What is Tear Gas and Pepper Spray Toxicity?
Tear gas and pepper spray belong to a variety of substances generally used for controlling riots or for self-defense. They were initially used by the military during World War I but are now commonly used for personal protection or by police to safely handle aggressive people or control large crowds. These substances cause immediate discomfort, such as eye pain, tearing, skin irritation, and difficulty breathing.
Examples of tear gases include substances known as CS, CN, and CR. CN was developed at the end of World War I but was never used in combat. Instead, it was widely used by the military and police until CS, a more potent and safer substance, was developed. CS, invented by Corson and Stoughton in 1928 and first used by the British army in 1958, replaced CN because it worked better outdoors and was considered safer.
Pepper spray, developed in the late 1970s, has become popular with law enforcement agencies since the early 1980s. The main ingredient in pepper spray is Oleoresin capsicum (OC), an oily concentrated extract from chili peppers. The effects of capsaicin, a substance found in OC, have been studied since the 1920s. In recent years, it became favored by law enforcement agencies for controlling riots. It has been found to cause similar effects to tear gases and has become popular for personal protection.
What Causes Tear Gas and Pepper Spray Toxicity?
These substances are normally used in a spray or liquid form. They may be used by law enforcement or the military, often in situations where grenades or canisters containing these substances are thrown into an area. They can also be released using handheld spray devices. The term “aerosol” often means spraying across a large area for crowd control. Meanwhile, “sprays” typically refer to handheld canisters used to disarm one individual.
One variation of spray uses a mix of substances known as CN and hydrocarbons in a canister for personal protection. Aside from sprays, these substances can sometimes be added to water and then spread over a large area using things like a water cannon, bombs, or big spray tanks.
As soon as these substances come into contact with a person, they start to affect the skin, eyes, breathing system, and the lining of the body’s cavities that produce mucus.
Commonly known as “tear gas,” CN, CS, and OC compounds aren’t actually gases but solids at room temperature. They don’t dissolve very well in water, which means they’re usually dissolved in organic fluids. This process then allows them to be used as aerosols or tiny particles. Alternatively, these agents can be made into an aerosol using high-temperature dispersion, typically reaching temperatures greater than 700 degrees Celsius.
Risk Factors and Frequency for Tear Gas and Pepper Spray Toxicity
Certain agents were originally made for military use, like CS gas which the US military used in the Vietnam War. Despite their initial military use, these agents have been prohibited in warfare since 1995. Nowadays, exposure to these agents in the US usually comes from law enforcement or civilian use. Mace and pepper spray are even available for civilians to use.
Data from the National Poison Data System in 2017 reported 4,007 total cases of people exposed to these agents, most of the cases being related to OC, followed by CN, CS, and other unknown sources. About 25% of these cases were seen in a healthcare facility, but most had minor effects and no deaths were reported. Based on data from Texas, from 1998 to 2002, 1531 people were exposed to pepper spray. Most incidents were accidental, mostly happened at home, involved males, and affected children and adolescents. While risk factors varied by patient age, most people managed outside health care facilities and experienced minimal clinical effects.
In another study based on data from California from 2002 to 2011, there were 3671 cases of pepper spray exposures. Most instances affected the skin and resulted in minor, short-term symptoms. Only a small amount reported severe symptoms such as persistent dermatitis, dermal burns, and blister formation, which included several incidents involving law enforcement training.
Signs and Symptoms of Tear Gas and Pepper Spray Toxicity
People exposed to gases or sprays used in riot control often start to feel discomfort within 20 to 60 seconds. Their symptoms usually begin with issues related to their eyes and breathing. Other reactions can include a sensation of burning and irritation, inflammation of the eyes, airways and skin. Some people might also experience systemic symptoms, such as coughing, shortness of breath, pain in the chest, headaches, feeling dizzy or even fainting. If people are exposed to a high concentration of these agents or are in a space with poor ventilation, their symptoms can be more severe, like tightening of the airways, coughing up blood, inflammation of the lungs, fluid build-up in the lungs, difficulty breathing or even death.
