Version 1, November 2002

Contents

• Basic Assessment & Emergencies
• Preparing for an Action
• Tear Gas & Pepper Spray
• Climate: Heat, Cold & Dehydration
• Dealing with Injuries
• General Aftercare

Basic Assessment & Emergencies

Imagine one of your friends is suddenly injured or sick. Or maybe you're the first one to find a person "down" at a protest. What do you do? Well, don't panic! Take a deep breath and think.

Remember, your brain is your best first aid kit!

Survey the scene:

• Is it safe?
• How many people need help?
• What are the danger factors? Look for things like:
  • tear gas or pepper spray
  • fire
  • falling debris
  • advancing police
  • an out-of-control crowd
  • traffic

Eliminate or prepare for potential hazards to the victim, to yourself, and to bystanders. Try to make sure that whatever happened to your friend or comrade doesn't happen to you too!

Use the crowd for moving obstacles, directing traffic, getting help, and keeping a safe space around injured people. Try to speak in a calm voice to help keep others calm. Remember, most people want to help.

While providing emergency care for others, it is important to also protect yourself from blood-borne diseases like HIV and hepatitis B or C. Wear latex or plastic gloves when touching blood. No gloves? A plastic baggie or a piece of plastic food wrap will work in a pinch. Be aware that some people are allergic to latex; because of this more and more health-care providers are switching to plastic (nitrile) gloves. Remember, diseases are rarely spread through rescue breathing (mouth-to-mouth resuscitation).

Next, determine if the person is conscious and alert by asking:

• Are you OK?
• What's your name?
• Do you know where you are?
• Do you know what day it is?
• Do you know what happened?

If the person does not respond to normal conversation, shout and tap-but do not shake, since this could make a neck or spine injury worse.

Neck and spine injuries can be very serious, even leading to paralysis. When helping a person who has been injured, your first goal should be do no harm!

• Do not move an injured person unless she is in more danger where she is (for example, inside a burning building) or you need to do so to provide life-saving care.
• When checking for breathing or doing rescue breathing, thrust the jaw forward instead of tilting the head back by bending the neck.
• If there are several people helping, one can stabilize the injured person's head and neck, keeping the head in line with the rest of the body.
• Don't put an injured person's head on a pillow.
• If a person falls in a contorted position and is breathing, leave her as she is.
• Look for someone with medical training who knows appropriate carries or how to use a backboard.

If the person is conscious:

Introduce yourself. Say who you are, that you want to help, and what your qualifications are, if any. Ask for consent before you do any further assessment or treatment.

If the person is unconscious:

Call 911. If other people are present, send someone else-two people if possible-to call 911 or look for help. Tell them to come back and let you know they did it. If they don't come back in 10 minutes, send more people. Sometimes emergency services personnel will not respond to what they consider an unsafe scene, or police may keep them away. If a person needs more help and emergency services are not available, send people out to look for someone with more medical training, ask the police for help, or try to find a car to transport the person to a hospital.

Check ABCs:

• Airway
• Breathing
• Circulation (bleeding)

Put your face next to the injured person's and look, listen, and feel for breathing for 15 seconds:

• Look to see if her chest rises
• Listen for sounds of breathing
• Can you feel her breath on your cheek?

Try to check for breathing without moving the person. If she is not breathing, carefully log roll her onto her back.

If you do not detect breathing, thrust the jaw forward. With the person lying on her back, put your fingers under the corner of the jawbone on both sides (below and slightly in front of the bottom of the earlobe) and push up. Look, listen, and feel again. Check the mouth for vomit, blood, knocked-out teeth, or debris. If visible, remove with your fingers (covered with a glove or cloth if possible). Look, listen, and feel again.

If a person is breathing, you can be sure she has a pulse. Finding a pulse can be difficult...don't waste your time unless you know how.

If the person is not breathing:

Start rescue breathing. Pinch the nose and breathe into the person's mouth. Look to see if the breath goes in (the chest rises). Give one slow breath about every 5 seconds to an adult, or one shallower breath about every 1 second to a child. Mouth-to-nose rescue breathing may also be done. Keep the jaw thrust forward while doing rescue breathing.

Start CPR if you know when and how to do so If you don't know CPR, search the crowd for someone who does

• For an adult: 2 breaths followed by 15 chest compressions, 80-100 compressions per minute
• For a child: 1 breath followed by 5 compressions

If the person is breathing (conscious or unconscious):

Check for bleeding. Even if you find one bleeding injury, keep looking-there may be other hidden injuries that are more severe (see "Dealing with Injuries").

Look for a MedicAlert tag around the neck, wrists, or ankles.

If the person is conscious, ask for more information:

• What happened?
• Where does it hurt? How bad is the pain (on a scale of 1-10)? How does it feel (burning, sharp, dull ache)
• Do you have any medical conditions (asthma, diabetes, pregnancy, psychiatric illnesses)?
• When did you last eat? Have you been drinking water?
• Do you have any allergies (medications, latex, foods, bee stings)?
• Are you currently taking any medications or street drugs?

If she is not conscious, friends can be a good source of information about medical conditions and what the person is usually like. Witnesses may be able to describe how an injury happened.

If you know how and it seems useful, you can do a more thorough physical exam. Look for:

• Bleeding
• Obvious deformities or soft spots on the head
• Limbs bent in ways they don't normally bend
• Swelling
• Clear or bloody fluid from ears or nose
• Seizures
• Pupils that don't respond equally to light

If something looks unusual on one side of the body, compare with the other side. Ask the person or a friend what is normal for her. For example, some people naturally have pupils that are different sizes; others have congenital abnormalities or abnormalities due to previous injuries.

