By Sarah Mann, MD

Have you ever been getting ready for a day of impassioned protests and civil unrest and not known what to wear? No? Too busy conscientiously objecting? It may feel like you should give 100% of yourself to the cause. That’s true. But if you stop and take care of yourself, not only will you stay safe and healthy enough to participate for days of remonstration, you will be ready to help those around you.

We are at a crucial time in our history. We can affect changes in some of the fundamental flaws of racism that are rooted deep in our origins. In the past two weeks, we have seen more police fired or prosecuted than ever before. We have seen entire departments crumble. We have seen the birth of change. It is unfortunate that this critical time intersects with a global pandemic on a scale so big it has impacted the personal lives of everyone in the world. We now have to make the choice between social justice and personal safety. However, if you are compelled to stand-up in a group and fight for social justice, do your best to mitigate our other global problems. Take action to not be the source of a mini-outbreak. Do all you can to not harm yourself or others in the quest to make this world a better place.

Here are some considerations for those attending protests in support of dismantling White Supremacy and demanding an end to police brutality. A packing list and first aid guide will follow.

The Day Prior to the Protest

If you have at least one day of notice before the protest, use that time to plan. Even if you are not the planning type, this would be an occasion to make a little extra effort. It would be like checking a parachute before a jump.

In the 24 hours leading up to the event, do your best to maintain a positive mindset. Avoid negative headlines as much as possible. But between the global pandemic and the civil unrest, that may not feel authentic. At the very least, make an effort to take a few short breaks from those things and allow your brain some much-needed rest. Maybe even watch a comedy before bed. If you have a therapist, talk to them. Get your thoughts out on paper in a journal entry. Don’t have a journal? Write a letter to your future self. Hug someone you love and feel the power of human contact. The day of the protest will be emotionally and psychologically draining. It will be more manageable if you aren’t near tears before the day begins.

Pack your bag for the next day. If you aren’t sure what to bring, there is an easy checklist below. Learn everything you can about the event from the organizer webpage and mainstream and social media. If you are not familiar with the neighborhood you will be in, study street maps. Know where the alleys and escape routes are in case you need to be a quick exit.

Get a full night’s sleep. Do not stay up late making signs and writing protest dirges. This is the most important time to take care of yourself. If you aren’t motivated by the benefits that rest grants your emotional and psychological health,¹ then remember that it will quicken your reaction time to run faster when avoiding any potential hazards. ^2,3

The Morning Of the Protest

Do not use oil-based lotions, sunscreens, or perfumes. They can absorb things like pepper spray and hold it against your skin in higher concentrations for longer periods of time. Consider avoiding makeup altogether. If you can tolerate glasses, wear those instead of contacts. Contacts can trap irritants between the lens and the eye, increasing pain and risk for injury. Wear clothes that cover in your entire skin and shoes you can run or stand in for hours. It would be best to layer for different weather conditions. Layers also give the ability to remove articles of clothing if you become the victim of biological warfare. Clothes that can be folded into tiny packable squares are ideal.

Wear a comfortable face mask. In a crowd that large, someone is certain to have COVID-19. You will need a mask that is tolerable for an entire day. Consider bringing protective goggles in the event of tear gas or projectiles. If you take some type of medication, pack yourself 36 hours worth, whether or not you think you will need it. If you are unable to get home that night, you may have to wait for a pharmacy to open the next morning. If you rarely need an inhaler, bring it anyway in case there is pepper spray exposure. Accessorize by writing your name, emergency contact, allergies and significant medical problems in permanent marker on your arm (choose your favorite color), in case you are unable to speak for yourself.

If you meditate, make sure to do so that morning. Choose one that you find the most grounding. If you don’t meditate, there are various apps you can download and try.

Eat a good breakfast, whatever that means for you. You will need all the energy you can get. Bring a protein bar or a quick snack in case your lunch plans are spoiled. If possible, carry it in a pocket just in case you get separated from your belongings. Think about how you will get lunch. Make sure you know your options for sustenance.

During the Activities

The goal is a peaceful event where the masses express their constitutional rights and can co-exist in peace with the authoritarian body attempting to maintain order. While I hope for the best and give all participating groups the benefit of the doubt, I also prepare for the worst. Here is a field guide for basic first aid. If we are not going to take care of each other, then why bother going out there?

