Burns in a Blackout

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Burns in a Blackout: First Aid When the Tap Doesn’t Run

By the Jase Medical Team

Almost every burn first aid guide starts with the same instruction: cool the burn under clean, cool running water.

But what happens when the tap doesn’t run?

For households that rely on a well, a power outage can also mean losing the electric pump that moves water through the house. At the same time, blackouts can introduce new burn risks as families start using candles, generators, space heaters, camp stoves, and other backup sources of light, heat, and cooking.

After Hurricane Ida, generator and cooking accidents accounted for 56% of storm-related burns treated at one New Orleans burn center, and most of those patients were admitted to the hospital.

So burn first aid during a blackout requires a slightly different plan. The fundamentals haven’t changed. Cool the burn, protect it, and know when it needs medical care. What changes is how you accomplish that when the usual faucet isn’t available.

First, Forget the Home Remedies

Before we get to the water problem, there are a few things that should never become the substitute.

Don’t put ice directly on a burn. Extreme cold can further damage already injured tissue. You want to cool the burn, not freeze it.

And skip the butter, oil, toothpaste, and other kitchen or bathroom remedies that tend to get passed down through generations. Greasy substances can trap heat against the skin and make the burn harder to assess and clean.

Butter does roughly the same thing for a burn that it does for a steak. It isn’t first aid.

For a fresh thermal burn, the goal is much less dramatic: clean, cool water.

What If You Don’t Have Running Water?

Running water is convenient because it continuously carries heat away from the injured tissue. But losing the faucet doesn’t mean you should skip cooling altogether.

If you have access to clean, cool water, use it to cool the burn. That might mean clean bottled water, stored potable water, or another safe source of cool water available in the home.

The water should be cool, not icy.

If you’re using a limited supply rather than a running faucet, the practical goal is still to cool the injured area without making the person excessively cold. This is especially important for children and for larger burns, where prolonged cooling can contribute to hypothermia.

Don’t sacrifice drinking water recklessly during a prolonged outage, but don’t assume that burn cooling only counts if the water comes directly from a faucet. If clean, cool water is available, it can still be useful.

A Few Seconds of Cooling Isn’t Enough

This is another place where common first aid habits can fall short.

Someone burns a hand on a hot pan, holds it under water for ten seconds, decides it still hurts, and moves on to finding a cream or bandage.

Cooling needs more time than that.

The American Burn Association recommends cooling thermal burns with clean, cool running water for at least five minutes. International burn guidance commonly recommends approximately 20 minutes of cooling, and research supports a meaningful benefit from adequate cool running water first aid.

The exact duration recommendations differ somewhat between guidelines, but the practical lesson is the same: don’t treat burn cooling as a quick rinse.

And if you couldn’t cool the burn immediately, don’t assume you missed your chance. Research suggests cooling can still provide benefit when started later, potentially up to several hours after the injury.

That matters during an outage. Maybe the burn happened while you were away from the house. Maybe clean water wasn’t immediately accessible. Maybe the first priority was getting away from the fire or shutting down the source of the injury.

Once the immediate danger is controlled and clean, cool water becomes available, cooling the burn may still be worthwhile.

After Cooling, Keep It Simple

Once the burn has been adequately cooled, remove jewelry, watches, or tight clothing near the injured area if they aren’t stuck to the skin. Swelling can develop quickly, and something that fits comfortably now may become constricting later.

Don’t pull away clothing or material that has adhered to the burn.

Then cover the area loosely with a clean, dry cloth or appropriate clean dressing. The goal is to protect the injured skin without wrapping it tightly.

For a small, superficial burn, that basic care may be enough while you monitor how it develops. But not every burn belongs in the home care category, and a blackout doesn’t change the threshold for getting help.

Some Burns Can’t Wait for the Power to Come Back

If the lights are out, roads are difficult, or the nearest urgent care is closed, it’s tempting to lower the threshold for what you’re willing to manage at home.

With serious burns, don’t.

Burns that are deep, extensive, or located in certain high-risk areas need professional evaluation. Burns involving the face, hands, feet, genitals, perineum, or major joints deserve particular attention because even a relatively small injury in these areas can affect function or require specialized care.

As a simple household reference, a burn larger than the injured person’s hand deserves medical attention. Deep burns, burns with white, charred, leathery, or numb areas, electrical burns, and chemical burns also require prompt evaluation.

Smoke exposure changes the situation too. Burns around the face or mouth, soot around the nose or mouth, coughing, hoarseness, difficulty breathing, or suspected smoke inhalation can signal an airway injury that isn’t visible from the outside.

Young children also deserve a lower threshold for evaluation. Their smaller bodies make both burn severity and problems such as hypothermia more consequential.

If you’re looking at the burn and wondering whether it’s serious enough to make the drive despite the outage, location, depth, size, age, and breathing symptoms matter more than whether the lights are on.

What About Blisters?

Blisters can develop with partial-thickness burns, often called second-degree burns. They don’t automatically mean a burn requires hospitalization, but they do tell you that the injury extends deeper than simple surface redness.

Avoid deliberately popping or peeling the blisters at home. The skin provides protection to the tissue underneath, and opening it creates another pathway for contamination.

Large or extensive blistering, significant pain, worsening swelling, signs of infection, or blistering involving high-risk areas such as the hands, face, feet, or major joints should prompt medical evaluation.

When you’re uncertain about the depth of a burn, let a healthcare professional make that assessment rather than trying to classify it from an online photo or description.

Preventing the Blackout Burn Is Easier Than Treating It

Power outages change normal household routines, and that’s often where the burn risk comes from.

Use flashlights or battery-powered lighting instead of candles whenever possible. Keep portable heaters well away from furniture, bedding, curtains, and anything else that can burn. If you’re using a generator, let it cool before adding fuel. Gasoline spilled onto a hot generator can ignite.

Generators also introduce another danger that may not produce a burn at all: carbon monoxide. They should never be operated inside a home, garage, or other enclosed space. We’ve covered that risk separately in our guide to carbon monoxide after a storm, including why early symptoms can be mistaken for the flu or heat exhaustion.

A few minutes of planning before an outage is easier than trying to improvise around heat, flame, fuel, and darkness once the power is already gone.

Medical Readiness Is Knowing What You Can Handle at Home

Burn first aid is a good example of why medical preparedness isn’t simply a matter of owning more supplies.

A first aid kit can’t make a deep burn superficial. A medication can’t undo an electrical injury. And nothing you keep in a cabinet changes the urgency of smoke inhalation.

What preparation can do is help you make better decisions before stress starts making them for you.

At Jase Medical, we’re a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation held to high clinical standards. That includes knowing what can reasonably be managed at home when normal access to care is disrupted and recognizing the point where home care needs to stop.

JaseCase provides physician-prescribed contingency medications for specific medical situations after review by a licensed provider. Those medications are intended for emergency use after first trying to reach a qualified healthcare provider. They don’t replace professional treatment for a serious burn.

So if the lights go out and someone gets burned, remember the basics. Cool it with clean, cool water if available. Skip the ice and home remedies. Cover it loosely. Then look at the burn itself, not the blackout, to decide whether it’s time to go in.

Because the power may be able to wait until morning.

A serious burn can’t.

The Jase Medical Team is a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation: clinically grounded readiness that complements, rather than replaces, the healthcare professionals you already trust.

