The events this week in Tijuana at the U.S.-Mexican border have been stunning.
Not only did we witness the use of tear gas on adult immigrants from Central America who were seeking asylum in the U.S., but on their children as well.
A toddler covers his nose with his shirt to shield against tear gas (AP Photo/Hasan Jamali)
It’s important to understand what tear gas actually is, and how it can have an even more pronounced effect on children compared to adults.
“The use of tear gas on children—including infants and toddlers in diapers—goes against evidence-based recommendations, and threatens their short and long-term health,” said Colleen Craft, MD, FAAP, President of the American Academy of Pediatrics (AAP), in a press release yesterday.
“ Children are uniquely vulnerable to physiological effects of chemical agents . A child’s smaller size, more frequent number of breaths per minute and limited cardiovascular stress response compared to adults magnifies the harm of agents such as tear gas,” she added.
Tear Gas 101:
So let’s explore what tear gas actually is, and dispel some myths surrounding its constituents and effects.
To begin with, tear gas isn’t a “gas” at all, but a powder that is heated and mixed with a liquid or solvent . It is released from canisters as an aerosol, with irritants that incapacitate you by causing pain and burning to the eyes, mucous membranes, throat, lungs, and skin.
In fact, tear gas should actually be thought of as a type of nerve agent that doesn’t just irritate cells, but activates specific pain receptors, (TRPV1, TRPA1) leading to the intense and burning pain on all affected surfaces and membranes.
In the eye, it leads to intense tear production and burning, along with exaggerated muscle cramping (blepharospasm) in the eyelid that leads to eye closure. In people with asthma, this can produce intense bronchospasm and airway closure, along with an overflow of mucous production that can lead to suffocation or the feeling of literally “drowning in your secretions”. In effect, tear gas leads to a chemical burn to the airways, skin, eyes, and all mucous membranes.
There are a number of types of tear gas, but the most common one used by law enforcement is known as CS (chlorobenzylidenemalononitrile). The next most common type is CN (chloroacetophenone).
Other types include PS (chloropicrin), which may also function as a fumigant, CA (bromobenzylcyanide), CR (dibenzoxazepine), as well as combinations of these agents.
The degree to which you are affected is determined by the amount, location (indoors or outdoors), and duration of the exposure. And how quickly you are decontaminated–eyes flushed, clothing removed, and skin scrubbed with cleaning agents–ultimately influences the duration of your symptoms.
The Immediate Effects
Effects of the irritants begin typically begin within seconds, and can last up to an hour.
Effects to the eye include excessive tearing (lacrimation), blurred vision, redness, and intense eye burning. Nasal effects include burning, nasal mucosal swelling, and a runny nose. You may experience difficulty swallowing, drooling, and severe burning inside your mouth and on your tongue. Effects on your lungs include wheezing, coughing, choking sensation, and difficulty catching your breath.
The net effect of this, especially in asthmatics, can mean an asthma exacerbation (attack) which can lead to respiratory failure and death. But a severe upper airway exposure and resulting burn can potentially lead to dangerous swelling in the upper airway, asphyxiation and even death.
So, if you don’t experience such devastating airway or respiratory effects, your skin feels like it’s on fire, and actual burns and blister formation may result. If this isn’t enough, add nausea and vomiting. You get it—not a pretty picture.
Potential Long Term Effects
A significant exposure—especially indoors, for a long enough period of time–can lead to serious eye effects including cataracts, glaucoma, and even blindness.
The good news is that if your symptoms quickly resolve after you undergo decontamination, the potential for long term effects, especially eye-related, are “unlikely to occur”, according to the CDC.
But, the effects of these agents, especially to the lungs and heart, are much more pronounced in children. Because tear gas is heavier than air, it remains in higher concentrations closer to the ground, consequently affecting children to a greater degree because they are shorter. Children also get a greater dose due to higher concentrations that occur closer to the ground, placing them at greater risk for lung injury.
This means that the amount of agent required to produce effects in children is significantly lower compared with adults, as Dr. Kraft emphasized in her recent press release.
How To Protect Yourself if Exposed
If you are exposed to tear gas, it’s important to get to fresh air, evacuate the affected area as soon as possible, and reach the highest ground possible. This is because dense vapor clouds of tear gas are heavier than air as explained above, and therefore tend to stay close to the ground. If you were exposed indoors, it’s vital to get outdoors as soon as you can.
Remove soiled clothes as soon as possible, followed by vigorous cleaning of your entire body with soap and water. Any clothing that needs to be pulled over the head, like a shirt or sweater, should be cut off, in order to eliminate any exposure to your eyes and mouth. Wearing rubber gloves is advised and all contaminated clothes should be placed in a plastic bag. Contact lens should removed with clean gloves, and eyeglasses cleaned with soap and water.
Difficulty breathing after exposure should be treated with oxygen, bronchodilators, and steroids on scene if possible, followed by transport to the emergency department. Chemical burns to the skin may require debridement, fluid resuscitation based on extent, and application of medicated dressings.
No antidote exists for exposure to tear gas, but wearing a gas mask is ideal to protect yourself if you anticipate the use of it.
That said, there are a number of homemade recipes touted to help ease symptoms after exposure. One includes use of lemon juice, or antacids such as Maalox in water. None of these approaches has actually been tested in a clinical fashion. That said, water remains the most available and effective solvent for irrigation in the setting of any type of ocular burn.
An agent known as Diphoterine demonstrated promise in preventing as well as treating CS exposure in 5 members of the French military in a small study from 2002, but is not widely available.
What’s clear is this: tear gas is not a benign chemical, and has the potential to lead to death, asphyxiation and life threatening burns . Children are at significantly higher risk for poor outcomes, as well as those with chronic lung disease, hypersensitivity syndromes, and older persons with heart and kidney disease.