Minor common issues

Dehydration

You should be drinking 2.7-3.7L of water per day, including that which is obtained from food. During physically demanding events, you will lose additional water via sweat and increased breathing. So you could potentially lose more water at vocal protests versus silent protests or marches where you may be taking a knee.
By the time you feel thirst, you are already 1-2% dehydrated. At this stage, dehydration can impact mood, attention, memory, and motor coordination,⁴ and might even decrease the amount of fluid in the brain. ⁵ At the first sign of thirst, fatigue or dizziness, find shade. Use a fan if possible. Drink water, remove tight clothing, and splash the face with cold water.

Without intervention, ongoing dehydration will progress to heatstroke, which can be fatal. It is characterized by muscle cramps, vision changes, nausea, vomiting, confusion, agitation, and high fever. Get this person out of the heat, apply cool water or ice packs to the skin, get them to drink water, and call for immediate medical attention.

Sunburns

Wear sunscreen, even if it is overcast. Don’t forget to reapply every two hours. Check the ingredients, and again, avoid all oil-based products. Have a light long sleeve layer in case there is no way to get out of the sun.

If you or someone around you does get a sunburn, use cool compresses, aloe, and an over-the-counter pain reliever to help with pain. You will lose water faster, so take particular caution to stay hydrated. Avoid more sun and heat exposure, even if that means leaving the event a little early.

Scrapes or abrasions

Treat the situation as follows:

1. Wash hands. Use hand sanitizer if hand washing isn’t a possibility.
2. Rinse with a bottle of water
3. If someone is bleeding, apply light pressure with a sterile gauze
4. Apply petroleum jelly or an antibiotic ointment or herbal equivalent
5. If it is a bump or bruise, use an ice pack
6. Consider an over-the-counter anti-inflammatory or herbal remedy such as curcumin, ginger or cannabis to reduce swelling. If there is significant bruising, consider topical arnica as well.
7. In the following days rest, ice, compress, elevate (known as RICE therapy). Continue to take your Western or herbal anti-inflammatory therapy, as recommended on the label. It is most effective when you combine topical and oral treatment.
8. If not noticeably improved in three days, check in with a doctor.

Pepper spray or tear gas

When the Geneva Convention ^6,7 banned tear gas in international warfare in 1925, the United States did not deter its use by law enforcement for crowd control and dispersal. In other words, we take a chemical that we wouldn’t spray on our worst enemy. That chemical is given to people tasked with maintaining law and order and they use it over large crowds. In order to avoid confronting one or two aggressors, the police stand back and control crowds from a distance with collateral damage to victims, bystanders, children, the elderly.

Pepper spray or tear gas exposure can cause burning and stinging in the eyes and mouth, and lung and skin irritation that usually last 15-30 minutes.

What to do if someone has been exposed to these chemicals:

1. Get the person to a safe place. They will be in pain, disoriented and potentially blinded. This leaves them at substantial risk for secondary injury such as getting trampled, stumbling into traffic, or a simple fall. Talk to them in a calming voice.
2. Reassure them that the pain will be gone soon. Guide them to a safe location. Make sure you are far enough from the dispersal area that there isn’t ongoing injury.
3. You can avoid direct contact by instructing them to hold onto an object and using it to guide them. Your picketing sign might be an option. If it has a post, that’s even better.
4. Do not let the person rub their eyes, face or skin. If they do, it will spread the irritant.
5. Check their breathing. If they have an inhaler, help them take it. Most people who get sprayed will have mild distress, which should subside. If they struggle to breathe, their lips or fingertips turn blue, or they become confused or lethargic, call for immediate medical assistance.
6. Remove contacts, which will trap the irritant between the lens and the eye. Don’t worry about finding a contact case, they are trash now.
7. Gently pour water or saline solution directly into the eyes, aiming away from the nose.
   If possible, position the person on their back. If that isn’t a possibility, have them sit and look up, with the neck extended as much as possible so that the fluid runs from the eyes toward the ears.
8. Use a hydration pack filled with a homemade saline solution with the tubing placed over the nasal bridge and allow the solution to flow over both eyes.
   *If the water isn’t flowing, rip the entire valve off, elevate the bag above the tubing, and let gravity work.
   *In the case of a severe injury requiring several liters of fluid, you can refill your system with water bottles and pre-measured salt packets.
9. Do not allow the solution to touch the forehead, as doing so would wash more irritant into the eyes
10. Do NOT force the eyes open. Closing the eyelid is a strong reflex. Trying to pry them open will further contaminate the eye and might even cause an additional eye injury in the process.
11. Have the person blink repeatedly while you are washing the eyes.
12. It is OK if the 1st round of rinsing is done when their eyes are clenched. Getting the irritant off the eyelids will help them open their eyes.
13. Rinse their eyes for 3-5 seconds. Have them close their eyes. Pour the decontamination fluid over the entire head, while continuing to point the head and face up (as if looking at the clouds).
14. Return to flushing the eyes for 15 minutes or until the pain has resolved.
15. The solution running out of the eyes will be contaminated. Protect the person and yourself from it.
    *Ideally, you would place a double cloth or absorbent towel on each of the patient’s temples and a plastic sheet or garbage bag over the chest and shoulders. But since you are far from an ideal situation, look around and find your closest options to improvise this.
16. Remove contaminated clothing, being cautious nobody touches it. Package it in your thoughtfully packed garbage bags (see packing list below). When you get home, wash the clothing. Hold the outside of the garbage bag and flip it inside out so that the clothes go directly into the washing machine. Then, without ever moving your hands from their original position, flip the bag back, ball it up and throw it away.
17. Wash the face with soap and water.
18. Dilute some gentle dish soap and soak paper towels, moderately saturated. Seal in a ziplock bag. Make sure to squeeze out all the air before sealing so it doesn’t pop open in the bag.
19. If the pain is not tolerable in 45 minutes, seek medical care.

