Clinical Review

Management of the effects of exposure to tear gas

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b2283 (Published 19 June 2009) Cite this as: BMJ 2009;338:b2283
  1. Pierre-Nicolas Carron, specialist in internal and emergency medicine,
  2. Bertrand Yersin, professor of emergency medicine
  1. 1Service of Emergency Medicine, University Hospital Center and University of Lausanne, 1011 Lausanne CHUV, Switzerland
  1. Correspondence to: P-N Carron Pierre-Nicolas.Carron{at}chuv.ch
  • Accepted 22 April 2009

Summary points

  • Tear gas and pepper spray used for crowd control are not without risks, particularly for people with pre-existing respiratory conditions

  • Pulmonary, cutaneous, and ocular problems can result from exposure to these agents

  • Treatment for the effects of exposure to tear gas requires chemical decontamination, including protective measures for healthcare staff

  • Some people are at risk of delayed complications that can be severe enough to warrant admission to hospital and even ventilation support

Despite the frequent use of riot control agents by European law enforcement agencies, limited information exists on this subject in the medical literature. The effects of these agents are typically limited to minor and transient cutaneous inflammation, but serious complications and even deaths have been reported. During the 1999 World Trade Organisation meeting and at the 2001 Summit of the Americas in Quebec, exposure to tear gas was the most common reason for medical consultations.1 2 Primary and emergency care physicians play a role in the first line management of patients as well as in the identification of those at risk of complications from exposure to riot control agents. In 1997 the National Poisons Information Service in England received 597 inquiries from doctors seeking advice about problems related to crowd control.3 Our article reviews the different riot control agents, including the most common tear gases and pepper sprays, and provides an up to date overview of related medical sequelae.

Sources and selection criteria

We searched the following resources for relevant information on the medical toxicity and management of acute exposure to tear gas and pepper spray: Medline, PreMedline, Embase, CINAHL, SCIRUS, the Cochrane Library, ISI Web of Knowledge, Toxnet, Google Scholar, and personal archives. We used the subject headings “riot control agents”, “pepper spray”, “lacrimator”, “tear gas”, “irritants”, “incapacitating agents”, as well as the toxicological terms “chlorobenzylidene-malononitrile”, “chloroacetophenone”, “dibenzoxazepine”, “chlorodiphenylarsine” …

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