It can be hard for someone without medical training to tell what's wrong. For example, breathing problems may be due to asthma, chemical weapons, or an anaphylactic reaction. Confusion could be due to diabetes, dehydration, psychological stress, or a head injury. Do not attempt to provide treatment beyond your level of skill and training.

If an unconscious person has vomited or is bleeding from the mouth and you do not suspect a neck or spine injury, roll him onto his side to prevent choking. He should be supported on one bent knee and one arm. Put a person in this recovery position if you must leave him alone.

Preparing for an Action

Being well prepared for an action can mean the difference between having a safe, empowering experience and having an unhealthy, frustrating one.

What to wear:

• Focus on comfort. Wear clothes you can easily move in.
• Cover your skin (long sleeves, long pants) to protect yourself from sunburn and chemical weapons.
• Wear sturdy, protective (closed-toe), comfortable shoes. This is not the time to break in that new pair of Docs!
• Wear thick socks. If it's wet, bring an extra pair.
• Dress for the weather: wear layers than can be taken on or off as needed.
• Wear a waterproof, windproof outer layer if it's cold or damp.
• Consider bringing an extra set of clothes in a sealed plastic bag in case you're exposed to chemical weapons and need to change.
• Wear shatter-resistant glasses or sun shades.
• To protect yourself against tear gas or pepper spray, use a gas mask or airtight goggles plus a respirator or bandana moistened with cider vinegar or lemon juice (See "Protective Gear").
• Use thick work gloves if you might be tempted to pick up a tear gas canister.

What to bring:

• Lots of water. Use a bottle with a sports top or squirt top.
• High-energy snacks such as Power Bars, nuts, fried fruit.
• Water-based or alcohol-based sunscreen.
• A watch, paper, pen, and camera (to accurately record events).
• Cell phone (if you're not afraid of possibly losing it or having it taken away)
• Enough money for phone calls, food, transportation, and other necessities.
• Personal medical supplies: inhaler for asthma, EpiPen for anaphylactic reactions, necessary medications. In case of arrest, carry several days worth of prescription drugs and a copy of your prescription.
• If you plan to get arrested, decide whether you want to carry ID. Bring ID only if you want to be cited out. Give emergency contact information and instructions to a support person who does not plan to get arrested.

What to avoid:

• Don't apply oil-based skin products such as sunscreen, lotion, or Vaseline (these can trap pepper spray).
• Leave your contact lenses at home if you think you might be exposed to chemical weapons.
• Avoid fuzzy garments that can trap chemicals.
• Avoid dangling earrings, jewelry, ties, and other items that can be easily grabbed.
• Consider covering ear and facial piercings with tape so they won't be yanked out.
• If you have long hair, tie it back or put it under a hat.
• Don't carry a lot of extra cash or credit cards.
• Crowds, sun, cold, and chemical weapons can be stressful -- or even dangerous -- for young children and pets. Consider carefully whether to bring them with you to a high-risk action.

Tear Gas and Pepper Spray

When most people think about health and safety for activists, they think of chemical weapons-tear gas and pepper spray-thanks to the rude awakening delivered during the 1999 Seattle WTO protests. But despite the hype, exposure to tear gas and pepper spray are not the worse thing that can happen. Most people in good health experience only brief effects. These weapons were developed by the military to control crowds, and they are used by cops to produce fear and disorientation. While they can have immediate incapacitating effects, for most people the effects are only temporary!

Tear Gas

Tear gas-various formulations include CN, CS, and CX-is dispensed from canisters that are thrown into crowds, releasing white or invisible smoke. The canisters are very hot-do not pick them up with your bare hands! Tear gas irritates the eyes and mucous membranes such as the linings of the nose, mouth, and lungs, causing increased fluid production. Some people find it hard to breathe. Effects may last as little as 5 minutes or as long as 30 minutes. Tear gas is mixed with various solvents and propellants.

Pepper Spray

Pepper spray-also known as oleoresin capsicum or OC-is derived from hot peppers. It is a liquid or foam usually sprayed at close range, either from a small dispenser or from a larger tank with a nozzle that looks like a fire extinguisher. Pepper spray burns the eyes, skin, and mucous membranes, causing pain. Effects last longer than those of tear gas-an average of about 20 minutes-and it is harder to remove. The Black Cross Collective conducted controlled trials of different pepper spray remedies, and their results provide the basis for some of the treatments most often used by street medics. Other remedies were developed during protests in the 1960s and remain the "state of the art" today.

Effects of Chemical Weapons

While pepper spray generally only affects the people on whom it is directly sprayed, a canister of tear gas can affect a large number of people within an area about the size of a block. People may even be affected well after a canister was released and all visible signs of gas are gone. Many of the effects of tear gas and pepper spray are similar, but some are more often associated with one or the other:

• Difficulty breathing (more likely with tear gas)
• Burning eyes
• Skin pain (more likely with pepper spray)
• Tears, runny eyes
• Runny nose, increased production of spit (more likely with tear gas)
• Coughing
• Nausea, vomiting (uncommon)

Advance Preparation

• Drink enough water, eat well, and get enough sleep before actions where you think chemical weapons might be used.
• Oil-based skin products (lotions, Vaseline, etc.) can bind with pepper spray and make it harder to remove, thus prolonging its effects. Avoid such products or use water-based substitutes (such as sunscreen).
• Some people recommend washing your body, hair, and clothes beforehand with a detergent-free soap such as castile soap (for example, Dr. Bronner's); however, it's not clear whether this has much of a protective effect.
• Cover up: long sleeves, long pants, gloves, hair covering, closed shoes.
• Keep clothes as dry as possible; wear a water-repellant outer layer to keep chemicals from soaking through clothes.
• Some people who expect heavy exposure tape or cinch their pants legs, sleeve cuffs, and collars to reduce skin exposure.
• Consider carrying an extra set of clothes in a sealed plastic bag in case your clothes are contaminated and you need to change.
• If possible, try to stay upwind of tear gas.