This article was prepared by the Jase Medical content team for informational purposes only and does not constitute medical advice. Prescription requirements, emergency dispensing rules, insurance coverage, and controlled-substance regulations vary by medication, jurisdiction, and individual circumstances. Consult a licensed healthcare provider or pharmacist regarding your specific medications.

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For Clinicians | Burn First Aid Without Running Water

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For Clinicians | Burn First Aid Without Running Water

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education
Medically reviewed and edited by Aaron Asay, PA-C, DMSc, FIBODM, FAWM

Every burn first-aid guide starts the same way: cool it under running water. That’s the one thing you can’t count on in a power outage, when homes on a well lose the pump, or at a campsite miles from the nearest faucet. Burns are already the most common injury in my house full of boys, and they’re hard enough to manage with running water. Without it, they feel so much harder. Today we’re covering where these burns come from, how long to cool one, how to do it without a tap, and which burns must be escalated to a provider no matter what.

Where do these burns come from?

Mostly from the heat sources we bring in when the usual ones aren’t there. In a power outage, that’s a candle lit for light, a space heater pulled too close to the couch, a pot of water on a camp stove, or fuel spilled on a generator that’s still hot. (That same generator is behind our carbon monoxide article, same outage, different injury.) After Hurricane Ida, generator and cooking accidents caused 56% of the storm-related burns treated at two New Orleans hospitals, and 78% of all those burn patients were admitted¹. Those high admission rates tell you these burns are serious stuff.

Outdoors the campfire is the big culprit. Interestingly, the most dangerous stage of the fire is the one that looks like it is put out. In a review of children burned by recreational fires, 40% fell into and another 30% crawled or walked onto the remnants of a fire that hadn’t been fully put out. The same study found a small charcoal fire stayed hot enough to burn at least 16 hours after it was lit². Hands and feet were the most common places those burns were incurred.

How do you cool a burn without a tap?

Cooling really matters here. In a human model, burns kept getting deeper after the heat was gone, and 20 minutes of cooling at 16°C (about 60°F) saved about a quarter of the skin’s deeper layer³. If that doesn’t make sense, picture a pan you just pulled off the stove. The flame is off, but the pan keeps cooking whatever it’s touching. Burned skin holds heat the same way.

How long? The Wilderness Medical Society’s 2025 burn guideline, written for remote and low-resource settings like a blackout or a campsite, recommends 20 minutes of cool running water for burns covering less than 10% of the body¹⁰. A 2022 systematic review backs the number: 20 minutes of cooling within the first 3 hours lowered the odds of needing a skin graft or surgery⁵. The American Burn Association’s patient page says at least 5 minutes⁴. That’s a minimum. The target is 20. Twenty minutes is roughly one good ‘ol sitcom episode.

All of that evidence comes from running water, which is exactly what a blackout or a campsite takes away. So, in our disaster scenario without a running tap the patient has to rebuild the water flow with what they have available:

  • Pour clean, cool water slowly and steadily over the burn from a jug, a bottle, or a camp water bag.
  • If there’s enough water but no way to keep it flowing, immerse the burn in a basin, pot, or cooler of cool water. WMS lists immersion as acceptable when running water isn’t available¹⁰.
  • Keep it cool, not cold, around 53 to 64°F¹⁰. No ice, which can worsen the damage⁴.
  • If water is scarce, a clean cloth soaked in cool water and swapped out often is the fallback. It’s less reliable than flow⁶, and it still cools and is better than nothing.

Watch the patient’s temperature along with the burn. Twenty minutes of cool water on a cold night, in a house with no heat, or at a campsite can drop a person’s core temperature, and WMS notes hypothermia is more common with larger burns and in older patients¹⁰. When hypothermia is a real risk, WMS suggests not cooling the burn in the field at all¹⁰. Short of that, cool only the burned area and keep the rest of the person covered and warm.

And don’t fret too much if that burn can’t be cooled right away. It can still be cooled late, so if the water shows up 30 minutes later, please use it.

What do you put on a burn?

First of all, nothing greasy on a fresh burn. The American Burn Association says to skip butter, oils, and ointments, because they trap heat⁴. Toothpaste is the other household remedy people sometimes use, and it doesn’t cool either. The British Red Cross notes that its menthol can feel cool on the surface without actually helping⁷.

Once the burn is cooled, cover it loosely with sterile gauze or a clean cloth⁴. If care is less than a day away, that’s all it needs. WMS says no antibiotic ointment or special dressing is required when definitive care is within 12 to 24 hours¹⁰.

Ointment earns its place after cooling, when care is delayed. For a deep partial-thickness burn (wet or waxy, with mottled color) that has to be managed in the field, or when getting to care will take a while, WMS recommends antibiotic ointment or honey¹⁰. Those deeper burns carry a much higher infection risk¹⁰, and they’re on the referral list below regardless. The ointment covers the gap until the patient gets there. Oral antibiotics aren’t part of this: WMS says not to use them prophylactically for burns, because they can raise the risk of a later resistant infection¹⁰.

For pain, start with over-the-counter analgesics, which WMS recommends as the first treatment¹⁰. Ibuprofen helps with both pain and swelling. Acetaminophen treats the pain. No aspirin for anyone under 19, obviously⁸.

And leave the blisters alone. MedlinePlus says to avoid breaking them⁸, and WMS agrees for most situations¹⁰. That fluid-filled roof is the body’s own dressing, and it matters even more when clean water and clean hands are in short supply. WMS makes one field exception: if a blister limits movement of a joint or sits where it would keep the person from hiking out, it suggests draining it through a small hole¹⁰.

Which burns can’t wait?

Some burns go to care no matter what the power grid or the camping trip is doing. The American Burn Association’s 2025 referral guidelines call for immediate burn center consultation, with transfer considered, for⁹:

  • Full-thickness burns
  • Partial-thickness burns covering 10% or more of the body
  • Deep burns of the face, hands, feet, genitals, perineum, or over a joint
  • Burns in patients with other medical conditions or other injuries
  • Pain that isn’t controlled
  • Any suspected inhalation injury, including facial burns, singed facial hair, or smoke exposure
  • All chemical burns, high-voltage electrical injuries, and lightning

Every pediatric burn (14 and under, or under 30 kg) may benefit from referral, and any burn that might be deep, at any size, warrants a consult⁹. That toddler with a campfire burn on their hand checks two boxes at once.

The ABA’s patient guidance uses size to help parents know when to stop self-treating and get to care ASAP: don’t delay care for a burn larger than a hand⁴. If the burn is on the face, hands, feet, or a joint, comes from a chemical or electricity, involves smoke, or is on a child, it gets care now, power outage or not.

What to tell patients before storm season or a trip

Burn first aid assumes running tap water to cool that ouchy burn. Plenty of families find out it’s missing at the worst possible moment. The middle layer of healthcare between “run it under the faucet” and “drive to the ER” is a plan made ahead of time. For patients on a well, in rural areas, running a generator, or heading out camping, that plan comes down to two questions: where would the cooling water come from, and which burns go straight to care? That’s a two-minute conversation in your office or your pharmacy before storm season or the trip.

That’s appropriate medical preparation for burns: the first-aid steps worked out before anyone needs them, and a clear line where first aid stops. We’re here for the times primary care isn’t there, and in no way a replacement for it. If you’d rather hand the preparation conversation off, you can refer patients to us at Jase.com. A licensed provider reviews every request before anything is prescribed, and every medication we dispense is for emergency use only, after first seeking help from a qualified healthcare provider. We’ll keep publishing how we draw these lines, including where first aid self-care ends and care begins.