Handcuffs

Handcuffs or zip ties can cause pain, restricted circulation, and nerve compression if applied too tightly. The numbness and tingling may last for days after the restrictive devices are removed. If you encounter someone who has been handcuffed:

• Wash any cuts or scrapes with soap and water.
• Do some gentle massage and stretching of the wrists.
• Massage with a topical anti-inflammatory like St John’s Wort oil, cannabis cream, Tiger Balm, or diclofenac cream. Make sure to massage the entire forearm, which contains all the muscles involved in moving the wrist.
• Hydrate. Plenty of fluids will help the nerves and muscles heal faster.
• If the pain does not resolve in a few days or gets worse, seek medical attention. If you notice muscle weakness, such as difficulty with holding objects or opening lids, seek medical attention.

Panic attacks

Panic attacks will be very common. When you look at those around you, remind yourself that you do not know what they have been through, where they come from, or what brought them there. People of color who are present may have lost someone close to them to police violence, or themselves been a victim. Some of the white people present may be realizing their privilege for the first time. Or they may have never been in physical danger before.

If someone at the protest is experiencing a panic attack:
Speak to them calmly. Keep reassuring them. Try and get them to look you in the eye. Without making physical contact, which may be a trigger, ask them to follow you to a safe area. If you feel physical contact is needed, be sure to ask first. “Is it OK if I touch your arm and help guide you out of here?”

Less Common but more serious situations

Rubber bullets, bean bag rounds, and blunt force trauma

The US military uses these weapons on our global nemeses in addition to its use by law enforcement on gathering crowds in the United States. They refer to them as non-lethal weapons, even though they have the capacity to kill, injure, or disable people. More accurately, they just kill less. In a 2017 meta-analysis looking at a total 1,984 people struck by rubber bullets, plastic bullets, and beanbag rounds, only 53 (3%) of people were killed. Not counting the 300 others who were permanently disabled, that means 82% fully recovered without any (physical) lasting effects of the trauma. ⁸ That compares with 25-50% mortality when the police shoot with actual bullets, depending on the city.⁹ Think about if a medication killed 3% and disabled 15%. I strongly doubt that would be accepted for the ability to use on the general public.

Being struck with a blunt projectile can cause a wide range of injuries depending on the area of impact. These guidelines would be true for all blunt force trauma, such as being hit with a baton or falling on the ground. Depending on the site of where the person was hit, different actions should be taken.

Arms & legs: It is rare for blunt force injury to an extremity to be immediately fatal.

• Make sure the scene is safe for both you and the person affected not, move them to a secondary area.
• Examine the area bruising, swelling, or deformities.
• If you do not see anything that would prompt immediate medical attention, follow the directions for “scrapes and abrasions” above.

Chest/Thorax: With lower velocity impacts, the ribs are adequate to protect the heart and lungs. With higher velocity impacts, there can be a collapse of the lungs, or bleeding within the chest cavity. If a person suffers multiple rib fractures on both sides, they are at risk for flail chest, a condition in which the chest wall moves in the opposite direction then it is supposed to, making breathing very difficult. These are all potentially fatal situations requiring emergency intervention.