There has been much debate about contact lenses. It is usually recommended that people not wear contact lenses if there is a risk of tear gas or pepper spray exposure, since the lenses might trap chemicals and cause eye damage. Also, wearing lenses can make treatment more difficult. Many people recommend that contact lenses be removed before an eye flush-which can be hard to do on the street with contaminated fingers. On the other hand, some people report that wearing contact lenses doesn't seem to make much of a difference.

Protective Gear

• A gas mask provides the best protection. Learn about the advantages and disadvantages of different types of masks. Then, learn how your particular mask works and make sure it fits properly. Lenses should be shatterproof. Be aware that wearing or carrying a gas mask is illegal in some areas (especially during protests) and can be used as an excuse to arrest you.
• A respirator (the kind used when working with paint or industrial chemicals) is also quite effective. These do not provide full-face protection like a gas mask, but they are less hot and don't reduce vision as much.
• A bandana, or any cloth that covers the mouth and nose, provides some protection. Many people find that putting apple cider vinegar (not white vinegar) or lemon juice on the cloth makes tear gas easier to tolerate.
• Paper surgical face masks or filters (the kind used by health-care workers) can also provide some protection.
• Goggles-for example, airtight swim or ski goggles-provide good protection for the eyes. They are easier to hide than a full gas mask. Make sure lenses are shatterproof. Prescription swim goggles are available.

High Risk Groups

Some people are more at risk than others from exposure to chemical weapons. They may suffer more severe initial effects and are more likely to experience long-term problems. The following people should be extra cautious and consider carefully whether they want to be at an action where tear gas or pepper spray may be used-remember, the behavior of the police is often unpredictable! Be responsible for children and pets who can't make this decision for themselves.

• Babies and young children (up to about age 6)
• Elderly people
• Pregnant women (and those planning to become pregnant soon)
• Nursing mothers
• People with asthma or emphysema
• People with bad acne, eczema, or other skin conditions
• People with eye conditions such as conjunctivitis
• People with weakened immune systems, such as those with HIV or those taking chemotherapy or steroids
• People with chronic health conditions

Treatment

General:

• Don't panic! Try to stay calm. A large, running crowd of panicked, blinded people can lead to worse injuries than chemical weapons.
• Don't rub your eyes-even though you will want to! This can make the irritation worse.
• Blow your nose, rinse your mouth out, and spit.
• Fresh air brings relief from tear gas. Face the wind and hold your arms outstretched to let it blow the chemicals away.
• Many people report that a drop or two of rescue remedy reduces pain and distress. Add a couple drops to drinking water or water used for rinsing eyes.
• If a person stops breathing or loses consciousness, move him to a safe place and call 911. Begin rescue breathing or CPR if needed and you know how (see "Basic Assessment & Emergencies," page 2).

For eyes:

• The most effective remedy for eyes exposed to tear gas or pepper spray seems to be a mixture of liquid antacid and water. Street medics call this LAW. Use plain, unflavored Maalox, Mylanta, or a generic equivalent (some people report that flavored antacid stings). Make a 1:1 (50/50) mixture if using regular strength; use more water if using extra-strength. Shake the solution before you use it, since the antacid will settle at the bottom. LAW is cloudy and can temporarily cause blurred vision.
• Water alone is also perfectly good for rinsing the eyes, and is something most people-we hope!-will always have on hand.
• The goal is to completely wash the chemicals out of the eyes. Some street medics like to rinse the eyes with LAW (more common on the west coast). Others prefer to vigorously flush the eyes with a stream of water, then apply a couple drops of LAW to reduce irritation (more popular on the east coast). Use bottles with a sports cap or squirt cap that can deliver a well-aimed stream. Some people prefer spray bottles.
• Flush the LAW or water from the inside corner of the eye toward the outside corner. Have the person tilt his head so the LAW or water runs onto the ground. Try not to get contaminated LAW or water on the person's skin. Also, try to keep the person as dry as possible (you can use a plastic poncho or garbage bag), especially in cold weather.
• Tear gas and pepper spray usually make people automatically squeeze their eyes shut. You will probably have to hold the person's eyelids open (if possible, wear a latex glove) or have them do so themselves. There are different ways to do this, such as putting your thumb on the eyelid and rolling upward. It's a good idea to practice this beforehand.