I’ve switched tenses in this article where it feels like I’m writing to the patient, but this is for you as healthcare professionals to communicate with patients before the disaster happens. 

The bottom line

Burn first aid without a tap comes down to a few moves. Cool the burn for 20 minutes with whatever clean, cool water is on hand, poured slowly or in a basin, and keep the rest of the person warm while you do it. Also, remove any clothing or jewelry like rings that could exacerbate the problem like swelling or contribute to infection. Keep anything greasy off a fresh burn, cover it loosely, and leave blisters intact unless one keeps the person from moving. Save antibiotic ointment for a deep burn after it’s cooled, when care is delayed. And know which burns go to care no matter what.

Sources

  1. Kopari NM, Rivera M, Phelan HA III, Kearns RD, Carter JE. 570 Burn-related injuries treated at two Gulf Coast hospitals following a Category 4 hurricane. J Burn Care Res. 2022;43(Suppl 1):S121. https://academic.oup.com/jbcr/article/43/Supplement_1/S121/6552619
  2. Cahill TJ, Rode H, Millar AJ. Ashes to ashes: thermal contact burns in children caused by recreational fires. Burns. 2008;34(8):1153-1157. https://pubmed.ncbi.nlm.nih.gov/18789590/
  3. Wright EH, Tyler M, Vojnovic B, Pleat J, Harris A, Furniss D. Human model of burn injury that quantifies the benefit of cooling as a first aid measure. Br J Surg. 2019;106(11):1472-1479. https://pubmed.ncbi.nlm.nih.gov/31441049/
  4. American Burn Association. Burn First Aid. https://www.ameriburn.org/patients/burn-first-aid
  5. Griffin B, Cabilan CJ, Ayoub B, Xu HG, Palmieri T, Kimble R, Singer Y. The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: a systematic review and meta-analysis. Australas Emerg Care. 2022;25(4):367-376. https://pubmed.ncbi.nlm.nih.gov/35688782/
  6. Yuan J, Wu C, Holland AJ, et al. Assessment of cooling on an acute scald burn injury in a porcine model. J Burn Care Res. 2007;28(3):514-520. https://pubmed.ncbi.nlm.nih.gov/17438497/
  7. British Red Cross. Learn first aid for burns. https://www.redcross.org.uk/first-aid/learn-first-aid/burns
  8. MedlinePlus Medical Encyclopedia. Burns. Reviewed April 9, 2026. https://medlineplus.gov/ency/article/000030.htm
  9. American Burn Association. Burn Center Referral Guidelines (2025). https://ameriburn.org/resources/burn-center-referral-guidelines/
  10. Bitter CC, Storkan M, Overmiller A, Respicio JA, McGowan T, Park A, Culhane JT. Wilderness Medical Society Clinical Practice Guideline on Care of Burns in the Wilderness. Wilderness Environ Med. 2025;36(4):549-558. https://journals.sagepub.com/doi/10.1177/10806032251345768. Recommendations cited, with grades: cool running water for 20 minutes for burns under 10% TBSA (strong recommendation, moderate-quality evidence); no field cooling when hypothermia is a risk (weak, low); blisters left intact in most situations (weak, low); drainage through a small window when a blister limits joint movement or self-evacuation (weak, low); antibiotic ointment or honey on deep partial-thickness burns when field management is attempted or evacuation is delayed (strong, moderate); over-the-counter analgesics as initial pain treatment (strong, moderate).

 

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How to Rehydrate Someone Properly When There Is No IV

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How to Rehydrate Someone Properly When There Is No IV

By the Jase Medical Team

When someone is losing fluid from vomiting or diarrhea, rehydration isn’t simply a matter of getting them to drink something.

The type of fluid matters. The amount matters. And especially when someone is vomiting, the rate matters.

That’s the science behind oral rehydration therapy, a remarkably effective approach to dehydration that has been used around the world for decades. The World Health Organization’s oral rehydration solution (ORS) contains glucose and sodium in carefully balanced concentrations, 75 mmol/L of each, with a total osmolarity of 245 mOsm/L. The glucose helps the intestine absorb sodium, and sodium helps bring water with it.

In other words, oral rehydration isn’t just “drink more water.”

It’s using the gut’s own transport system to move water back into the body.

An Electrolyte Drink Isn’t Necessarily an Oral Rehydration Solution

Walk down the hydration aisle and you’ll see sports drinks, electrolyte powders, flavored waters, hydration packets, and products promising rapid hydration.

They aren’t all the same thing.

A true oral rehydration solution is formulated with a specific balance of glucose and electrolytes designed for replacing fluid lost through illnesses such as diarrhea and vomiting. WHO’s reduced-osmolarity ORS contains 75 mmol/L of sodium and 75 mmol/L of glucose.

That is different from a beverage designed primarily for exercise, flavor, or everyday hydration.

So if someone is dehydrated from a stomach illness, prepackaged oral rehydration solution should be your first choice when it’s available. Look for a product specifically labeled for oral rehydration rather than assuming anything marketed as an “electrolyte drink” serves the same purpose.

And don’t assume you can turn a sports drink into ORS simply by diluting it. Adding water changes all of its concentrations—including the sodium you’re trying to replace.

When Someone Is Vomiting, How They Drink Matters

One of the most common problems with oral rehydration happens when a very thirsty person tries to drink a large amount at once.

Their stomach may send it right back up.

Instead, oral rehydration can be given in small, frequent amounts and gradually increased as tolerated. CDC guidance for children with vomiting describes starting with about 5 mL, roughly one teaspoon, every five minutes and increasing gradually. A spoon or oral syringe can make those small amounts easier to control.

That may feel painfully slow when a child is thirsty and you know they need fluid. But getting a small amount to stay down repeatedly can be more useful than having them drink a large glass and vomit it back up.

Vomiting also doesn’t automatically mean oral rehydration has failed. CDC guidance notes that most children with vomiting accompanying acute gastroenteritis can still be successfully rehydrated orally when ORS is given in limited, frequent amounts.

How Much Oral Rehydration Solution Does Someone Need?

This is where age, weight, degree of dehydration, ongoing fluid losses, and medical history matter.

For children, clinicians use weight-based approaches to determine how much fluid is needed for rehydration and how much additional ORS should be given to replace continuing losses from diarrhea or vomiting. WHO guidance also provides age-based amounts of ORS after loose stools when preventing dehydration: for example, 50–100 mL after each loose stool for children under 2 and 100–200 mL for children ages 2–10.

That doesn’t mean every sick child should be managed at home by calculating a formula.

If you’re unsure how much fluid a child needs, or you’re concerned they’re already significantly dehydrated, contact their pediatrician or another qualified medical professional.

The useful household principle is simpler: oral rehydration isn’t one big drink. It’s a process of replacing what has already been lost while continuing to replace what the person is still losing.

What If You Don’t Have Commercial ORS?

Prepackaged oral rehydration solution is preferable because the concentrations have already been measured for you. WHO describes ORS as a pharmaceutical product and recommends manufacturing it according to quality standards.

If proper ORS truly isn’t available, a homemade sugar-and-salt solution may be used as an emergency fallback following established public-health instructions.

Do not improvise the proportions.

Too much salt can be dangerous, particularly for infants and young children. Don’t use heaping spoonfuls, estimate quantities by eye, or decide that making the solution “stronger” will make it work better.