Physical effects on the eyes may include tear production, redness of the inner surface of the eyelids, uncontrollable blinking, sensitivity to light, eye inflammation, and swelling around the eyes. The agents used in riot control typically do not cause major eye injuries, but there have been instances of such injuries. Some reported injuries include bleeding in the anterior chamber of the eye, inflammation within the eye, corrosive eye inflammation, tissue death caused by coagulation, pressure increases within the eye leading to glaucoma, cataracts, injury to the optic nerve, and loss of sight. Some of these injuries may have been due to explosive devices, the use of an organic solvent or unintentional injury from vigorous rubbing of the eyes. Skin reactions can range from redness, rashes and purple areas as result of blood leakage, skin shedding, the formation of small fluid filled sacs (vesicles), blistering, first-degree, second-degree and third-degree burns, flaking skin and swelling beneath the skin.
The severity of skin reactions gets worse with moisture. Some gases used in riot control have been noted to cause more severe injuries. Delayed skin reactions like an allergic response causing dermatitis and a sudden rash with pustules can appear about 12 to 24 hours or more after exposure.
In most cases, people start to feel better 10 to 30 minutes after they’re no longer exposed to the source. The cough and shortness of breath might persist, especially in people who have ongoing lung disease. In animal studies, a large reduction in breathing volume noted in both exposure scenarios could also be due to the organic solvent. Usually, vision returns to normal within this same time. Redness of the eyelid margins and sensitivity to light could last longer. A runny nose and salivation might last for about 12 hours. Headaches can stick around for up to 24 hours. Redness of the skin typically goes away after an hour, while blistering and more severe skin reactions usually resolve within four days.
Testing for Tear Gas and Pepper Spray Toxicity
If someone has possibly been exposed to harmful substances, the first thing to do is to wash the substance off thoroughly. This not only helps to treat the person but it also prevents any other people responding or caring for the person from being exposed to the harmful substance. It’s uncommon, but there is a chance that people could be exposed to substances used for crowd control and develop symptoms as a result.
In these situations, medical professionals need to make decisions based on the severity of the person’s symptoms. If a person doesn’t have other serious injuries, it’s best to clean off any harmful substances before bringing them into a healthcare facility. The cleaning process can even start out in the field if emergency medical services are involved. It’s best to lift a person off the ground because harmful gases are heavier than the air and stay closer to the ground. Emergency vehicles should try to park on higher ground away from where the gases are dispersed. It’s especially important to flush any harmful substances out of a person’s eyes on the scene.
Eye relief drops, like proparacaine, can be used to make it easier to cleanse the eyes. Healthcare workers should use their regular safety gear and remove any contaminated clothing from the victim. They may need to wash off the victim’s skin and eyes with a lot of water. It’s also important to check the victim’s skin and eyes for any injuries or foreign objects if there were any explosions used to spread the harmful substances. Depending on how severe a person’s eye symptoms are, doctors might decide to perform a detailed eye exam with corneal fluorescein staining, a technique that can reveal damage to the surface of the eye.
If there are signs or symptoms of lung damage, things like a pulse oximetry test, arterial blood gas analysis, and chest X-ray can be used to help assess for any acute lung injury. As of now, there are no regular lab tests that can identify or confirm exposure to crowd control agents.
Treatment Options for Tear Gas and Pepper Spray Toxicity
When managing patients exposed to substances used in riot control, doctors first ensure the patient can breathe properly, their body is receiving enough oxygen, and their blood circulation is stable. The patient’s face is carefully cleaned using a moist towel to remove any particles before proceeding to a more thorough wash. They then use a large amount of water and soap to cleanse away contaminants. If the skin is significantly damaged, saline (a solution of salt in water) is used instead.
In some cases, other solutions like milk, baby shampoo, or antacids might be used. Studies on these methods have shown various results regarding their effectiveness, but they aren’t harmful. In research settings, a solution called ‘amphoteric chelating irrigation fluid’ has been successful in decontaminating a variety of chemical exposures on the skin or eyes. But this is often not available in many clinical settings, and using water to clean the exposed areas is prioritized.
If the patient’s eyes have been exposed, they are thoroughly washed with water or saline for at least 10 to 20 minutes, but may continue longer if the patient has eye-related symptoms. Any contact lenses are removed before this process. A topical anesthetic, a medication applied directly to the area to reduce pain, may be used to ease discomfort and aid the cleaning process. For certain types of exposures, the solution might be mixed with soap or shampoo for better results.
If the exposure on the skin or eyes is severe, the patient might be given systemic corticosteroids, medicines that reduce inflammation. They also might need to consult with an eye specialist in cases of significant eye injuries.