For skin:

• Tear gas usually does not have much of a prolonged effect on the skin beyond mild irritation, so treatment is generally not needed.
• Pepper spray should be removed from the skin as soon as possible. Street medics use a procedure called MOFIBA-mineral oil followed immediately by alcohol. Firmly wipe the pepper spray off the skin using a gauze pad, clean cloth, or paper towel moistened well with mineral oil (the oil binds to the pepper spray, making it easier to remove). Then, immediately wipe off all the mineral oil with a fresh gauze pad or cloth moistened well with isopropyl rubbing alcohol (the kind you can buy in a drugstore). If a large area of the skin is exposed, do small sections at a time in order to get the mineral oil off as quickly as possible. Some people like to follow with a water rinse since alcohol can irritate the skin.
• Unfortunately, MOFIBA can be difficult to do correctly in the chaos of a protest. It also necessitates carrying multiple bottles that can easily get mixed up (bottles should be well marked or color-coded). People are always trying new remedies in the hope of coming up with something better.
• Some people find that LAW applied with a gauze pad or cloth soothes the skin after a minor pepper spray or tear gas exposure; some also like to use LAW as a mouth rinse.
• Once you are away from the thick of things, change clothes and wash with soap and water.

Commercial products such as BioShield and Sudecon are sold by police suppliers to neutralize tear gas and pepper spray. They are usually a mixture of sugar and baby shampoo, and are sold in spray bottles or as individual wipes. Reports are mixed about how well they work. The Black Cross Collective did not find them effective in their pepper spray trials. But others have said the products work for them. A major disadvantage is their high cost-especially when dealing with a large number of exposed people. An advantage is that the wipes can easily be used by individuals on themselves, even while running.

Treatment Myths

Over the years, numerous different tear gas and pepper spray remedies have been circulated. Many are merely useless, but some can be harmful or make the pain last longer. Some are based on misinformation and miscommunication, but others have no clear origin. The following are not recommended:

• Lemon juice or vinegar in the eyes - these are often used to wet a bandana worn over the nose and mouth, but should not be applied to the eyes or skin.
• Mineral oil or alcohol in the eyes - these are used for MOFIBA, a treatment for the skin, not for the eyes.
• Toothpaste - reportedly originated in protests in South Korea as a way to seal a gas mask to the face. There's no evidence that smearing toothpaste around your eyes or on your skin will reduce the effects of tear gas or pepper spray.
• Vaseline, egg yolk, or other gunk - the theory here is that substances that coat the skin can help protect it from irritating chemicals. However, there's no evidence that this is the case. In fact, various kinds of gunk can make pepper spray harder to remove.
• Milk - this actually works well as an eye flush (much like LAW), but milk can spoil and many vegans don't want it used on them.
• Burning tires - there are mixed reports about whether burning rubber helps ameliorate the effects of tear gas...but are tire fumes any better for you?!

Decontamination

Once you're away from the action, wash your body, hair, and clothes to remove the chemicals. Tear gas and pepper spray can linger for a long time in clothes. People can even suffer the effects of exposure if a contaminated person walks into an enclosed room. Before you enter a convergence center or clinic after an action, you'll probably be asked to remove your clothes if they're contaminated.

For you:

• Shower with cold water and scrub your skin with soap. Hot water opens pores, which may let chemicals penetrate more deeply.
• Don't take a bath-you don't want to soak in the chemicals!
• Position yourself so that contaminated water from your hair does not run all over your skin-especially your face.

For your clothes:

• Place contaminated clothes in a sealed plastic bag until you can wash them or dispose of them.
• Clothes contaminated with tear gas can be hung out in the wind. It may take several days before the smell is gone.
• Wash clothes with a strong detergent-based soap (this is not a time for eco-friendly, detergent-free products).
• Coats, furniture, rugs and other items can be exposed to air or steam cleaned; some recommend adding 5-10% baking soda to the steam water.

Aftercare

The effects of tear gas and pepper spray are usually temporary. Seek medical attention if you experience any of the following:

• Severe or ongoing breathing problems
• Ongoing eye irritation
• Skin rash
• Symptoms that persist, worsen, or reappear.

Many people feel fatigued or ill after chemical exposure. This is a good time to take extra good care of yourself. Drink a lot of water, eat nutritious food, and get enough sleep. Many different herbs can help detoxify the body-ask an herbalist for recommendations. Some people experience critical incident or post-traumatic stress after exposure to chemical weapons and will need additional care (see "General Aftercare").

Chemical crowd control weapons are banned in some countries because of their potentially dangerous effects. Use of tear gas and pepper spray in protest situations has not been well studied. But pepper spray has been associated with numerous deaths of people in police custody. The long-term effects of propellants and other chemical additives in tear gas are not known.

Climate: Heat, Cold & Dehydration

Heat-Related Illnesses

Preventing heat-related illness:

• Drink plenty of water
• Make sure to eat
• Pay attention to the weather forecast
• Dress for the weather; if it's hot, wear light, loose-fitting clothes that breathe-or wear layers that can be removed as it warms up
• Try to stay out of the sun
• Children, older people, and people with other illnesses or recent injuries are more prone to heat-related illness and should take extra precautions

Heat exhaustion symptoms:

• Fatigue
• Weakness
• Dizziness
• Headache
• Nausea, vomiting, diarrhea
• Muscle cramps
• Dilated pupils
• Skin is clammy (damp) and cool to the touch
• Heavy sweating
• Normal body temperature

Heat stroke symptoms:

• Exhaustion, lethargy
• Extreme weakness (prostration)
• Confusion or disorientation
• Irritability, aggression
• Headache
• Nausea, vomiting
• Rapid pulse
• Small pupils
• Skin is red, dry, and hot touch
• Person is no longer able to sweat
• Very high body temperature
• Loss of consciousness

Treating heat exhaustion:

• Move to a cool area-into the shade or a cool building.
• Remove heavy clothing and uncover head.
• Drink plenty of fluids; sip slowly to avoid vomiting.
• Water is good, as are sports drinks or water mixed with Emergen-C.
• A salty snack is good, but do not use salt tablets.
• Cool off by spraying or sponging with cool water; soaking clothes in water; placing cloths soaked in cool water on the neck, armpits, and groin; immersing body in cool water
• Use ice, especially on the neck, armpits, and groin; do not place ice directly against skin (instead, wrap ice in a cloth).
• If the person does not feel better after 15 minutes or so, get help. Heat exhaustion can quickly turn into heat stroke.

