Pepper spray is a popular option to subdue violent incarcerated persons when other de-escalation methods fail. It is preferred over options of lethal force in most correctional settings.

A call just came in from cell block D. Officers are enroute with an incarcerated patient 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 of the 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 before an incident occurs 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 patient concern 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.

Take Action

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.

• Respiratory

There is some indication that pepper spray is particularly hazardous to those with asthma or a current respiratory infection. Check the health record for past history and complete a thorough respiratory evaluation. Capsaicin oil causes wheezing, dry cough, shortness of breath and gagging.

• Cardiac

A vital sign check and cardiac history should also be obtained, as some have reported acute hypertension initiated by extreme pepper spray use. Symptoms usually clear in the first hour after the incident, but prudent care requires monitoring, and action if it does not normalize.

• 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 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, fluorescein staining and slit lamp evaluation may be necessary.

Caution Warranted

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 the need for a brief stay in your infirmary or special housing in “Medical Observation” for closer observation before discharge to general population.

Please share your experiences caring for incarcerated persons who have been pepper sprayed.