Respiratory symptoms like difficulty in breathing after exposure to these agents are usually mild and improve within 10 to 20 minutes once the patient is removed from the source of exposure. If the patient has excessive secretions in the airways, suctioning (removing secretions by suction) may be needed. If the airways have constricted, medications that relax the airway muscles or steroids may be used. Sometimes, substances used in riot control can trigger severe respiratory conditions requiring a breathing tube and mechanical ventilation. In rare cases, patients may later develop other lung issues, which are managed depending on their severity.
Another possible reaction to these substances is gastrointestinal discomfort, including nausea and vomiting. If the patient has ingested the riot control spray, these symptoms might be more likely. Doctors manage these symptoms by administering intravenous fluids, medications to control nausea, and replacing essential body salts. As these symptoms usually resolve by themselves and are considered minor, procedures to remove the substance from the stomach are not typically necessary.
In situations where law enforcement or military personnel are being trained to deal with these substances, using the amphoteric chelating irrigation fluid before exposure may provide some protection. One study showed that police officers who were treated with this solution experienced less facial pain and were able to resume activities sooner after being exposed to the substance.
What else can Tear Gas and Pepper Spray Toxicity be?
Most of the time, if someone has been exposed to pepper spray or tear gas, they will know it because they were around when it happened. They will also have typical signs of exposure. People accidentally coming into contact with these substances without realizing it is much less common. There are other substances like certain toxins, lung irritants, or sprayed harmful chemicals, that could cause similar symptoms.
What to expect with Tear Gas and Pepper Spray Toxicity
Tear gas and pepper spray are usually not lethal and people exposed to these substances typically have a positive outcome. The majority of affected individuals, when removed from the exposed area, will see a resolution of symptoms within 10 to 20 minutes. However, if someone is exposed for a longer period, they may experience severe injuries and breathing problems. Even in these cases, patients usually recover quite swiftly.
Patients exposed repeatedly to tear gas or pepper spray might experience a slight deterioration in lung function, as shown by formal lung tests.
While death due to exposure is extremely rare, there are some recorded cases. In these cases, autopsies revealed fluid in the lungs, bleeding inside the tiny air sacs of the lungs, cell death in the respiratory lining accompanied by fake membrane formation, early bronchopneumonia (an inflammation of the lungs and bronchi), small reddish-purple spots on the serous membranes (the tissues that line the cavities of the body), swelling in the brain, and a change in the liver cells where they accumulate fat.
Possible Complications When Diagnosed with Tear Gas and Pepper Spray Toxicity
Exposure to tear gas-like substances, known as lachrymator agents, is predominantly harmless, with the irritation usually resolving in 30 minutes. However, in rare cases, the exposure can cause more serious damage to the eyes, skin, and respiratory system.
Potential Eye Injuries:
- Hyphemia – pooling of blood inside the eye
- Uveitis – inflammation inside the eye
- Necrotizing keratitis – severe infection of the cornea
- Cataracts – cloudy areas in the eye lens
- Traumatic optic neuropathy – damage to the optic nerve, which can lead to vision loss
Skin injuries may vary from minor rash to severe full-thickness burns, which are burns affecting all layers of the skin. Severe breathing-related injuries can include bronchospasm (narrowing of the airways), chemical pneumonia (inflammation of lung tissue), fluid in the lungs (pulmonary edema), and even suffocation serious enough to need intensive care. Death is, however, extremely rare.
Preventing Tear Gas and Pepper Spray Toxicity
Many people might know that tear gas, also known as lacrimator agents, have been prohibited for use in war situations. However, what they may not realize is that these substances are still used by both police and ordinary people for self-defense. In fact, their use to control crowds, especially at protests, has been gaining prevalence in the U.S. and other parts of the world. Therefore, it’s not unexpected to encounter tear gas at such events.
For those worried about the effects of tear gas, please note that the vast majority of side effects, like eye irritation and difficulty breathing, usually disappear within 10 to 20 minutes, and most people don’t require medical care to manage these symptoms. If you think you could be exposed while attending or observing a protest, look for the presence of medical aid stations at the event. These stations are typically equipped with plenty of water and numbing eye drops to provide quick relief.
If you have conditions like asthma, it’s important that you carry a rescue inhaler with you to such events to avoid any breathing complications. It’s interesting to note that only 25% of tear gas exposures are examined at healthcare facilities. If you experience ongoing discomfort or issues with your eyes following contact with tear gas, you should reach out to an eye specialist for a full exam.
Lastly, there’s also preparation fluid called amphoteric chelating irrigation fluid that may prove beneficial as pre-treatment in law enforcement and military training activities involving tear gas.