Treating heat stroke:

• Urgently lower body temperature by any means available.
• Heat stroke is a medical emergency; get help immediately.

Aftercare for heat-related illness:

• Rest in a cool area and avoid exertion for the rest of the day; one episode makes it more likely that a person will have another.
• Continue drinking water.
• Eat a nutritious meal or snack.
• Seek medical care if symptoms persist, worsen, or reappear.

Any time you're exposed to the sun-especially if you're not used to it-you risk getting sunburned. This is especially true in the summer, during the middle of the day, and at high altitudes. Protect yourself by wearing long sleeves, long pants, and a hat. Or, use sunscreen or sunblock. Sunscreen lets you stay in the sun longer without getting burned. The higher the Sun Protection Factor (SPF), the more protection a product provides. Some people have found that oil-based products can worsen the effects of pepper spray. If there's a risk of chemical weapons exposure, use a water-based sunscreen.

Don't forget that a sunburn is a burn. Treat it as you would any other kind of first or second degree burn. If you get a mild sunburn, use water to cool the skin. Aloe vera can also help cool the skin, and moisturizing lotion can help prevent peeling. If you get a serious sunburn (bad blisters, fever, chills), seek medical care.

Dehydration

Dehydration occurs when your body does not get enough fluids. This can happen if you are not drinking enough, or if you are losing a lot of fluids through vomiting or diarrhea or heavy sweating. Dehydration often happens when it's hot out, but can also happen when it's cold.

Preventing dehydration:

• Drink plenty of water.
• Pre-hydrate: drink a lot before an action (the evening before, the morning before, and an hour before).
• Avoid drinks with caffeine or alcohol; these are diuretics that can actually make you lose more fluids by peeing more.
• Drink consistently throughout the day (about 1 liter or 30 ounces per hour); don't wait until you feel thirsty.

Dehydration symptoms:

• Thirst
• Dry mouth, parched throat
• Less than normal urination
• Dark yellow or orange urine (if well hydrated, urine should be clear or pale yellow)
• Headache
• Confusion or disorientation
• Dizziness
• Increased heart rate and rapid breathing
• Skin loses elasticity; it "tents" and does not immediately flatten out when pinched

Treating dehydration:

• Replace fluids by drinking.
• Sip slowly to avoid vomiting.
• Drink cool rather than very cold fluids to avoid cramps.
• If a person is unconscious or losing consciousness, do not give fluids by mouth (to prevent choking).
• Water is good, as are sports drinks or water mixed with Emergen-C.
• A salty snack is good, but do not use salt tablets.
• Avoid drinks with caffeine or alcohol.
• A rehydration solution can be made by mixing sugar and a small amount of salt with water.
• If dehydration is due to diarrhea, the BRAT diet (bananas, rice, applesauce, white toast) or anti-diarrhea medications may help.
• In serious cases, intravenous fluids may be needed.
• If severe (loss of consciousness, seizures), call 911.

Aftercare for dehydration:

• Continue drinking water.
• Eat a nutritious meal or snack.
• Rest and avoid exertion for the rest of the day.

Cold-Related Illnesses

Hypothermia is the name for cold-related illness. People can get hypothermia even if the temperature is above freezing, especially if they are not used to the cold. Different people may experience hypothermia at different temperatures. In very cold conditions, "chillblains," frostnip, or frostbite may occur. Chillblains refers to red, tender skin that may later blister. Frostnip is freezing of the outer layer of skin. Frostbite is when ice crystals form in deeper layers of tissues. The areas most often affected are the toes, fingers, tip of the nose, and tips of the ears. Severe frostbite can lead to gangrene, and may necessitate amputation of the affected body part.

Preventing cold-related illness:

• Drink plenty of water-dehydration can occur in hot as well as cold weather!
• Make sure to eat.
• Pay attention to the weather forecast.
• Dress warmly; wear layers that can be added or removed as the temperature changes
• Cover your head, since this is where the most heat is lost.
• Stay as dry as possible. Try to avoid heavy sweating and wear under-layers that wick sweat away from the skin. If it's wet, wear a waterproof outer layer. Carry a spare pair of dry socks.
• Avoid tight socks, shoes, and gloves (these can restrict blood flow).
• Try to stay out of the wind or wear a windproof outer layer.
• Use chemical hand and foot warmers if available.
• Exercise hands and feet to keep them warm and check for numbness.
• Move indoors or to a warmer area if feet or hands feel cold or numb.
• Avoid smoking (tobacco smoking restricts blood flow).
• Children, older people, and people with other illnesses or recent injuries are more prone to heat-related illness and should take extra precautions.