For that reason, we recommend keeping commercially prepared ORS packets or ready-to-use oral rehydration solution available rather than relying on memory for an emergency recipe.

If you do need to make a homemade solution, use a recipe from a recognized public-health authority and follow the measurements exactly using level measures and the specified amount of clean water.

Pedialyte vs. Gatorade: Does It Matter?

For ordinary exercise or replacing fluid after sweating, a sports drink may be perfectly reasonable for many people.

But rehydrating someone who is losing significant fluid through vomiting or diarrhea is a different job.

Products formulated as oral rehydration solutions are designed around the balance of glucose and electrolytes needed to promote absorption and replace losses. Sports drinks are formulated for a different purpose and may contain considerably different amounts of sodium and sugar.

So when the problem is dehydration from gastroenteritis, don’t choose solely by which bottle says “electrolytes” on the front.

Look for an actual oral rehydration solution.

When Oral Rehydration Stops Being a Home Problem

Oral rehydration is powerful, but it isn’t appropriate for every situation.

Severe dehydration or shock requires urgent medical treatment and may require IV fluids. CDC guidance specifically identifies shock or near-shock as situations requiring initial IV treatment.

Seek urgent medical care for concerning signs such as severe lethargy or difficulty waking, confusion, fainting, very little or no urine, inability to keep even small amounts of fluid down, blood in the stool or vomit, severe abdominal pain, or other signs that the person is becoming seriously ill.

Infants deserve an especially low threshold for contacting a pediatrician because dehydration can progress quickly.

And if your instinct is telling you that someone is getting worse rather than better, don’t let the fact that you’re giving ORS create false reassurance. Oral rehydration is a treatment tool, not a substitute for medical evaluation when someone is seriously ill.

Why Knowing Oral Rehydration Still Matters

It’s easy to think of IV fluids as the “real” treatment and oral fluids as the backup.

The healthcare system has repeatedly been reminded why that isn’t always true.

After Hurricane Helene damaged Baxter’s North Cove manufacturing facility in 2024, the disruption affected a facility that had been producing approximately 60% of the IV solutions used each day in the United States. Hospitals and health systems had to conserve IV fluids and reconsider when patients could safely receive hydration through other routes.

But households never had an IV bag hanging in the kitchen in the first place.

What you can have is an appropriate oral rehydration solution and an understanding of how to use it: the right fluid, the right amount, and the right pace.

At Jase Medical, we’re a family team of physicians, PAs, and pharmacists focused on appropriate medical preparation. That doesn’t mean trying to turn your home into an emergency department. It means understanding which simple, evidence-based tools can help when ordinary access to care is delayed and knowing exactly where home care needs to stop.

For vomiting and diarrhea, that starts with something surprisingly basic:

Don’t just replace water. Rehydrate properly.

The Jase Medical Team is a family team of medical doctors, PAs, and pharmacists focused on appropriate medical preparation: clinically grounded readiness that complements, rather than replaces, the healthcare professionals you already trust.

This article was prepared by the Jase Medical content team for informational purposes only and does not constitute medical advice. Prescription requirements, emergency dispensing rules, insurance coverage, and controlled-substance regulations vary by medication, jurisdiction, and individual circumstances. Consult a licensed healthcare provider or pharmacist regarding your specific medications.

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Five Halloween Hazards That Look Harmless

Five Halloween Hazards That Look Harmless

Five Halloween Hazards That Look Harmless By the Jase Medical Team The scariest things this Halloween might not look scary at all. A bag of black licorice. A pair of costume contacts. A medication you take every night. A mushroom growing in the yard. A bat that...

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For Clinicians | Oral Rehydration When IV Fluids Aren’t Available

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For Clinicians | Oral Rehydration When IV Fluids Aren’t Available

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education
Medically reviewed and edited by Kristen Carpenter, PA-C

Hi again, it’s Jamie, your pharmacist who loves writing about appropriate medical preparation.

In the past we’ve focused on specific medications and natural disasters, but haven’t properly covered hydration. Today we are fixing that! Getting fluids into someone when an IV isn’t available, or when it’s just not convenient. Sometimes that’s a real access problem. More often it’s 9pm, urgent care closed at 8, and you’re standing in your own kitchen holding a liquid that a sick kid has decided is their mortal enemy.

I’ve dealt with this from behind the counter and I’ve dealt with it at home as a mom of 4 boys. Today we’re covering what oral rehydration is, what it does, and how it works; especially without an IV available. I’ll speak generally about kids specifically in this article, but it applies to teens and adults (you kids at heart) as well. 

Why plain water doesn’t rehydrate

Quick refresher, because this is one of those things we all learned and then filed away. I know I needed this refresher to write this article.

A patient who is vomiting and having diarrhea isn’t just down a volume of water. They’re down sodium, potassium and chloride, and they’re losing more with every episode. Plain water replaces the volume, but none of the salts. If the patient is only drinking water and still has ongoing losses then the plain water dilutes the sodium that’s left. Juice, soda and broth have either too much sugar, not enough sodium, or sodium with nothing to carry it across those cell membranes. 

Before I wrote this article I thought off the top of my head that an oral rehydration solution is a salt delivery system and the sugar is just in there for taste. But I was wrong! The sugar is the mechanism to get the salts out of the gut and into the blood stream.

One of the doors into the gut wall only opens when glucose and sodium show up together. They cross the wall coupled, and water follows the sodium across by osmosis. That’s why an oral rehydration solution is built at roughly equal parts sodium and glucose. ¹ The ratio is the design. Enough glucose to work that door, and no more than that, because sugar past that point doesn’t move any more sodium and it raises the osmolarity of what’s sitting in the gut, which pulls water in the wrong direction.

Plenty of drinks contain both. Very few contain them in the amounts that make the transport work. Both ingredients being present doesn’t make something an oral rehydration solution.

What to use, and what to make when there’s nothing in the house

A packaged oral rehydration solution is the first choice every time. It’s already mixed to the ratio, and it carries two things the kitchen version can’t: potassium, to replace what’s going out in the stool, and citrate, which buffers the acidosis that comes with it. Nobody has to measure anything at 2am.

Here’s the recipe for a rehydration solution made at home: one litre of clean water, 3 g of table salt, and 18 g of sugar, which is about four level teaspoons. ¹

WHO writes that 3 g as “one level teaspoonful.” Don’t pass that along to an American patient. A level US teaspoon of table salt holds closer to 6 g, the full 2,300 mg of sodium you see on a nutrition label, and it doubles the salt in the litre. Counsel half a level teaspoon, or 3 g on a kitchen scale. Level spoons for the sugar too, not heaping ones, and not a soup spoon out of the drawer.


* And one note for those of you doing the math in your head wondering how in the heck this salt and sugar recipe is a 1:1 ratio. Eighteen grams of sugar against 3 g of salt doesn’t look like equal parts of anything. The molecule counts are the same though. A sugar molecule weighs about six times what a unit of table salt weighs, so 6 to 1 by weight comes out to 1 to 1 by molecule. What the transporter responds to is how many molecules of each are in the glass, not how much they weigh.

WHO prints that recipe and then says it isn’t generally recommended, for three specific reasons: the recipe gets forgotten, the ingredients aren’t always there, and people end up giving too little of it. ¹ That caution is written for public health programs deciding what to teach at scale. We at Jase are usually talking to someone whose options have already narrowed to what’s in the kitchen, and for them a recipe they can remember beats a packet they can’t reach. Know it. Use it when there’s nothing better.

