Acid attacks are a particularly disturbing type of violence in which an attacker throws corrosive liquid onto a victim. And they’re on the rise in London in recent years — so much so that medical professionals are now issuing guidance for how bystanders can intervene to limit victims’ suffering.

That guidance, published Wednesday in the BMJ, reflects medial professionals’ increasing alarm over the attacks.

According to the Metropolitan Police in London, there were 261 acid attacks in 2015 and 454 in 2016, and the number is on pace to be even higher in 2017.

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According to Dr. Johann Grundlingh, a consultant in emergency medicine at Barts Health NHS Trust in London who co-authored the editorial, acid is an appealing alternative to guns and knives for gang violence because it is an unrestricted substance: It is easy to get, and can be carried legally in large quantities without a license.

“[Gangs] have picked up on the fact that they can carry around these very devastating weapons without any threat of law enforcement catching up with them unless they’re caught in the act,” Grundlingh said.

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Grundlingh said that the emergency department where he works sees at least one acid attack case per day.

Grundlingh suspects the acid, often hydrochloric or sulfuric, is purchased online or made at home using online instructions. In a typical attack, the acid is carried in an acid-resistant squeeze bottle, and sprayed onto the victim’s face at close range. It immediately begins burning the skin and eyes, and the burns, similar to those that occur in a fire, can cause severe scarring or blindness.

Victims who are gang members have told him that “the purpose is not to kill the other person, but to scar him, to disfigure him,” Grundlingh said — “so that he’ll always carry that very visual image of the fact that he’s been targeted, almost like a badge of shame.”

The guidelines he and two other physicians wrote stress the need for urgent treatment with copious amounts of water. Grundlingh said bystanders mistakenly think that pouring a half-liter bottle of water over the burn is enough, when in fact it often takes over 10 gallons to sufficiently dilute the acid.

How quickly and how thoroughly the acid is rinsed off makes an enormous difference.

“We’ve seen people who have had highly concentrated acids thrown at them but they washed it off so quickly with a lot of water, that they only really end up with what looks like a bad sunburn,” Grundlingh said. “And then you get other people who have had a weaker acid on them, but they didn’t take it that seriously, they didn’t really wash it off effectively, and then they end up with quite severe scarring.”

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Once a victim is transported to the emergency department, doctors will continue to rinse the skin and eyes with large amounts of water until the acid has been neutralized, while administering pain medications and intravenous fluids to combat dehydration. A plastic surgeon may use skin grafts to minimize scarring in badly burned areas, and an ophthalmologist will attempt to prevent or reverse eye damage, though Grundlingh emphasized that “once the damage is done, it’s very, very difficult to repair.”

And while Grundlingh and other medical professionals are working to educate the public about how to respond to an acid attack, the U.K. government is also weighing its options. The House of Commons met in July to begin discussing legislation around acid attacks, including whether purchasing and carrying acid without a license should be illegal, and how to create an action plan for reducing such attacks.