Hypothermia symptoms:

• Feeling chilled
• Shivering (including involuntary shivering that a person can't stop); if hypothermia is severe and prolonged, the person may stop shivering due to exhaustion.
• Fatigue, lethargy
• Confusion or disorientation (unable to count backwards from 100)
• Irritability, aggression
• Lack of coordination (unable to walk a straight line)
• Decreased body temperature

Treating hypothermia:

• Move inside or to a warmer area protected from the wind.
• Cover with extra clothes, blankets, space blanket.
• Keep dry.
• Use hot water bottles, especially on the neck, armpits, and groin (be careful not to burn the skin-test water temperature first).
• Warm drinks such as tea can help a person feel warmer and reduce dehydration; avoid drinks with caffeine or alcohol.
• Ginger (fresh, dreid, or candied) can also help a person feel warmer.
• Do not exercise to warm up-instead, conserve energy.
• If hyperthermia is severe, seek medical help.

Aftercare for hypothermia:

• Avoid cold for the rest of the day; one episode makes it more likely that a person will have another.
• Drink fluids, especially warm beverages.
• Eat a nutritious meal or snack.
• Seek medical care if symptoms persist, worsen, or reappear.

Chillblains, frostnip, and frostbite symptoms:

• Red, tender skin (chillblains)
• Pain, itching, numbness, or "pins and needles" sensation
• Whitish or grayish skin (frostnip)
• Deep red or purple skin (frostbite)
• Tissue feels hard to the touch (frostbite)
• Blisters may appear

Treating chillblains, frostnip, and frostbite:

• Slowly warm the affected area.
• Immerse affected feet or hands in warm (not hot) water.
• Do not rub or massage (this can cause further tissue damage).
• Do not walk if feet are frostbitten.
• Do not thaw if you cannot be sure that refreezing won't occur.

Aftercare for chillblains, frostnip, and frostbite:

• Treat the area gently and with care as it heals.
• If blisters develop, try not to break them.
• If skin is broken, keep open areas covered with a clean, dry dressing.
• Get a tetanus booster shot if appropriate (more than 10 years since the last one).
• If signs of infection develop (redness, pus, worsening pain, fever or chills, swollen lymph nodes in armpit or groin), seek medical care.
• Seek medical care if symptoms persist, worsen, or reappear.

Dealing with Injuries

Bleeding

After ensuring that an injured person is breathing, the next important step is to stop bleeding. Loss of blood can lead to shock and eventually death.

To stop bleeding:

• Apply firm direct pressure to the injury. Use a sterile gauze pad, a clean cloth, clothing, or even your hand if necessary. If the person is able, he can put pressure on his own injury.
• If the first piece of gauze or cloth soaks through with blood, add more on top of it.
• Don't lift the gauze or cloth to check if bleeding has stopped. This can dislodge the blood clot and make bleeding start again.
• If pressure alone does not stop the bleeding, elevate the injured area above the level of the heart.
• If this still does not stop the bleeding, apply pressure to the pressure points on the underside of the upper arm or on the inner thigh near the groin. By squeezing the artery, you reduce blood flow.
• Do not use a tourniquet, since this can lead to the amputation of an arm or a leg.

Seek immediate medical care (call 911) if:

• Bleeding does not stop in about 15 minutes.
• A wound is spurting blood (this usually means an artery has been cut).

Head Injuries

Head injuries can be among the most serious of all injuries. They can cause brain damage and swelling inside the skull.

Signs of possible head injury:

• Loss of consciousness (passing out, fainting)
• Confusion or disorientation
• Drowsiness or unusual fatigue
• Severe headache
• Nausea, vomiting
• Different size pupils, pupils that do not respond equally to light, eyeballs that do not move together
• Blurred vision
• Speech problems
• Clear or bloody fluid coming from the ears or nose
• Personality or behavior changes
• Seizures
• Partial or complete paralysis
• Amnesia or memory lapses

The symptoms of a head injury can resemble many other things, so it's important to rule out other possible causes. If a person is confused or seems to be acting strangely, try to find out if they have other medical conditions (diabetes, dehydration, intoxication, psychiatric conditions). Ask her friends what she is usually like.

• Assess level of consciousness: does the person know her name, where she is, what day it is, what happened?
• Has the person been using alcohol or drugs? Does she take any medications?
• Was the person unconscious at any time after the injury? Losing and then regaining consciousness often indicates a mild concussion.
• Are symptoms getting progressively worse?
• Are there any obvious bumps, bleeding, tender areas, or deformities on the head?

Head, neck, and spine injuries often occur together. If a person has a head injury, follow precautions for neck and spine injuries. Remember, sometimes head injury symptoms do not appear right away, but may develop quickly and become life-threatening. Although a minor concussion is not that serious, more severe problems could develop. If you think a person has a head injury, call 911 or bring them to a hospital.

Aftercare for head injuries:

• For a minor head injury, be careful not to sustain a second head injury within a few days. Multiple concussions can be life-threatening.
• For a more serious head injury, hospital assessment is recommended.
• The injured person should not be left alone for at least 24 hours in case symptoms reappear or worsen.

Seek medical care if a person:

• Cannot be awakened or aroused
• Is confused, disoriented, or restless
• Has persistent headaches
• Has a stiff neck
• Is vomiting
• Has a fever
• Has difficulty breathing
• Is unable to move arms and legs equally well on both sides
• Has pupils of unequal size

Eye Injuries

Eye injuries can be serious, and are distressing since the person may not be able to see. If the eyes are exposed to tear gas or pepper spray, flush them out with water or liquid antacid mixed with water (see page 11). If a person has an object impaled in an eye, do not attempt to remove it. Stabilize the object (a Dixie cup over the eye works well), cover the eye, and get medical help. Many experts recommend covering both eyes, since the eyes move together and the goal is to prevent movement of the injured eye. Make sure someone stays with a person who cannot see.

