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