This is a brief, 30-minute primer on considerations for the response to protests and civil disturbances

1. With Steve and Dave
S1- Ep 10“Protest

2. Administrative
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• Example:
• Medic 18, Joe Snuffy (611), Beetle Baily (644) and Olive Oil (613)
This Photo by Unknown Author is licensed under CC BY-NC

3. Key Point:
• The purpose of this lecture is to orientate
EMS and other first responders to the
unique considerations of providing care
during protests and civil disturbance, not to
either support nor oppose any specific
political position or action.
• In other words, this information is
educational not political, with the intend of
helping us be more effective in our roles as
professional EMS responders.

4. Resources
• NHSTA: Fire and Emergency Medical Services Response to Civil Unrest
• EMS1: Scene safety and responding to civil unrest
• NFPA : 2015 NFPA responders forum Civil Unrest Paper
• IAFC: Best Practices for EMS and Fire Response to Incidents During Civil Unrest
• Idaho Office of Emergency management: RISK ASSESSMENT: CIVIL DISTURBANCE
• Paper Revolution: The Street Medic Guide
• Medic Wiki: https://medic.wikia.org/
Officers from the Boise Police Department and Idaho State Troopers watch a crowd of people protesting at the Idaho Statehouse, on Sunday, May 31, in Boise
Idaho. Darin Oswald/Idaho Statesman/AP

5. Objectives
• Discuss the unique considerations with EMS response in a protest or other civil disturbance
• Describe best practices for response
• Discuss some treatments for common injuries
• Describe the presence of “Protest Medics” and their implication on EMS response.

6. General Best
Practices

7. Comment on Best
Practices
• These “best practices” are
pulled from the NHSTA,
NFPA, and IAFC documents.
• They do not replace
departmental or incident
plans, policies, or specific
command instructions.

8. Important: Agitators are becoming more
organized, more equipped and more violent
• “Emotional contagion”
• Protestors vs. Agitators
• Improved Communication and coordination
• Use of Scouts
• Use of Social Media
2020 Photo credit: Chicago Police Department:

9. Remember, you
are always being
filmed
• Not just with Cell Phones, Professional
Photographers are now present at may protests.
• Longer range with higher fidelity
• Drones
• Just because you cant see them, does not mean
they cannot see you.

10. Best
Practices:
Preparation
• Consider wearing civilian clothes when
reporting to and returning from duty for
these events.
• Come to work prepared for extended
operations from your vehicle
• Establish a family communication plan to
share information with responder families
• Training: There is much overlap with NFPA
3000 trainings (Active Shooter Events) but
these are not the same events.
• Active Shooter Events are usually “over” in
minutes
• Civil unrest can last multiple operational periods

11. Best Practices: Operations
• ICS Counts
• Unified Command?
• Establish ICS early
• Communicate through your ICS
• (Chief and company officers) Personnel accountability is
essential
• Radios for every responder
• Fresh Batteries at beginning of each op period or event
• Physically carried on person at all times
• Flashlights for every responder
• Develop uniform code words for secure
communications of emergency actions (building or area
evacuation, apparatus/station abandonment, etc.)
• Back Up Communications
• No “V-Mute” for active operations

12. Never go anywhere alone
Best Practice: Buddy System
Photo Credit: Phillip Hettinger – Louisville EMS

13. Remember: Protests are mobile, Fluid in location, and
unpredictable
Protesters gathered at the Colorado Capitol for the Justice for George Floyd,
Breonna Taylor and Sean Reed & Others rally.
Evan Semon Photography

14. Best Practices: Vehicles
• Park / Stage for rapid egress
• Lock Exterior Compartments
• Cover Hose Beds with Tarps
• Tape Windows to limit flying glass
• Keep full / water tanks full for extended operations
• Consider extra SCBA tanks

15. Be prepared to leave
your vehicle
• Keep personnel IDs, keys, wallet,
etc., on your person
• Plan your communications if you
have to abandon your post/vehicle
• Develop rally points should
apparatus or stations need to be
abandoned and pass on to
members.
• These may change due to situational
changes.