So the counseling on this is to for sure use a proper rehydration packet if your patients have one or can reasonably get access to one. If they’re mixing it themselves, have them use an actual measuring spoon and level it off, because the difference between a level teaspoon and a heaping one is a big difference, especially for kids.

The homemade version carries no potassium and no citrate. It’s the bridge to getting a rehydration packet, not a complete replacement for one.

Most electrolyte drinks are not oral rehydration solutions

I’m guilty of this one too. If the label said electrolytes, I assumed it would do the job for a kid who needed fluids.

So, here’s the yardstick. An oral rehydration solution built at the WHO ratio, poured into a 16 oz glass, is about 800 mg of sodium and about 6 g of sugar. ¹ WHO set that 75 mmol/L by lowering it from an older 90, because less sodium worked better in ordinary childhood diarrhea than the cholera-era formula did. The studies behind that change ran down to 50 mmol/L, so the American products sitting under 75 are sitting inside the evidence, not outside it. Anywhere in that range is an oral rehydration solution. Far below it is a beverage.

  • Pedialyte Classic: about 520 mg sodium, about 7 g sugar ²
  • DripDrop: about 660 mg sodium, about 14 g sugar³
  • Gatorade Thirst Quencher: about 216 mg sodium, about 27 g sugar⁴
  • LMNT: 1,000 mg sodium per stick, zero sugar⁵

Pedialyte lands in range. It’s the only one on the list that was built for this, and it shows on both numbers.

DripDrop gets the sodium into the neighborhood and then doubles the sugar. The idea is right; the sugar is twice what the transport needs, and the extra is the part that raises osmolarity. Probably not a big deal clinically, but not ideal.

Gatorade misses on both ends, a quarter of the sodium and more than four times the sugar. That isn’t a mistake on their end. It’s built to replace what comes out in sweat during a workout, not what comes out in stool during a rotavirus.

LMNT is the big example of a drink that isn’t going to help here, and it’s the poster child I’d use to teach this whole thing. All salt, no sugar at all. Go back to that door in the gut, the one that only opens when salt and sugar show up together. Without the sugar, the salt doesn’t have a ride across. It sits in the gut, pulls water in with it, and makes a miserable kid more miserable.

How much they need to drink, and how fast

So now we know what should be in the cup. That’s one part of it…but not the end. We still have to know how much they need to drink and how often, because the right liquid in the wrong amount doesn’t rehydrate anybody.

The working numbers are 50 mL per kilogram over four hours for mild dehydration, 100 mL per kilogram for moderate, plus another 10 mL per kilogram after each diarrheal stool, capped at about a cup per stool.⁶ WHO’s plan for a small child uses a flat 75 mL per kilogram. ¹

In kids, for mild dehydration:

A 2-year-old at 30 lb needs about 680 mL over four hours. Call it three cups.
A 10-year-old at 80 lb needs about 1.8 litres. Seven or eight cups.

Double both of those if they’re moderately dehydrated. One problem with doubling it. You’re now asking a 2-year-old to drink a cup and a half an hour. WHO says a kid that size tops out around a cup.¹

For an adult the weight formula stops being useful, and the instruction becomes replacing what’s going out: about a cup after every loose stool, and drinking to thirst rather than on a schedule.

Especially for kids, this goes by spoon or cup, never a bottle.¹ WHO’s rate for a child under 2 is a teaspoonful every one to two minutes. Older kids and adults can take frequent sips straight from the cup.¹ If they’re vomiting, start slower, around a teaspoon every five minutes, and build up as they keep it down.⁶ A big gulp on an irritated stomach comes right back. And if they do vomit, wait 5 to 10 minutes and start again more slowly, a spoonful every two or three minutes.¹

The spacing is the whole thing. A teaspoon every five minutes, held there for four hours, comes to about one cup. Every one to two minutes gets you somewhere between two and five. The 2-year-old needs three. So five minutes is where you start when they’re throwing up, not where you stay.

When they can’t keep anything down

And this is where oral rehydration falls apart out there in the real world. Not on the science. Because it’s a lot of liquid, it generally tastes awful, and a sick kid fights every ounce of it. The kid who throws up the first three teaspoons makes the family quickly lose faith in this rehydration approach because it can be so hard and stressful to help kids who are miserable keep the dang liquid down. I know, because I’ve been there many late nights with my own boys and I was ready to pull my hair out because it feels like there’s no way to get liquid down a gullet that doesn’t want to swallow. 

Ondansetron is the medication for this with solid evidence. In 2006 a trial was run with 215 children between 6 months and 10 years with gastroenteritis and mild to moderate dehydration. They got a single oral dose or placebo, then started a standardized rehydration protocol. Vomiting during rehydration: 14% with ondansetron, 35% with placebo. Needing IV fluids: 14% versus 31%.⁷

Then in July 2025 a much larger trial tested children 6 months to 18 years who went home from six pediatric emergency departments with six doses of ondansetron or placebo for caregivers to give over the next 48 hours as vomiting continued. Moderate to severe gastroenteritis over the following week: 5.1% with ondansetron, 12.5% with placebo.⁸ Side effects were comparable between groups, with a small increase in diarrheal stools among the children who took three doses or more.

So, if throwing up or severe nausea is a problem, give an antiemetic first, then the fluid. Ondansetron doesn’t treat the illness itself. It buys the window where oral rehydration can actually succeed.

The treatment layer that doesn’t exist

A family either reaches a clinician or they’re alone with whatever is in the cabinet. What’s usually in their house is a sports drink. There’s nothing sanctioned in between.

Hospitals hit a similar wall twice in seven years. Hurricane Maria took out Baxter’s Puerto Rico plants in 2017. Helene took out North Cove in 2024, the plant making roughly 60% of the country’s IV fluids.⁹ Surveyed afterward, most affected hospitals had converted IV medications to oral, and well over half had written themselves an oral hydration protocol.¹⁰ They built the middle layer under pressure, because the alternative had disappeared.

That right there is the layer we work on at Jase, and appropriate medical preparation is what we call it: the clinical decision made ahead of the illness instead of during it, so the person standing in the kitchen at 9pm already has the right rehydration packet and a plan for how often to give it. Whether an antiemetic belongs in a particular house is a prescribing decision. A licensed provider reviews every Jase request and writes the prescription, and anything dispensed that way is for emergency use only, after first trying to reach a qualified provider.

None of this replaces primary care. It complements it, for the hours when primary care isn’t reachable. If this is a conversation you’d rather hand off in your own clinic, you can refer patients to us, and we’ll keep publishing the criteria we use so you can judge them yourselves.

Where oral rehydration stops

Now I want to make it really, really clear: oral rehydration is only for mild to moderate dehydration. It is not the answer for severe dehydration, shock, or a child who isn’t mentally there. That really does require an IV, and urgently.

If you’re having trouble judging how severe it is, here’s the general checklist. Lethargic or unconscious. Sunken eyes. Skin that tents and stays tented. Not able to drink at all.¹ Two or more of those are past what a cup is going to fix, and they need to get to care with an IV urgently.

The end!

Thanks for joining us on dehydration. Dehydration shows up from so many different directions: throwing up and diarrhea, sure, but also a fever that runs for days, a sore throat or mouth sores that make a kid refuse to drink, a hot afternoon with too much play and not enough water, and plain lack of access to clean water. The cause changes. The ratio, the volume and the rate don’t.

