Pepper spray is a popular option to subdue violent or psychotic inmates when other de-escalation methods fail. It is preferred over options of lethal force in most correctional settings.
THE SITUATION: A call just came in from cell block D. They are enroute with an inmate for evaluation after being subdued with several applications of pepper spray following an aggressive incident. Two officers also sustained minor injuries during the take-down. What should the nurse prepare to do in the pepper spray evaluation?
A spray of concentrated capsaicin oil incapacitates most individuals due to the noxious odor and burning eyes and skin. Concentrations of the pepper oil can range from 5-15% depending on the product used. Potential health impact is directly correlated to the strength of concentration. If possible, obtain information about the standard products used in your facility to assist with your post-spray assessment.
The effects of pepper spray are related to skin and eye irritation, as well as neurogenic inflammation. When pepper spray comes in contact with eyes, nose and mucous membrane it causes involuntary eye closure and a sensation of shortness of breath. These conditions provide greater chance of apprehension and incapacitation. Officers should use the minimum amount necessary to contain the situation, however, sometimes a great deal of spray is necessary and your patient may arrive having been immersed in oil.
Use a well-ventilated exam room to assist in eliminating respiratory effects of pepper spray. Focus on these areas when performing your evaluation and determining follow-up treatment or observation.
There is some indication that pepper spray is particularly hazardous to those with asthma or a current respiratory infection. Check the medical record (if available) for past history and complete a thorough respiratory evaluation. Capsaicin oil causes wheezing, dry cough, shortness of breath and gagging.
As some have reported acute hypertension initiated by extreme pepper spray use, a vital sign check and cardiac history should also be undertaken. Symptoms usually clear in the first hour after the incident.
- Skin Irritation
Skin irritation can be intense and include burning, tingling, redness and occasional blistering. Remove any remaining vestige of irritant by having the patient wash exposed skin with soap and water. Change any soaked clothing. Irritation should clear in 30-60 minutes. Cool water or an ice pack can help to relieve a burning sensation.
- Eye Irritation
Redness, swelling, extreme pain, tearing and conjunctival inflammation are experienced with direct contact of the oil on eye surfaces. Eye exposure should be treated as with any other chemical eye contact – flush with water (or normal saline) for at least 15 minutes. Your medical unit should have an eye station for this purpose. Corneal abrasion can also occur, especially if contact lenses are in place. If corneal abrasion is possible, slit lamp evaluation may be necessary.
Although the majority of your patients will recover from pepper spray incidents quickly and without need of treatment, several in-custody deaths have been attributed to the chemical. A focused nursing assessment will reveal any issues of concern. Cardiac or respiratory involvement may indicate a brief stay in your infirmary for closer observation before discharge to general population.
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