Families to the Left

The active ingredient in pepper spray is capsaicin, derived from cayenne and other peppers. The chemical is extracted from the pepper in an organic solvent such as ethanol. The solvent is then evaporated, and the remaining waxlike resin is oleoresin capsicum (OC). An emulsifier like propylene glycol is used to suspend the OC in water, and it is pressurized to aerosolize it as a pepper spray.

Capsaicin is not soluble in water, no matter what volume is used. Ask victims to not rub their eyes or skin, which may cause greater exposure or penetration. No difference has been found between water, milk, antacid solutions, baby shampoo and lidocaine gel in reducing the pain of an exposure. Time after exposure, generally 7 to 15 minutes, is the best predictor of pain control. State laws attempt to control the strength of these sprays and who may carry them; many states restrict products to no more than 10% of the OC active ingredient for standard pepper sprays, 5% in most animal-repellent sprays, and up to 20% in some wildland sprays. All concentrations are effective in incapacitating animals and humans when a spray is directed to the face.

Pepper “hotness” is measured on the Scoville scale. Scoville heat units (SHUs) correlate to the amount of capsaicin present in a pepper or pepper product. An SHU value of 1 million units will produce temporary debilitating results and stop an attacker. Many sprays designed for criminal deterrence also contain a small amount of fluorescent dye. This is invisible to the naked eye, but an ultraviolet light will cause it to fluoresce on exposed skin. This is used to identify an attacker.

Case Discussion

The Attack Crew participated in the patient triage and gathering and reporting of information vital to establishing the cause of this incident. They reduced parental concern by recognizing family needs and, where possible, allowing family members to assist in calming patients and sharing information.

It is important in pepper spray incidents for hazardous-materials teams to provide rapid scene evaluation and chemical identification, though in many incidents it’s difficult to identify the exact chemical used. In this incident, rapid detective work identified the chemical, source and area of likely exposure. This allowed symptomatic victims and others to be managed appropriately without unnecessary transports or decontaminations.

The Attack One Crew knew hazardous-materials exposures often result in multiple-casualty incidents, and important information may come from transporting the most symptomatic patients to hospitals. In this incident, there was an efficient exchange of information between the scene and the ED. This is facilitated if one knowledgeable EMS member from the transporting crew remains on a radio at the hospital. That individual would be aware of who was working the scene, which party had what information, and what questions needed to be answered at any given time. In other incidents the ED can do rapid testing for toxins, and in some cases provide information back to the field that results in patients being treated there and not removed to hospitals. Alternatively, it may discover a substance is unusually toxic, more victims need to be transported to hospitals, and a few EDs may even have to be taken offline to handle incoming patients and provide further decontamination.

The Attack One crew also chose to use the regional poison control center for coordination of toxicology information. These facilities can coordinate information exchange between hospitals and out to the community when doctors’ offices, clinics and other medical facilities may be seeing the aftermath of a large chemical release.

In potential hazmat incidents involving children, victims require evaluation and sometimes care at the scene, then a coordinated approach to transportation and communication with parents. When possible, rescuers should allow parents, teachers and guardians to assist in calming students and facilitating management of those acutely injured or ill.

Learning the Incident Management System lets school officials function effectively with emergency responders in addressing students’ needs. School systems can provide PIOs and communication centers for contacting parents and reunifying families. This can be useful for emergency personnel, as schools often have available phone systems and personnel to make calls, as well as parent and guardian names, and can definitively tell worried parents their children’s status.