Production and transportation of large amounts of chemicals are everyday realities in industrial societies and the handling of these chemicals is surrounded by strict laws and regulations to prevent human exposures. Nevertheless, exposures to hazardous compounds occasionally occur due to accidental leakage or deliberate release. After a major chemical incident with a great number of exposed people there is a risk that the domestic health care system becomes overwhelmed and that patients might need to be sent abroad for medical intensive care. The object of this report is to give an overview of the medical management guidelines of chemical-induced lung injuries in some of the countries that could be involved in a Swedish patient-exchange after a major chemical incident, and to evaluate if there is a consensus concerning the medical treatment between these countries. Another objective is to summarize new emerging therapies for acute lung injuries that in future may apply to chemical-induced lung injury. From our comparative study we conclude that the international medical guidelines for treatment of lung injuries induced by inhalation of the irritant gases ammonia, sulfur dioxide or chlorine are very similar. Specific antidotes are not available; instead medical care is focused on symptomatic treatment of the chemical-induced lung injury. The most apparent differences between the countries studied are the divergent prescriptions of anti-inflammatory corticosteroids. In Sweden, Denmark and Germany, only inhalation treatment with corticosteroids is advocated, while the Norwegian and Finnish guidelines support systemic administration of corticosteroids in addition to the inhalation therapy. In the UK, corticosteroid treatment is only recommended by oral administration while countries like the U.S. and the Netherlands recommend against corticosteroid treatment of chemical-induced lung injury. Several new drugs are being tested for treatment of acute lung injury, but up to this date, only corticosteroids have been shown to have beneficial outcome on survival.