Pepper spray uses capsaicin from chili peppers to cause intense burning of the eyes, skin and airways, usually for 30 to 60 minutes. Most people recover with decontamination and time, but patients with asthma or close-range eye injuries need careful assessment.
Key symptoms
- Intense eye burning, tearing and forced eyelid closure
- Burning, red skin
- Coughing, a choking feeling and shortness of breath
- Runny nose and throat irritation
- Anxiety and panic
What you find on exam
- Protect yourself: avoid contact, ventilate the area, wear PPE
- Eyes: redness, corneal injury, foreign material
- Breathing rate, wheeze and oxygen saturation
- Skin for burns or blistering
- History of asthma, restraint or other injuries
Tests
- Oxygen saturation
- Fluorescein eye stain if pain persists
- Peak flow or capnography if wheezing
- Further tests only if severe or atypical
Treatment basics
- Move to fresh air; remove contaminated clothing and contact lenses
- Irrigate the eyes with plenty of water or saline
- Wash the skin with soap and cool water without rubbing
- Inhaled albuterol for bronchospasm; oxygen as needed
- Monitor restrained patients for positional asphyxia
Red flags
- Severe breathlessness or wheeze that does not improve
- Eye pain or vision loss that persists after irrigation
- Restrained or agitated patient with trouble breathing
Practice it in Making Synapses
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.