• Assess the person’s breathing. They might be a little short of breath, but should not be struggling to breath or gasping for air. If they are, call for help immediately. Remember, help may be delayed in situations like this.
• If the breathing starts out OK, but then gets slowly worse, it might mean that the lung is collapsing or the chest is filling with blood. Emergency medical personnel should be called immediately.
• Remember: a person is at just as much risk being struck in the back as the chest.

Abdomen/Pelvis: The biggest concern with a blunt force trauma to the abdomen is bleeding. You can lose several liters of blood into the abdomen without seeing it, which makes it very dangerous. There is also a risk of organ rupture, particularly to the spleen, liver, kidney, and testes. In these cases, blood loss is still the most immediately dangerous blood loss.

• Even if the person feels OK, they need to be watched for the next few hours.
• If they become pale, dizzy or short of breath they need immediate medical evaluation.

Head: Any blunt force trauma to the head should be evaluated because the person does not always know they are injured. The following indicates bleeding in the brain and should prompt immediate medical evaluation.

• Disorientation – does not know their name, location, or the date
• Loss of consciousness (LOC)
• Slurred speech, difficulty finding the right words, misnaming objects
• Blow to the temple with LOC – although you would call for anyone with LOC, if they were hit in the temple first you might only have minutes to get help.
• Period of normalcy before becoming progressively confused or lethargic.
• Asymmetric weakness (i.e. only left arm is weak, or left arm and left leg)

Face: While facial injuries can be very painful, very bloody, and horrifying to look at, they are rarely fatal. The most dangerous type of facial injury is one that somehow compromises the airway, making it difficult to breath. For example, a severe nosebleed. This should prompt an immediate call for help. Otherwise, a less urgent medical evaluation should take place for any changes in vision, numbness, tingling, or weakness.

Bleeding

If someone is experiencing bleeding, you can address it by following the guidelines below.

1. Hold pressure for five minutes without lifting the gauze to check. Time it. It will feel a lot longer.
2. Gently lift the corner to see if there is still bleeding. If not, hold pressure for five more minutes. If there is still bleeding, quickly restore pressure. Hold the gauze for 10 more minutes without checking. Definitely set a timer for this one.
3. Gently lift the corner and check again. If no bleeding, hold the pressure for five more minutes. If the bleeding continues, quickly restore pressure and have someone call for medical assistance.
4. Do not apply a tourniquet. You can cause damage. If the bleeding is severe enough that you think you need one, call for help.

Penetrating injuries

This one is easy. Don’t remove the object and call for help. It is OK to put bandages around the foreign object to stabilize it, so it doesn’t pull itself out. As soon as it is removed, you have uncontrolled bleeding to deal with, which is worse.

COVID-19 Concerns

When you touch someone, you not only expose yourself to their viral shedding, but also everyone else they were in contact with that day. Be mindful. Keep your distance. Wash your hands frequently. Help others when the situation calls for it. But before placing yourself in harm’s way, ask yourself two questions:

1. Does the situation really call for it?
2. Will disregarding precautions actually help this person, or rather make you feel like you are helping?

If you are assisting someone who is sick enough to require medical attention, don’t hesitate to call EMS or seek out local medical personnel. Keep in mind that crowds and high call volumes may delay the response. That means if you wait until you absolutely have to call, as people tend to do, it might be too late. While you are waiting for medical personnel, ask the person to record their allergies, medical problems, and medications. If the person worsens before help arrives, being able to provide it for emergency personnel could make the difference between life and death. This would be of particular concern with any type of head injury, breathing concern, chest pain, bleeding, or if the patient appears even a little confused.

Evidence shows that racial discrimination causes faster aging down to a cellular level, partially accounting for an increase in diseases like coronary artery disease. ⁹ Now, instead of an isolated racist event, people are watching a barrage of extreme racism on loop. When out protesting for equal rights, the dismantling of our racist system, and the end to police brutality, be sure to take care of yourself. Hopefully, these guidelines will ensure you can be at your best to take on whatever situations arise between protestors and the police.

Dr. Sarah Mann is a physician board-certified in Internal Medicine, Critical Care Medicine and Neurocritical Care; she will be eligible for board certification in Integrative Care Medicine in 2021. She divides her critical care time between the ICU and the Mindful Medicine Clinic, which she founded. She is heavily involved in cannabis education, including curriculum development and teaching, with several higher-level educational institutions.
 
 
 
 

Additional Reading:

44 Black Mental Health Support Resources for Anyone Who Needs Them

More by Dr. Sarah Mann

• The Gaping Hole in Medical Education on Cannabis
• Choosing Route of Consumption
• Sex, Intimacy, and Cannabis
• Changing My Specialty