Approach Considerations
No antidote to riot control agents (RCAs) exists, so treatment is symptomatic and supportive. Treatment measures for RCA exposure include the following:
-
Remove the patient from the source. Since aerosolized tear gas is heavier than air, HAZMAT rescuers should get the incapacitated victim off the ground as expeditiously as possible. [2]
-
Remove clothes if clothing has been contaminated by RCAs.
-
Ocular exposures initially require thorough eye decontamination. Flushing the eyes with water or saline for 10–20 min is the most often recommended for initial decontamination.
Prehospital Care
Most people exposed to irritants do not seek medical care, and effects are self-limited. When persons seek care, first withdraw them from exposure. Responders should wear appropriate personal protective equipment (PPE). Decontamination should then proceed as follows:
-
Remove contaminated external clothing.
-
Acceptable decontaminating solutions are water or soap and water.
-
Do not use hypochlorite; this relatively caustic solution may worsen the condition of skin injuries already suffered from exposure to irritants.
-
Thoroughly flush eyes with water or saline; Patents may require a topical anesthetic to enable them to open their eyelids sufficiently for effective irrigation. Contact lenses should be removed before flushing.
-
Devote specific attention to very young, infirm, and elderly patients, since their responses to these agents may be significant.
-
Bronchodilator therapy may be used for those with postexposure bronchospasm.
-
Warn patients that the pain worsens during decontamination.
-
In patients with severe respiratory compromise, aggressive airway control, including invasive measures, may be required.
Emergency Department Care
ED personnel should don proper personal protection equipment (PPE) to minimize accidental exposure. Secondary exposure during endotracheal intubation, extubation, and nasogastric tube insertion has been reported. [16] A site should be established for the disrobing and general decontamination (see Prehospital Care) of the patients.
Initiate or continue care in the emergency department (ED) as follows:
-
Flush the eyes of patients with eye complaints with normal saline or water to remove any particulate matter before fluorescein slit lamp examination for corneal abrasion.
-
Treat more severe injuries, which occur in fewer than 1% of patients, in the usual fashion.
-
Corneal abrasions can be treated with local antibiotics, oral analgesics, and close follow-up care.
-
The rare eye foreign body may merit ophthalmologic consultation.
-
Treat burns based on the severity and location of injury.
-
Treat bronchospasm with bronchodilators.
-
Topical/parenteral analgesia as needed.
Most patients with irritant exposure can safely be discharged from the ED, as the few reported dangerous effects occur rapidly.The rare patient with significant respiratory damage may require oxygen supplementation, aggressive bronchodilator therapy (if bronchospasm is present), and admission to the hospital, possibly a critical care unit.
Characteristically, hospital admission for extended medical care is not indicated. Should hospitalization be required, consider alternative diagnoses.
Medical Care
Victims should be made aware that initial symptoms may be minimal or that there may even be a latent period. Should any clinical deterioration occur the patient should be re-evaluated.
Medical follow-up is indicated for a minority of patients, including those with any of the following:
-
Very young age
-
Advanced age
-
Comorbidities
-
Significant dermal injuries
-
Prolonged respiratory difficulties
Consultations
Consultations with one or more of the following may be indicated:
-
Ophthalmologist
-
Burn specialist
-
Mental health specialist
-
Pulmonologist
Long-Term Monitoring
Consider the following in long-term monitoring:
-
Opthalmologist consultation with possible significant damage to the eyes
-
Pulmonologist consultation should there be any long-term respiratory complications
-
Mental health
-
Burn care
