Riot control agent protocol
Riot control agents are a set of chemicals commonly used by the state to disperse or otherwise inhibit the function of people they wish to control. Several chemical formulations exist, and differing delivery mechanisms (grenades, sprays and pellets are common); however all known agents are aerosols (suspensions of fine solid or liquid particles in the air), and all have the same treatment and protocol.
The primary dangers of riot control agents are threats to the airway and injuries inflicted by crowds in the upheaval following their use.
Treatment of riot control agents is not limited to washing out eyes, and requires work before, during and after their use, and often extended mental health support.
This protocol describes the QueerCare method for dealing with riot control agents.
- 1 How to prepare for riot control agents
- 2 What to do before treating riot control agents
- 3 When to treat riot control agents
- 4 How to treat riot control agents
- 5 What to do after treating riot control agents
How to prepare for riot control agents
If you are planning to attend a protest where it is likely that riot control agents may be used, you should:
- Avoid wearing contact lenses, as particles may become trapped behind them.
- Avoid wearing skin creams, lotions, or makeup: particles of tear gas/pepper spray will cling to the oil on your skin.
- Bring a change of outer clothes, and sealable plastic bags for contaminated items
- Bring water in sports-cap bottles
- Prepare appropriate PPE. For riot control agents this should be:
- Multiple pairs of disposable nitrile gloves
- Goggles which seal around the eyes, such as swimming or diving goggles
- A respirator mask, when available. Ideally, use a reusable, silicone fitted respirator mask with interchangeable cartridges. If not, you can use a disposable N100, N99, KN100 or FFP3 filtering facepiece mask, properly fitted. If these are not available, N95, KN95 or FFP2 can be used.
Respirator masks with exhalation valves should not be used as infection control during the COVID-19 pandemic, as they do not protect others from infectious particles in your breath. During the pandemic, you should wear a mask or face covering without a valve for infection control during the protest. If your respirator mask has a valve, carry it with you and use only when RCAs are used. .
When there is not a common pandemic, masks can make you a target for police- you can keep it in your bag and using it only when RCAs are used.
What to do before treating riot control agents
- If you think there is a strong chance riot control agents are going to be used, try to brief potential targets before their use:
- Explain the risks of panicking and the need to protect each other from stampede injuries when deployed (see 'Crowds' below)
- Explain the physiological risks and try to ensure that people with respiratory conditions can get away from the danger zone (see 'Respiration' below)
- Explain decontamination techniques following their deployment (see 'Decontamination' below)
- Encourage people to remove contact lenses to prevent particles from being trapped behind them.
- Be aware that this may leave some people unable to see clearly and at heightened risk of being knocked down or exposed to other dangers. Try to ensure that other protestors are buddying anyone who is in this situation.
- Put on your own PPE
- Encourage people to cover their noses and mouths (e.g. with a bandana) if they are not already doing so.
During the COVID-19 pandemic, you may need to remove a surgical mask or fabric face covering in order to put on a respirator mask. If so, you must take care not to spread infection from your used mask to your hands. Handle your used mask by the fastenings only, without touching the face area. Immediately store it in a disposable bag and sanitise your hands if possible.
When to treat riot control agents
Riot control agents should be treated as part of your accident procedure.
If there are other dangers or life-threatening injuries(such as haemorrhages), deal with these first.
In your "danger" step you should be especially conscious of crowds and your own breathing and ability to work through riot control agents, especially if you have a respiratory condition such as asthma.
When encountering airway issues, consider whether teargas may be a cause.
How to treat riot control agents
If you see riot control agents in the vicinity, work through the following issues in order of priority.
You can use the acronym 'CRED' to remember this: first consider Crowds, then Respiration, then Eyes, then Decontamination.
When approaching people who have been targeted with riot control agents, remember that they are likely to be in pain, confused and unable to see clearly. It is vital that you approach calmly, introduce yourself and check that you have their consent before taking any actions.
- You should try your utmost not to run, as this may incite panic and encourage others to do the same.
- Look for crowds of people running or potentially running, and urge them to walk quickly away from the incident
- You can shout "WALK!" or "STAY CALM".
- Avoid saying 'DON'T RUN', - this people may only hear the word 'run'
- Look for people who may have fallen in the crowd and help them up or clear space around them to prevent them from being further injured if you can.
(This is part of the Danger section of your accident procedure)
The most significant danger from riot control agents is to the respiratory system.
- You must Look listen and feel for breathing issues, and move anyone having trouble breathing away from the incident as fast as possible.
- Tear gas particles will sink downwards: try to guide the person towards an area of higher ground, and discourage them from sitting down while they are in the affected area.
- If someone is having trouble breathing, you should try and find out if they have a preexisting respiratory condition, especially asthma, by asking them or their friends. If they do, give them their inhaler.
If someone, when clear of the agent, continues to worsen in their breathing or begins to lose consciousness, get definitive care.
(This is part of the Breathing section of your accident procedure)
During the COVID-19 pandemic, remember that there is a greater-than-usual risk of respiratory complications among people in crowd who may have been affected by the virus.
If someone is coughing, remember that this also increases their potential to emit infectious droplets which can pass the disease to others. Try to clear as much space around them as possible.Encourage them to face away from others and to cover their mouth with a tissue while coughing. If they are wearing a face covering which is hindering their breathing, encourage them to remove this and offer them a disposable bag to place it in, but do not touch the face covering yourself.
