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Title: Riot Control Agents - submitted by Jake Danoff

Category: Toxicology

Keywords: Riot control agent, Mace, pepper spray, tear gas (PubMed Search)

Posted: 6/4/2020 by Hong Kim, MD

 

Over the past several days, riot control agents have been used against the protest participants (related to Mr. George Floyd’s death). There are 3 widely used riot control “lacrimating” agents: 

  1. Mace (2-chloroacetophenone)
  2. Pepper spray (capsaicins)
  3. Tear gas (O-chlorobenzylidene malonitrile)

These agents (irritants) primarily affect the eye, skin, and respiratory tract.

 

 

Organ

Effect

Management

Eyes

·    Lacrimination

·    Blepharospasm

·    Conjunctiva irritation/conjunctivitis 

·    Periorbital edema

·    Corneal abrasions 

·     Copious H20/saline irrigation with Morgan Lensor Nasal Cannula jury-rig

·     Slit lamp exam for corneal abrasions 

Skin

·    Burning sensation

·    Blister

·    Contact dermatitis

·    2nd degree burns (mace) 

·     Wash with soap and water

·     Wound care 

Airway/respiratory tract

·    Respiratory tract irritation

·    Rhinorrhea

·    Laryngospasm

·    Bronchospasm

·    Chemical pneumonitis

·     B2-agonists for bronchospasm

·     Steroids if worsening underlying reactive airway disease 

·     CXR to evaluate for possible pneumonitis 

·     Supplementary oxygen as needed

 

Mangement:

  • Initial management involves copious irritation of the affected area with water. 
  • There is limited evidence that decontamination with milk, milk of magnesia, or baby shampoo is better than water. 
  • Always consider projectile or blunt trauma that may be associated with the riot-control-related ED visits/complaint. 
  • Protect yourself by wearing PPE when evaluating/treating these patients.

References

  1. Fisher, W. (2020). Procedurettes.com. Retrieved 3 June 2020, from https://www.procedurettes.com/eye-irrigation.
  2. Schep, L., Slaughter, R., & McBride, D. (2013). Riot control agents: the tear gases CN, CS and OC—a medical review. Journal Of The Royal Army Medical Corps, 161(2), 94-99. https://doi.org/10.1136/jramc-2013-000165
  3. Stopyra, J., Winslow III, J., Johnson III, J., Hill, K., & Bozeman, W. (2018). Baby Shampoo to Relieve the Discomfort of Tear Gas and Pepper Spray Exposure: A Randomized Controlled Trial. Western Journal Of Emergency Medicine, 19(2), 294-300. https://doi.org/10.5811/westjem.2017.12.36307
  4. The Morgan Lens for emergency eye irrigation. Youtube. (2020). Retrieved 3 June 2020, from https://www.youtube.com/watch?v=ig_W9tkH5Bw.