Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

After dispersal of riot control agents, nasal burning and pain, copious rhinorrhea, and
persistent sneezing begin along with oral irritation and salivation. Pulmonary effects
include chest tightness and burning, bronchorrhea, bronchospasm, and coughing.
Gagging, retching, and vomiting frequently accompany mucosal and airway irritation.
Exposed skin stings and may progress to erythema, vesiculation, and bullae depending on
the conditions of exposure; prolonged exposure, high ambient temperature, and humidity
favor worsening skin effects. These manifestations may occur hours to days after
exposure to CS. Skin exposed to CR may become painful in water for up to 2 days after
exposure. CN and CS can cause allergic contact dermatitis in people who are repeatedly
exposed.
Severe clinical effects from riot control agents are uncommon. Intense exposure to CS,
CN, and pepper spray has caused laryngospasm, pneumonitis, bronchospasm, and
noncardiogenic pulmonary edema. Often, the agent was released in an enclosed space, or
the victim was not able to leave the vicinity of the agent. Individuals with asthma are
predisposed to serious pulmonary symptoms. Experience with a 4-week-old infant who
was unintentionally exposed to pepper spray at close range suggests that severe lung
injury from Oleoresin capsicum is reversible in young children, provided that intensive
medical support is provided. Deaths caused by pulmonary effects have occurred after CN
exposure in victims who had previously normal lung function. Pepper spray was
implicated in the death of one asthmatic prisoner in custody. Prolonged reactive airway
disease has also been described after CS exposure in a previously healthy person with no
prior history of atopy. In general, riot control agents are incapacitating but rarely lethal,
especially relative to other deployable chemical agents such as the nerve agents,
vesicants, and pulmonary agents.
Diagnosis
Some physical characteristics of the compounds can assist in detection when riot control
agents are used. The most common agents (CS, CN, and pepper spray) are deployed in
identifiable canisters. CS and pepper spray have a pungent pepper odor. CN has a flowery
apple odor. Pepper spray frequently contains fluorescein dye that becomes readily
apparent on exposed skin under a Wood’s lamp. No environmental monitoring systems
currently exist for riot control agents.
Differentiation of clinical effects caused by riot control agents from those of other
chemicals can be a challenge during early management. Tearing, salivation,
bronchorrhea, bronchospasm, and vomiting suggest the cholinergic effects of nerve agent
exposure. Intense exposure to riot control agents with pneumonitis and pulmonary edema
mimic symptoms of exposure to pulmonary agents, such as chlorine and phosgene. The
potential for delayed skin effects, including vesiculation and bullae, with riot control
agents makes them similar to vesicants such as sulfur mustard. However, symptoms
rapidly resolve once contact with the agent ceases. Lack of progression to more severe
symptoms such as bone marrow failure, paralysis, and seizures, combined with negative
results from field detection systems and the physical characteristics mentioned above
make identification of riot control agent release ultimately possible.
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