Removing RCAs from the eyes can ease pain and reduce the risk of long-term eye injury. Once you have triaged for respiratory problems, you should approach people who have been targeted and ask if they would like their eyes to be rinsed. Make sure that you explain every step in advance and check for the person's consent before proceeding.
If a person is wearing contact lenses, these must be removed in order to rinse the eyes and dislodge particles trapped behind them.
- Do not attempt to remove the person's lenses yourself unless you have been trained in this: you may scratch their eyeball.
- If they are in too much pain to remove the lenses immediately, you can follow the instructions below to rinse their eyes until the pain has lessened, then ask them to remove the lenses and rinse again.
- You can offer to hold their eye open while they pinch the lens out.
- Encourage them to discard the contaminated lens, rather than attempting to clean and replace it.
- If they are reluctant to do so because they are concerned about having restricted vision while on the protest, try to ensure that they have support to get home safely.
How to do an eye rinse
- Put on fresh disposable gloves.
- Help the person to tilt their head sideways and forward, so that the water will flow directly out of the eye onto the ground, without spreading the chemical onto the skin.
- Hold the eye open on the side of the head which is nearer to the ground:
- Place your index finger on the skin between their eyebrow and eyelashes.
- Gently push it upwards towards their eyebrow.
- At the same time, use your thumb to pull down the lower eyelid.
- Do not try to hold the eyes open by putting your finger underneath the lashes of their upper eyelid – this will be painful, and risks spreading infection.
- Using a sports cap bottle when available, gently squirt or pour water into the inner corner of the eye, next to the bridge of the nose. It should run over the surface of the eye and towards the ground.
- Help the person to tilt their head to the other side and repeat the process with the other eye.
What to use for an eye rinse
- You must use clean water (from a tap or commercial bottling plant) or sterile saline (from a pharmaceutically produced bottle or eye pod) to wash out eyes.
- You must not use milk to wash out eyes. This may cause allergic reactions, or infections from bacteria that grow in unrefrigerated milk. It has not been shown to provide any benefit in relieving pain, compared to water.
- You must not use oil to wash out eyes, as this absorbs and spreads the RCA, meaning it can linger on the skin.
- You should not use baby shampoo: this has not been shown to provide any benefit compared to water.
- You should not use suspensions of baking soda or other chemicals unless you can be sure it does not contain any crystals which would scratch the eye - if you are not doing this under supervision of a pharmacist or person with similar experience, you must not do this.
- A 1:1 ratio of liquid antacid and water may have some benefit to relieve pain on the skin , but its suitability for use in the eyes is unconfirmed. If you do use it, you must:
- Only use a liquid antacid based on magnesium hydroxide and aluminum hydroxide, eg Maalox, Mylanta or a generic equivalent.
- Do not use a flavoured variety - these contain ingredients (e.g. mint) which may cause pain if added to the eyes
- Do not use a tablet form crushed in water - this may contain crystals which damage the eyes
- Do not use any other kinds of antacid which contain different active ingredients.
- Ensure that the antacid is in date and that you use clean water.
- Mix a fresh batch for each protest.
(This is part of the damage section of your accident procedure)
If you are assisting more than one person, it is even more vital than usual during the COVID-19 pandemic that you change your gloves between each patient, so that you do not risk spreading the virus from one person to another by touching their eye area when your hands are contaminated with fluid from another person's eyes. When you change gloves, be very careful not to touch the contaminated exterior (see Glove protocol). You should also sanitise your hands between patients if possible.
You should also use fresh bottles of water for each person, as the tip of the bottle may become contaminated with fluid from the eyes
There is a limited amount that can be done on site to decontaminate riot control agents.
- You should not attempt to wash the substance off the person's skin while at the protest, as this may spread the chemical around without removing it.
- If you are using liquid antacid and water, you can dab this carefully onto the affected areas of skin.
- The person should immediately remove any contaminated face covering and place it in a sealed bag until it can be disposed of.
- They should remove contaminated outer clothing if possible, depending on the weather conditions and environmental risks.
You should advise the person to follow these procedures after leaving:
- Remove their outer clothing before they enter a confined space. ** When entering warm, enclosed spaces (such as transport, houses, etc), particles of riot control agents can be dispersed from clothes, causing a secondary gassing effect.
- Put their clothes in a sealed container, such as a plastic bag, until they can be washed in a washing machine or similar.
- Contaminated clothes must be washed separately from other clothing.
- Take a cold/lukewarm shower and wash thoroughly with soap or shampoo before taking a hot shower.
- Warm water can redisperse particles on the skin, and open the pores, allowing more RCA to penetrate.
- When showering, the person should tip their head back/sideways while rinsing their hair, to prevent RCA particles in their hair from running down their face and into their eyes.
(This is part of the environment section of your accident procedure)
What to do after treating riot control agents
You must change your gloves so that you do not spread the RCA.
- Barry et al,'A Randomized Controlled Trial Comparing Treatment Regimens for Acute Pain for Topical Oleoresin Capsaicin (Pepper Spray) Exposure in Adult Volunteers'; Prehospital Emergency Care Oct-Dec 2008
- Stopyra et al, 'Baby Shampoo to Relieve the Discomfort of Tear Gas and Pepper Spray Exposure: A Randomized Controlled Trial'; Western Journal of Emergency Medicine March 2018
- Lee et al, 'Magnesium–Aluminum Hydroxide Suspension for the Treatment of Dermal Capsaicin Exposures'; Academic Emergency Medicine June 2008