Soft Tissue Injuries and Wounds

There are many different types of soft tissue injury:

• Lacerations (cuts)
• Abrasions (scrapes)
• Blisters
• Contusions (bruises, bleeding under the skin)
• Punctures
• Avulsions (part of the tissue is torn away or body part is severed)

Blisters are a type of soft tissue injury caused by repeated pressure or rubbing. Prevent foot blisters by wearing comfortable, well-broken-in shoes and socks and keeping your feet dry. Bandaids, tape, mole skin, or "second skin" products can help if a "hot spot" is developing. If a blister forms, try not to break it (to reduce the chance of infection). If the blister will be under continued pressure and you think it will burst, you can release the fluid by poking a small hole at the edge of the blister with a sterile needle and pressing gently to drain the fluid. Cover with a Bandaid.

Treating wounds:

• First, stop bleeding with direct pressure or by elevating the injured area.
• Clean the wound with water; remove all visible dirt. Use the cleanest water available. If there is only a little clean water, use dirtier water first and the cleanest water last. Sports-top bottles and plastic bags make good irrigation tools.
• For a major wound like an avulsion, stop the bleeding and get medical help immediately-don't worry about cleaning.
• More and more health-care providers do not recommend rubbing alcohol, hydrogen peroxide, or topical antibiotics such as Neosporin.
• Dress the wound with a dry sterile gauze pad or a clean cloth. Tape or bandage the dressing so it stays on.
• Do not remove an impaled object; stabilize it in place and seek medical care.
• Deep wounds (the white fat layer under the skin may be visible), avulsions, and cuts on certain parts of the body such as the hands, feet, or face may require stitches (sutures). Stitches should be done within about 8 hours. Sometimes Steri-Strips (tape closures) can be used instead.
• If a body part such as a finger is torn off, save the severed part. Wrap it in a clean dry gauze pad or cloth. Keep it cold, but do not put in direct contact with ice.

Seek further medical care for:

• Cuts on the hands, face, chest, abdomen, or back (unless very small and shallow)
• Injuries that can't be completely cleaned, or that may have a foreign object broken off inside
• Wounds that need stitches
• Avulsions or severed body parts
• Bites-especially cat and human bites
• Any injury that causes numbness, weakness, or impaired movement (may be signs of nerve damage)

Aftercare for wounds:

• Keep the wound clean; wash gently with soap and water daily.
• Change dressings daily.
• Get a tetanus shot if you haven't had one in 5-10 years.
• Herbal remedies such as arnica and calendula may help promote healing.
• Seek medical care if signs of infection develop.

Tetanus, or lockjaw, is a disease caused by bacteria that can contaminate wounds. It is most likely with deep puncture wounds, injuries from dirty knives or nails, and foot wounds that become contaminated with soil. Tetanus can cause convulsions and death, but can be prevented with a vaccine. For any open wound, get a tetanus shot if you haven't had one in more than 10 years. For more serious injuries, get a tetanus booster if you haven't had one in more than 5 years. A booster shot should be given within 48 hours after the injury.

Burns

Burns can be caused by heat or chemicals. Burns have different levels of severity:

• First degree - affects upper layers of skin only; redness, mild pain, possibly slight fever (includes most sunburns and pepper spray burns).
• Second degree - affects deeper layers of skin; red or mottled skin, blisters, very painful (includes severe sunburns).
• Third degree - affects all layers of skin plus underlying tissue; skin and tissue may appear charred; burned area may be red, yellow, white, or black; usually no blisters; may be little pain due to nerve damage.

Treating burns:

• Cool burns with a large amount of cold water. Run water over the burn for several minutes or immerse the burned area in cool water.
• Decontaminate chemical burns by flushing with water.
• Remove burnt clothing if it's not stuck on.
• Blot the burned area dry and cover open burns with a dry sterile (or as clean as possible) dressing.
• For minor burns, commercial burn creams or sprays containing lidocaine and herbal remedies such as lavender, aloe vera, or black tea may help relieve pain.
• Do not put burn cream, butter, herbal preparations, or anything else on a serious burn that requires further medical care.
• Keep the person warm.
• Be alert for dehydration, since a lot of fluid can be lost with a serious burn.

Seek further medical care for:

• First degree burns over 20% of the body (or less in the case of a child)
• Second-degree burns on the hands, feet, joints, genitals, or face
• Burns accompanied by fever, chills, nausea, or vomiting
• Burns that are not painful (may indicate nerve damage)

Aftercare for burns:

• Keep the burned area clean.
• Change dressings daily. Use a dry, sterile, non-stick dressing or a product made especially for burns.
• Try not to break blisters.
• Rest with burned area elevated above the heart to reduce swelling.
• Seek medical care if signs of infection develop

Sprains and Strains

Sprains and strains are types of blunt trauma injury. Although these injuries are usually closed (don't break the skin), they may be accompanied by internal injury and bleeding.

• Sprain - a stretched or torn ligament
• Strain - a stretched or torn muscle

Symptoms are similar, including mild to moderate pain and swelling. Bruising is often seen. The person may be able to walk or move the injured part, but doing so will usually hurt, sometimes severely.