Sources

  1. World Health Organization. The Treatment of Diarrhoea: A Manual for Physicians and Other Senior Health Workers. 4th rev. Geneva: WHO; 2005. Source for the reduced-osmolarity ORS composition (sodium 75 mmol/L, glucose 75 mmol/L, total osmolarity 245 mOsm/L), the home-made salt and sugar solution and WHO’s reasons for not generally recommending it, Treatment Plan B at 75 mL/kg over four hours, administration by spoon or cup rather than a bottle with a 5 to 10 minute pause after vomiting, and the Table 1 signs used to classify severe dehydration.. https://www.who.int/publications/i/item/9241593180
  2. Abbott Nutrition. Pedialyte Classic. Nutrition panel read 21 September 2026: 390 mg sodium and 5 g total sugars per 12 fl oz (360 mL), which works out to about 520 mg sodium and about 7 g sugar per 16 fl oz. https://www.abbottnutrition.com/our-products/pedialyte-classic
  3. DripDrop. Product FAQ. Read 21 September 2026: 660 mg sodium per 16 fl oz prepared, with about 14 g sugar per 16 fl oz. https://dripdrop.com/pages/faq
  4. Gatorade. Gatorade Thirst Quencher, 20 fl oz. Product FAQ read 21 September 2026: about 270 mg sodium per 20 fl oz, which works out to about 216 mg per 16 fl oz. Total sugars of 34 g per 20 fl oz, about 27 g per 16 fl oz, from the nutrition panel recorded 18 September 2026. https://www.gatorade.com/sports-drinks/gatorade-thirst-quencher/orange
  5. LMNT. Ingredients and formulation. Read 21 September 2026: 1,000 mg sodium, 200 mg potassium and 60 mg magnesium per stick, and no sugar. https://drinklmnt.com/pages/ingredients
  6. Merck Manual Professional Edition. Oral Rehydration Therapy. Confirmed 21 September 2026: 50 mL/kg over four hours for mild dehydration and 100 mL/kg for moderate, an additional 10 mL/kg (up to 240 mL) for each diarrheal stool, starting at 5 mL every five minutes and increasing as tolerated. https://www.merckmanuals.com/professional/pediatrics/dehydration-and-fluid-therapy-in-children/oral-rehydration-therapy
  7. Freedman SB, Adler M, Seshadri R, Powell EC. Oral ondansetron for gastroenteritis in a pediatric emergency department. N Engl J Med. 2006;354(16):1698-1705. Single oral dose of orally disintegrating ondansetron versus placebo in 215 children aged 6 months through 10 years, given before a standardized oral rehydration protocol. Vomiting during rehydration 14% versus 35% (RR 0.40, 95% CI 0.26 to 0.61); intravenous rehydration 14% versus 31% (RR 0.46, 95% CI 0.26 to 0.79). Hospital admission rates did not differ between the groups. https://pubmed.ncbi.nlm.nih.gov/16625009/
  8. Freedman SB, Williamson-Urquhart S, Plint AC, et al., for the Pediatric Emergency Research Canada Innovative Clinical Trials Study Group. Multidose ondansetron after emergency visits in children with gastroenteritis. N Engl J Med. 2025;393(3):255-266. Randomized, double-blind trial in six Canadian pediatric emergency departments; 1,030 children aged 6 months to under 18 years received six take-home doses of ondansetron or placebo for use over 48 hours. Moderate-to-severe gastroenteritis over the following 7 days occurred in 5.1% versus 12.5% (adjusted odds ratio 0.50, 95% CI 0.40 to 0.60). https://pubmed.ncbi.nlm.nih.gov/40673584/
  9. American Hospital Association. Supply chain updates following temporary closure of Baxter’s plant in North Carolina due to Hurricane Helene. 2024. Source for the North Cove facility supplying roughly 60% of US IV solutions. https://www.aha.org/special-bulletin/supply-chain-updates-following-temporary-closure-baxters-plant-north-carolina-due-hurricane-helene
  10. Gorgens S, Alshadad A, Malek A, et al. The impact on healthcare facilities of the 2024 IV fluids shortage after Hurricane Helene: a mixed methods study. PLoS One. 2026;21(4):e0344524. Survey of 17 respondents drawn from a 200-member national critical care task force, an 8.5% response rate: 88.2% of hospitals affected by the shortage, 58.8% created an oral hydration protocol, 81.3% converted IV medications to oral. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0344524

 

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What Crowd Medicine Actually Looks Like — And What to Have Before You’re In It

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What Crowd Medicine Actually Looks Like — And What to Have Before You’re In It

By Aaron Asay, PA-C, DMSc

I’ve worked mass casualty events. I’ve been the person making triage decisions under conditions that don’t look like a hospital, don’t feel like a clinic, and don’t come with a pause button. What I know from that work is that medical knowledge matters most before the noise starts — because once you’re in the middle of it, there’s no time to look anything up.

This isn’t a piece about any particular crowd or cause. Millions of people have been in the streets this year — at protests, counterprotests, festivals, sports events, political gatherings. Some chose to be there. Some happened to be nearby. Clinically, that distinction doesn’t exist. Exposure determines the injury. Affiliation doesn’t.

Here’s the medical brief I wish existed for the people heading into any large crowd event — and for the family members trying to figure out what ‘be careful out there’ actually means.

What tear gas and pepper spray actually are

These are often called ‘chemical agents’ or ‘gases,’ but the term is misleading. CS gas and pepper spray are both aerosol particulates — they ride on droplets and particles, not as free-floating gas. This matters for two reasons: how to treat an exposure, and what happens when someone comes home.

The first-line treatment is water. Fifteen to twenty minutes of continuous irrigation of the eyes, nose, and mouth. This is not a controversial point — it’s the standard, and it shows up in the clinical literature, in the AAO’s February 2026 statement on ocular exposure, and in every evidence-based first aid protocol for chemical agent exposure. The milk debate that shows up in protest photos? Comparative trials have shown that milk does nothing water doesn’t do — and milk is not sterile. It introduces contaminants to an already-irritated eye. Water is the answer.

Contact lenses must come out immediately after any exposure. Don’t try to wear them through it, don’t try to rinse them in place. They trap particles against the eye and extend the exposure time. Take them out, discard them, don’t put them back in. Glasses don’t have this problem.

Household decontamination is real

Here’s what almost no first aid guide tells you: the agent travels home. Tear gas and pepper spray particles adhere to clothing, hair, and skin. Someone who was exposed and comes home without decontaminating is still off-gassing agent into the house — it will affect anyone who’s there, including children and elderly family members who were nowhere near the event.

Decontamination before entering the house: remove and bag all clothing outside if possible. Shower thoroughly, including hair. Wash all exposed skin. This is basic HAZMAT principle applied at a household level, and it’s genuinely protective.

The stop-the-bleed piece

Kinetic impact projectiles — rubber bullets, baton rounds — are designed to be less-lethal, not non-lethal. A BMJ Open systematic review found that over 3% of documented kinetic impact injuries resulted in death, and more than a quarter caused permanent injury. Head, thorax, and abdomen are the high-concern impact zones. A rubber bullet to the chest is not a bruise you walk off — it’s a chest X-ray conversation. A head impact with any loss of consciousness, confusion, or vision change needs emergency evaluation. Period.

Bleeding injuries at crowd events are typically the same mechanisms as any soft tissue wound: compression works. Direct pressure with a clean cloth, maintained for a minimum of ten minutes without lifting to check, is the field management for most lacerations. Know where the nearest medical station is before you need it.

