An eye flush is the primary first aid treatment for chemical weapons exposure, such as tear gas or pepper spray.
When approaching patients that have been exposed to chemical weapons, take a moment to call out “Who here has been sprayed?” Patients who are clearly making eye contact and respond to you may not be your first priority. Remember it is often the patients who are unable to seek care that need it most. Once you’ve approached a patient:
- Introduce yourself and get consent. Remember the patient may be blinded and enraged. Do NOT become a second patient!
- Immediately ask if the patient is wearing contacts or has asthma. If the person is wearing contact lenses, they MUST be removed before flushing the eyes. The physical motion of the flush could push the contaminated lenses into the back of the eye and cause further harm.
- Encourage calm and steady deep breathing. This will lessen panic.
- Move patient to an uncontaminated area if there’s gas in the air. Ask for consent, then put gloved hands on patient and guide them.
- Encourage coughing and spitting. Patient doesn’t want to swallow the chemicals.
- Flush eyes with saline or water (if possible, add a pinch of salt to the water)
Follow these instructions when giving someone an eye flush:
- Get patient lower than you- kneeling, or sitting, or hunched over. If they can lean forward, it will reduce the amount of water that gets on their clothing. If they can't lean forward and getting wet would increase chances of hypothermia, find something to keep them dry (rain jacket, plastic trash bag, etc.)
- Tilt head to the side you are going to flush
- Hold eye open for patient by pinching the skin just below the center of the eyebrow. Not too hard! But enough to force the eye open. It's likely they won't be able to open their eyes.
- With a quick movement, stream water from the inside corner of the eye to the outside - do not aim for the tear duct. Be careful to not let it (and the chemicals it is moving) run across the face or into the ear. If it runs into the other eye, you are tilting their head in the wrong direction.
- Tilt head the other way and repeat flushing the other eye
- Tell the patient to blink and ask if that helped. They may want you to do it again.
An eye wash with LAW is the secondary first aid treatment for chemical weapons exposure, such as tear gas or pepper spray.
If the patient consents, pour or dribble some L.A.W. (liquid antacid and water) in the eyes using a plastic dropper bottle or spray bottle (use as a mist, NOT use a stream - the fine point of water may cause injury):
- we recommend 50% Maalox brand liquid antacid and 50% water
- NOT milk of magnesia or Pepto-Bismo
- avoid liquid antacids containing alcohol (look for words ending in –ol; except sorbitol)
- unflavored Maalox for best results (mint works)—though some generics work also.
- Active ingredients to look for are magnesium hydroxide and sodium hydroxide.
- The anti-gas ingredient simethicone is not known to be dangerous or helpful.
- Tell patient repeatedly to blink.
- Try not to drip LAW and chemical weapons onto patient.
- Remind patient not to touch eyes.
- You can also squirt LAW into patient’s mouth, have them swirl it around, and then spit it out.
- After several rounds, if patient’s mouth feels better, they can swallow some LAW to help innards. This also seems to help people breathe more easily.