Treating sprains and strains:

• RICE: rest, ice, compression, and elevation.
• Apply ice or cold packs during the first 24 hours. Wrap ice or packs in a towel; do not apply ice directly to the skin.
• Wrap a sprained joint with an elastic (Ace) bandage to provide compression and restrict movement. Make sure not to wrap it too tightly-check for circulation and sensation. Take off the bandage at night.
• Use a splint, sling, or crutches for a few days to allow the injured part to rest and heal.

Seek further medical care if:

• The injured part feels cold or numb or appears blue.
• Swelling increases.
• Pain becomes unbearable.
• There is no improvement after the first 48 hours.

Aftercare for sprains and strains:

• After 2-3 days, switch from cold to heat to promote healing.
• Rest with the injured part elevated to reduce swelling.
• Resume movement and exercise gradually.
• Mild pain relievers-such as ibuprofen (Advil) or acetaminophen (Tylenol)-can help reduce pain.
• Herbal remedies such as arnica and calendula may help promote healing.
• Seek medical care if signs of infection develop.

Fractures

A fracture is a broken bone. Usually fractures are very painful and the person generally cannot walk or move the injured part. A compound fracture is when a severed bone end pokes through the skin. A dislocation is when a joint gets popped out of its socket or becomes misaligned.

Treating fractures:

• Check fingers and toes for circulation and sensation.
• Immobilize the fracture with a splint. For a fracture of a straight bone, immobilize the joints above and below the broken bone. For a joint fracture, immobilize the straight bones above and below the injured joint.
• Many materials can be improvised to make splints: sign handles, wooden poles, folded cardboard, rolled newspapers. For tying splints use bandanas, duct tape, strips of cloth.
• Put a broken arm in a sling (use a triangular bandage, large bandana, kaffiyeh). Immobilize the entire arm by binding it to the chest or pinning the sling to the person's clothes.
• Immobilize a broken leg by tying it to the other leg.
• heck again for circulation and sensation to make sure the splint is not too tight.
• Seek medical care to properly set the broken bone.

Various signs can help you assess whether circulation is impaired or nerves are damaged. Check circulation and sensation before and after applying an elastic bandage or splint to make sure it's not too tight.

• Are his fingers and toes warm?
• Are his fingers and toes a normal color? Does the red color return within 2 seconds after a finger or toe is squeezed?
• Does he feel a numb or tingling sensation in his fingers or toes?
• Can he feel your touch?
• Can he wiggle his fingers and toes?
• Can he squeeze your hand or push against your hand with his foot?

Infection

Any wound or injury in which the skin is broken can lead to infection. This is most likely to happen within 48 hours. Be on the lookout for the following signs and seek medical care if infection seems to be developing:

• Redness, including red streaks radiating out from the injured area (if you are unsure whether the red area is getting larger, draw a circle around the current red zone and check whether it expands)
• Increased swelling
• Increased warmth around the injured area
• Increased pain
• Pus (a thick white or greenish fluid) accumulation or drainage; pus develops after about a day-before then, clear straw-colored serum fluid may be present, but this is not a sign of infection
• Foul odor
• Fever or chills
• Swelling of lymph nodes in the neck, armpits, or groin
• Failure to heal-or at least start healing-after 1-2 weeks

General Aftercare

After an intense action or time in jail, people often experience physical and emotional stress. Experiencing brutality-whether it happened to you or to someone else-can bring on critical incident stress or post-traumatic stress disorder. Symptoms of emotional distress may include:

• Flashbacks (vivid memories or feelings of "reliving" a traumatic incident)
• Intense dreams or nightmares
• Feelings of fear, grief, rage, shame, or guilt
• Irritability
• Difficulty concentrating
• Changes in normal sleep patterns (insomnia or excessive fatigue)
• Changes in appetite
• Changes in desire for sex
• Increased desire to use alcohol or drugs
• Difficulty dealing with normal responsibilities or getting back into regular routines.

The following steps can help you recover, but you may also need additional medical care or professional counseling.

Physical:

• Do some type of regular exercise.
• Drink plenty of water; adding lemon may help flush toxins out of the body.
• Eat nutritious food.
• Consider avoiding alcohol, tobacco, and recreational drugs, which can stress the liver.
• Get enough sleep, including naps during the day if needed.

Emotional:

• "Debrief" about what happened. Talk with others, especially those who have shared your experiences; many believe it's beneficial to do this before you first go to sleep after an action.
• Some people find it helpful to write, create art, or communicate and document their experiences in other ways.
• Don't hesitate to cry.
• Don't isolate yourself from friends, family, and allies.
• Remember that friends and comrades who attended an intense action may also be stressed and irritable and may lash out-try not to take it personally.
• Consider counseling if you experience ongoing emotional distress.

Practical:

• If possible, try to take some time off from work or school.
• If possible, get others to help with household and family responsibilities.
• Get help dealing with outstanding legal issues. Organizers for most large actions provide some type of legal support for protesters.

Medical:

• Document any injuries as soon as possible.
• Seek medical care if your physical symptoms persist, worsen, or reappear.

Herbs

Many different herbs can help detoxify, strengthen, and tonify the body. Herbs that detoxify the liver (for example, milk thistle, burdock root, dandelion) may be especially helpful after chemical weapons exposure. Rescue Remedy can often help reduce distress. Place a few drops directly on the tongue or mix with drinking water. Ask an herbalist for more recommendations.

Activist Systems of Care

Activists are working to develop systems of care, ranging from healing spaces at actions to supportive aftercare in local communities. For more information, see http://healingtrauma.protest.net or www.geocities.com/healingtrauma/index2.html.