What to have in your bag

For any large crowd event — whether you’re there intentionally or you’re a bystander:

A rescue inhaler if anyone in the party has reactive airways. Chemical agent exposure can trigger bronchospasm even in people who don’t normally have asthma symptoms. If someone has an asthma history, the inhaler comes.

A glucose source and the medication list for anyone managing a time-sensitive condition. A written list of your medications on paper, in a pocket. A small basic kit: gauze pads, medical tape, nitrile gloves, saline wound wash.

How the Jase Medical Response team thinks about this

I work with Jase because we’re charting the grey areas, making the evidence accessible before the moment of need, and holding a high clinical bar even when the topic is uncomfortable. Riot first aid is exactly that territory — common, predictable, well-evidenced, and almost entirely absent from the professional guidance layer.

Learn more at https://jaseresponse.org/

Aaron Asay, PA-C, DMSc, is a disaster medicine practitioner and PA working with the Jase Medical Response team. This post is for informational purposes only and does not constitute medical advice.

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For Clinicians | Protest First Aid: Tear Gas, Pepper Spray, and Crowd Injury Basics

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For Clinicians | Protest First Aid 


Tear Gas, Pepper Spray, and Crowd Injury Basics

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed and edited by Aaron Asay, PA-C, DMSc, FIBODM, FAWM

Protests are a part of life around the world, and this summer they are a large part of life here: on single days this year, organizer estimates put several million Americans in the streets. That means our patients are in those crowds, near those crowds, or raising kids who are headed to one. Whether someone marches on purpose or catches a drift of tear gas at a bus stop, the medicine is identical. And I don’t know about you, but this is medicine I never actually learned in my professional program. Pepper spray, tear gas, rubber bullets, crush injuries, and heat all have first aid, and right now the best available guidance is written by street medics and tactical gear companies instead of by us. Today we’re covering the clinical version: what actually works, what is myth, which injuries need real evaluation, and the two-minute pep talk worth giving any patient who brings up that they will be near a protest anytime soon.

What actually treats tear gas and pepper spray exposure?

Before we talk treatment, scene safety comes first. If crowd movement, violence, or ongoing deployment of crowd-control agents makes the area unsafe, leaving the scene is the first intervention. Trauma priorities come next: serious bleeding or trouble breathing outranks any chemical exposure. And anyone providing aid should use appropriate PPE for the anticipated environment: nitrile gloves for providing aid, eye protection when feasible, sturdy closed-toe footwear, and hearing protection in situations where crowd-control munitions or explosive noise are possible.

Once the patient is somewhere safe, the short answer is: fresh air and water, in that order. The first move is out of the cloud, upwind, somewhere air is moving, and no rubbing: the agent is on their hands, and eyes are where it wants to go. Contact lenses come out and go in the trash. They trap the agent against the cornea, and rinsing over the top of them accomplishes very little. Then irrigation, 15 to 20 minutes with water or normal saline, per the American Academy of Ophthalmology’s clinical statement on ocular exposure to pepper spray and tear gas from February of this year.¹ Exposed skin gets soap and water; skip the lotions and creams afterward, since they trap residue against the skin. Refer anyone with persistent symptoms, reduced visual acuity, or anything that suggests corneal damage.The eyes get the headlines, but these agents are respiratory irritants too. Most exposures cause cough, chest tightness, and burning in the nose and throat that settle within about half an hour of reaching fresh air.⁶ The exception is reactive airway disease: patients with asthma, COPD, or chronic bronchitis can tip into a true exacerbation. Most clinicians will never see a severe riot control agent exposure, so the escalation criteria are worth committing to memory: persistent hypoxia, worsening bronchospasm despite rescue medication, inability to speak normally, stridor, or altered mental status. Those distinguish a routine irritant exposure from a patient who needs a higher level of care.

Now the myths, because your patients have seen the photos of people getting milk poured across their faces, and a lot of them believe that’s the treatment.

  • Milk: comparative trials show no advantage over water for pepper spray pain, and milk is not sterile.² It has no business in anyone’s eye.
  • Baby shampoo mixes: a randomized trial found no benefit over water alone, and the AAO explicitly declines to endorse it.³
  • Antacid solutions (the half-Maalox, half-water spray bottles from the street medic playbook): same story, no demonstrated advantage over plain water.²
  • Vinegar: this one comes with a story from this article’s reviewer. Aaron was tear gassed countless times as a bystander at protests while living in Venezuela several years ago, and resorted to carrying a small bottle of vinegar everywhere because it took the sting out of breathing (he and his companions doused their ties in it). No change to morbidity or mortality, but it sure felt like it made the symptoms tolerable. That’s the right frame for most folk remedies: comfort, maybe, but not treatment, and no substitute for fresh air and irrigation.

And remember, tear gas is not a gas. CS and OC agents are aerosolized particulates that settle into hair, skin, and clothing and keep re-exposing the patient, and everyone who hugs them at home, until the clothes come off and the shower happens.⁴ Rinsing the eyes at the scene treats the eyes. It does not decontaminate the person. The home half of the advice is simple: clothes off at the door and washed separately, shower with soap, hair included.

And one decontamination note for our side of the counter: a contaminated patient who walks into a pharmacy, clinic, or emergency department brings the agent along, and staff can develop symptoms from clothing residue alone. If someone arrives straight from an exposure, decontamination comes before the waiting room, not after.

The two-minute pep talk for a patient headed to a protest

Here’s what’s strange about this topic: the information exists, it just wasn’t written for us. On one side are the street medics: volunteers who train each other, sometimes through twenty-hour courses, and who genuinely know their decontamination and scene safety.⁵ Their material is solid, but it’s written by activists, for activists. On the other side are tactical gear companies selling trauma kits with a side of fear. When your patient searches “protest first aid kit” tonight, those are the two voices they will find. What’s missing is the neutral clinical layer, the version a family clinician or a pharmacist would actually give. So here is one.

We already have the muscle for this. It’s anticipatory guidance, the same thing we do for international travel: we don’t weigh in on whether the trip is a good idea, we make sure the patient comes home healthy. A patient who mentions an upcoming protest is handing you the same opening. The whole talk fits in two minutes:

  • Bring your critical medications, especially the rescue inhaler. Crowd-control agents are respiratory irritants, and reactive airway disease is the one condition that can turn a self-limiting exposure into something dangerous.⁶ Add glucose for anyone on insulin or a sulfonylurea, and a dose of anything critical in case getting home takes hours longer than planned.
  • Carry a medication list on paper. Phones die on long days, and a card in a pocket answers the questions a stranger or a medic will need answered.
  • Wear glasses, not contact lenses. Lenses trap chemical agents against the cornea, and nobody wants to be doing lens removal with contaminated fingers on a sidewalk.
  • Carry more water than seems reasonable. It covers heat and dehydration, and it doubles as eye irrigation, which as we just covered is the actual treatment.

And we’ve got to talk about the blazing heat, because at any large summer gathering it causes more medical trouble than anything else on this list. A demonstration is a long outdoor event with dense crowds, limited shade, adrenaline, and no easy way to leave, which is a reasonable recipe for heat exhaustion. The advice here is pretty simple: water before thirst, shade breaks, and treat dizziness, nausea, or confusion as a reason to get out of the crowd now rather than after the speeches. One clinical layer worth adding: patients on diuretics, stimulants, anticholinergics, or antipsychotics run hotter than they realize, and they are exactly the ones who won’t connect their med list to the weather forecast.

