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Ocular management for CS gas exposure: exploring treatment in the pre-hospital setting

02 August 2017
Volume 9 · Issue 8

Abstract

Problem: The use of CS gas has increased dramatically in recent years yet how to implement optimal management is still a matter of debate. A lack of a sandardised approach to care has left a vacuum in which various treatments have been proposed, some with no evidence base. Whilst some of these treatments may simply not work, others will increase the pain and time taken to recover. Approach: This paper looks, specifically at the ocular management of exposure to CS gas as the eyes are often the most severely affected of organs and therefore the focus of the first aider's efforts. Suggested ocular treatments proposed by the general public were explored alongside existing professional guidelines and available academic literature. Conclusions: Recommending best practice remains difficult and treatment will often have to be adapted to the local environment. Adherence to commonly agreed principles is essential and includes preventing secondary effects by use of personal protective equipment, removing those affected into a well ventilated area, removing contaminated clothing and offering reassurance.

The use of tear gas as a Riot Control Agent (RCA) by law enforcement agencies has dramatically increased in recent years and is used worldwide to control riots, protests and civil unrest (Rothenburg et al 2016). It is employed in a variety of settings from refugee camps and humanitarian contexts (MSF 2016a, BBC 2016, Strickland 2015, Baumard 2016) to football match riots and state protests (Stephens 2016, Aciksoz 2015) and can present numerous challenges for the attending healthcare worker (HCW). Yet how to best manage victims exposed to tear gas is still a matter of debate (Brvar 2015). In the absence of an accepted standardised approach, the general public have adopted their own strategies for dealing with the burning sensations associated with tear gas. An example of which is demonstrated by (Aciksoz 2015) who refers to ‘emergency aid stations’ offering lemon halves, vinegar solutions and liquid antacid and water during the 2013 Gezi protests in Turkey. Nottinghamshire Police (2016) warn that some of these remedies being used are ‘mythical at best and at worst, may exacerbate the pain and length of time taken to recover’. As the eye is the most sensitive and immediately affected organ (Blain 2003) it is no surprise that it is the main focus of the first aider's efforts when attending to tear gas victims. ‘First do no harm’ is a concept that all medical professionals will be familiar with and so it is reasonable to expect that we have a knowledge of the types of treatment used by the general public in order to promote and to practice safe medicine. This paper will therefore investigate some of the general public's more popular treatments alongside available academic literature in order to critically explore best practice for ocular management post exposure to tear gas.

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