remove the acid and can trap it against the skin while making the wound harder for doctors to clean and assess later. If someone reaches for it out of habit, gently stop them and get water running instead.
Don't try to neutralise the acid with something else. Putting a base on an acid burn, or an acid on an alkaline burn, sounds like it should cancel the damage out, but it doesn't. The reaction between the two releases heat, which adds a fresh burn on top of the original one. Water is the only thing that belongs on the injury.
Don't put cream, milk, butter, or any other household substance on it either. This is the instinct most people have for any kind of burn, but it traps the chemical against the skin instead of washing it away, and can seal in heat rather than releasing it.
Don't assume low pain means low damage. Some chemicals, especially alkaline ones, can feel painless at first while doing the deepest damage underneath. Treat every exposure as serious, no matter how the person says it feels in the moment.
Don't pull off clothing that's stuck to the skin, since it tears the skin away with it. Cut around it instead, and keep it wet until medical staff can take over.
Don't stop rinsing just because the person seems calmer, since calm isn't the same as neutralised. Keep going for the full time, even if it feels like a long time to keep pouring water on someone who's already in pain.
Don't touch acid or acid-soaked clothing with bare hands if you can help it. Use gloves, a barrier, or anything you have on hand, because protecting yourself isn't optional here. An injured helper can't help anyone.
Don't settle for the nearest hospital without asking if it can actually treat burns. A few extra minutes spent choosing the right facility can save the longer delay of a second transfer later.
Don't leave evidence and reporting for “later.” It's tempting to focus only on medical care and deal with the police afterward, but clothing gets washed, memories fade, and delayed reports weaken cases. A family member can usually handle this in parallel while the survivor is being treated, so nothing has to wait.