What emergency treatments and triage protocols do pediatric units follow after infant exposure to riot-control agents?
Executive summary
Pediatric units treating infants exposed to riot-control agents prioritize rapid removal from exposure, decontamination, and symptomatic support—there is no specific antidote—while triaging most cases as minimal or delayed unless respiratory distress or ocular/dermal injury is suspected [1] [2]. Care emphasizes airway/respiratory monitoring and oxygenation, copious eye irrigation, removal and containment of contaminated clothing, and a low threshold for escalation in patients with pre-existing respiratory disease or signs of severe exposure [3] [4] [5].
1. Immediate scene actions and triage: rapid evacuation and initial categorization
First-line triage begins with removing the infant from the contaminated environment to fresh air and applying basic protective measures for rescuers; most sources state that toxicity correlates with concentration and duration, and that rapid evacuation minimizes effects [6] [1]. Casualties without respiratory compromise, significant ocular injury, or prolonged/high-dose exposure are typically triaged as minimal or delayed because effects are usually transient, but any signs of distress move the infant into immediate or urgent categories [2] [1].
2. Decontamination: clothing removal, containment and skin washing
Pediatric protocols require removing clothing promptly and sealing contaminated items (to avoid secondary exposure), then washing skin with mild soap and copious water because water is widely recommended as the preferred decontaminant for dermal exposures [4] [2]. Guidance warns that particles may persist on fabrics and dried residues can re-expose caregivers, so containment of clothing and use of standard precautions are part of triage and treatment workflows [4].
3. Airway and respiratory support: monitoring, oxygen, bronchodilators and escalation criteria
Because inhalation is the primary route of harm, monitoring respiratory status—pulse oximetry, work of breathing, and readiness to provide oxygen and assisted ventilation—is essential; bronchodilators and steroids are used when bronchospasm or reactive airways disease is present, and severe cases (eg, prolonged hypoxia or respiratory failure) require advanced airway support and intensive care [5] [3] [7]. Pediatric units maintain a low threshold to escalate for infants who are infants by virtue of anatomy and limited reserve or who have pre-existing asthma, since delayed pulmonary edema and prolonged bronchospasm have been reported [8] [1] [3].
4. Ophthalmic management: copious irrigation, analgesia and ophthalmology consults
Eye exposure is managed immediately with copious irrigation—saline or potable water for 10–20 minutes is recommended—and topical anesthetic can be used to facilitate irrigation in children; persistent symptoms or suspicion of particulate impaction prompts fluorescein staining and slit-lamp exam by ophthalmology [4] [8] [2]. Solid particles from close-range sprays can mechanically injure the cornea, so infants with continuing pain, visual disturbance, or corneal defects are fast-tracked for specialist evaluation [4] [2].
5. Observation period, diagnostics and disposition decisions
Most exposed patients resolve within about 30 minutes to a few hours and can be observed for several hours prior to discharge, but infants with significant symptoms, oxygen requirement, evolving respiratory signs, or prolonged exposure are admitted for monitoring and supportive care; chest radiography, arterial blood gas, and oximetry are used selectively when pulmonary injury is suspected [2] [7]. Long-term complications such as reactive airways dysfunction syndrome (RADS) are uncommon but reported, and documentation, follow-up planning, and counseling about delayed respiratory symptoms form part of disposition planning [2] [1].
6. Pediatric-specific considerations, team coordination and limitations of evidence
Children—especially infants—have higher surface area-to-volume ratios, smaller airways and limited physiologic reserve, which inform a lower threshold for escalation, and interdisciplinary coordination (ED, pediatrics, ophthalmology, respiratory therapy, toxicology) is recommended; there are few high-quality pediatric trials, so guidance relies on case series, military/public health reviews and expert protocols [7] [9] [1]. Reporting acknowledges that most recommendations are symptomatic and pragmatic—no antidote exists—and that clinicians must balance rapid decontamination and supportive care with infection control and avoidance of secondary contamination [4] [1].