The pharmacology refresher here for the ‘why’ these meds promote hyperthermia is this: diuretics start the day volume-depleted, anticholinergics switch off sweating, which is the body’s main radiator, stimulants generate extra metabolic heat, and antipsychotics blunt the hypothalamic thermostat that would normally sound the alarm. Less sweat, more heat, and a later warning.

One final consideration is risk stratification, because the crowds this summer are not all twenty-five-year-olds. Patients with significant cardiopulmonary disease, pregnancy, advanced age, or limited mobility may require more individualized counseling based on their ability to tolerate respiratory irritants, heat, prolonged standing, or rapidly changing crowd conditions. For some, the discussion may shift from what to bring to whether attending is medically advisable at all.

How dangerous are rubber bullets, really?

More dangerous than the name wants you to think. “Less lethal” is a comparison to live ammunition, not a safety rating. The best evidence we have is a 2017 systematic review in BMJ Open covering kinetic impact projectiles (rubber bullets, beanbag rounds, and their cousins) in crowd-control settings from 1990 to 2017: at least 53 deaths, some 300 people left with permanent disability, and 71% of the 2,135 documented survivor injuries were severe.⁷ Head and neck strikes did the worst of it, accounting for roughly half the deaths and more than 80% of the permanent disabilities.

Our smarty pants exam-room translation: location is the triage. A projectile impact to the head, neck, chest, or abdomen deserves prompt medical evaluation, with imaging guided by the clinical examination and mechanism of injury. Anything near the eye goes to ophthalmology the same day. The bruise on the thigh can usually be a bruise on the thigh. 

Crowd compression deserves its own section, because it is often overlooked. People die all the time in mob crushes, and it’s likely a significant injury if a patient comes out of a stampede alive. Patients who have been pinned or compressed may develop occult thoracic injuries, delayed respiratory compromise, compartment syndrome, rhabdomyolysis, or crush syndrome after prolonged entrapment. None of those announce themselves at the scene: chest pain, worsening shortness of breath, escalating limb pain or swelling, or dark urine in the hours or days afterward means evaluation, not watchful waiting. And the advice Aaron gives his own patients is worth two sentences of anyone’s pep talk: consider a crowd like a river. Go with the flow, and angle to a side to find an avenue of escape, like a doorway, alley, or street, then get as far from the mob as possible.

Bleeding is the one place where the layperson layer already exists, and it’s good. Stop the Bleed came out of the American College of Surgeons’ Hartford Consensus work and teaches direct pressure, wound packing, and tourniquet use in a course that takes about an hour.⁸ It treats bystanders as immediate responders instead of spectators, which is exactly the right frame. If a patient wants one concrete thing to do beyond the pep talk, point them there. It’s the only part of this whole topic that already comes in an ordinary-citizen version.

Quick reference

  • Scene safety first: if the area is unsafe, leaving is the first intervention. Trauma priorities before decontamination.
  • Chemical exposure (tear gas, pepper spray): fresh air first, no eye rubbing, contact lenses out and discarded, irrigate eyes 15 to 20 minutes with water or saline, soap and water for skin. Refer for persistent symptoms, reduced acuity, or suspected corneal damage. Emergency evaluation for persistent hypoxia, worsening bronchospasm despite rescue medication, inability to speak normally, stridor, or altered mental status.
  • Projectile impact: head, neck, chest, abdomen, or eye means prompt medical evaluation, with imaging guided by the clinical examination and mechanism of injury. Eye strikes go to ophthalmology.
  • Crowd compression: pinned or caught in a surge means evaluation, not watchful waiting. Watch for delayed chest pain, breathing trouble, limb pain or swelling, or dark urine in the hours to days afterward.
  • Heat: dizziness, nausea, or confusion means out of the crowd, cooling, and fluids.
  • Bleeding: direct pressure, wound packing, tourniquet if trained. Stop the Bleed courses teach all three in about an hour.
  • At home afterward: clothes off at the door and washed separately, shower with soap, hair included. Contaminated patients decontaminate before the waiting room, not after.

The missing middle layer

Notice where everything in this article came from. The eye protocol is from a statement written for ophthalmologists. The projectile numbers are from a review written for policy researchers. The decontamination habits are from street medics. All of it useful, none of it written for the exam room, the pharmacy counter, or the patient standing at either one. That’s the pattern we keep running into at Jase: when the question is how to get ready for predictable medical trouble, care today is all or none. Either your patient reaches a professional in time, or they’re on their own with whatever the search results serve up, milk bottles and all.

Appropriate medical preparation is the name we’ve given that missing middle layer: the bounded, clinician-built work of getting ready before the bad day instead of during it. Most of our work is on the medication side, and if the pep talk surfaces that a patient has no plan for their critical medications, that part you can hand to us at Jase.com. The rest we publish in the open, every week, articles like this one included, so the neutral clinical version of these answers exists and none of us has to improvise it. None of it replaces anyone’s doctor, and it isn’t meant to. A water bottle, a paper med list, and a two-minute conversation are complements to care, not substitutes for it.

The bottom line

Protests are not going away, and neither is the medicine around them. Water and time for the chemical agents. Location as triage for the impacts. Clothes off and a shower at home. A rescue inhaler in the pocket where it belongs, and a pep talk that takes two minutes to give. None of this requires new training or a single piece of gear, just someone in the room who thought about it ahead of time. As of today, that’s you.

Sources

  1. American Academy of Ophthalmology. Ocular Exposure to Pepper Spray and Tear Gas: Evaluation and Management. Clinical statement, February 2026. https://www.aao.org/education/clinical-statement/ocular-exposure-to-pepper-spray-tear-gas-evaluatio
  2. A randomized controlled trial comparing treatment regimens for acute pain for topical oleoresin capsaicin (pepper spray) exposure in adult volunteers. Prehospital Emergency Care. 2008;12(4). Compared Maalox, 2% lidocaine gel, baby shampoo, milk, and water; no significant difference between regimens. https://pubmed.ncbi.nlm.nih.gov/18924005/
  3. Baby Shampoo to Relieve the Discomfort of Tear Gas and Pepper Spray Exposure: A Randomized Controlled Trial. Western Journal of Emergency Medicine. 2018;19(2). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851502/
  4. Centers for Disease Control and Prevention. Facts About Riot Control Agents. https://www.cdc.gov/chemical-emergencies/chemical-fact-sheets/riot-control-agents.html. See also: Tear Gas and Pepper Spray Toxicity. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK544263/
  5. Atlanta Resistance Medics. How to Organize a 20-Hour Street Medic Training. https://www.atlantaresistancemedics.org/street-medic-training/
  6. Tear Gas and Pepper Spray Toxicity. StatPearls. Respiratory symptoms are mostly self-limited; patients with asthma, emphysema, or bronchitis may present with acute exacerbation. https://www.ncbi.nlm.nih.gov/books/NBK544263/
  7. Haar RJ, et al. Death, injury and disability from kinetic impact projectiles in crowd-control settings: a systematic review. BMJ Open. 2017;7(12):e018154. https://pubmed.ncbi.nlm.nih.gov/29255079/
  8. American College of Surgeons. STOP THE BLEED. https://www.stopthebleed.org/
  9. No Kings protests. Britannica. Organizer-estimated 8 to 9 million participants across roughly 3,300 events, March 28, 2026. https://www.britannica.com/event/No-Kings-protests

 

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