16. Best Practices: Wear Protection

17. Some things to consider:
• Hostility to LE presence
• Hostility to EMS
• Bystander Agitators
• “Protest Medics”
• Casualty Collection Areas
• Do you have plans for response, rehab and return to
duty for:
• Response to Injured LE
• Response to Injured EMS/FIRE
• Response to Protestors
• Response to Bystanders/third parties (i.e. Reporters,
etc)

18. Treatment of Common
Injuries
Activist Kathy Wray Coleman, of Cleveland, who was handcuffed by police during a protest at the Republican National
Convention, is transported to an ambulance after she complained of chest pains on Monday, July 18, 2016, in Cleveland.
Coleman is a leader of the Imperial Women's Coalition. Photo by Antonella Crescimbeni

19. General Injury Considerations
• Abrasions and Lacerations 58%
• Contusions and blunt force trauma: 36%
• OC agents, Respiratory Distress, Other Ailments: 6%
• Deposition:
• 97% Discharged. Treated , or released
• 3% admitted
• New phenomena:
• GSW – No data yet
• Thrown Objects- No Data Yet
• Pyrotechnics used by protesters – No Data Yet
• High Intensity Lasers used to blind – No data yet

20. Eye Injuries
• Debris
• Dust
• Blunt trauma
• Irrigation with Saline
• Sooner is better than later
• Have patient remove contacts prior to irrigation if
possible (very important)
• Tetracaine may be an option for severe cases
of abrasion without direct trauma/open
injury to eye

21. OC spray to the eyes
• OC/CS agents
• Use of High-Pressure sprays of any type at ranges
less than 3 feet may cause severe damage
• High Pressure Sprays at less than 3 feet may cause
corneal Abrasions or lens separation
• Corneal Damage may occur with isopropyl Alcohol
Compositions
• Irrigation with Saline
• Sooner is better than later
• LOW PRESSURE
• Have patient remove contacts prior to irrigation if
possible (very important)
• Time Cures All Ills

22. Using a Nasal
Cannula

23. Blunt trauma to Eyes
• Bilateral Periorbital ecchymoses
• Racoon Eyes
• Chemosis – Swelling of the conjunctiva
around lens
• Edema of Eye Lid
• Subconjunctival hemorrhages
• Epistaxis with eye injury
• Facial Asymmetry/Instability
• Facial Deformity with blowing nose, etc
• Vision Disturbances
• Check EOMs
• This checks for orbital fractures, etc
• Suspected eye injures should be
evaluated by a physician

24. Check the
Extra Occular
Movements

25. Chemosis and Hyphema

26. Tetracaine
• Do not use for OPEN Eye
Injuries or signs of increased
pressure
• Dose is 1-3 drops in affected
eye
• Contraindication:
• Previous allergy , or allergy to
similar anesthetics (i.e. Lidocaine)
• Open Eye Injury

27. Key Point:
Direct trauma to
the eye, visible
injures, visual
disturbances, and
“gritty”
/abnormal
sensations to eye
should be
evaluated by a
physician.
When in doubt,
send them out.

28. What are "Protest
Medics”

29. Protest medics?
• “Protest Medics” AKA “Action Medics” “Riot Medics”
or “Street Medics”
• Marked generally with a “Red Cross” or “Green
Cross”
• No uniformity in identification or color of clothes
• No uniform typically.
• No formal Certification as “Protest Medics”
• May be “First Aid”, May be Physicians too, or Nurses.
• In state, or out of state
• Currently Licensed, or not licensed at all
• Most care provided is typically at the Lay Person
level/First Aid/Stop the Bleed level of care

30. Protest Medic
Philosophy
• “The job of a street medic is not to perform
battlefield surgery, but to provide what care they
can within the context of a chaotic situation, or (in
the case of major injuries) to attempt to comfort,
protect, and/or stabilize an injured party until
they can be moved into professional care. To
waste valuable time trying to “fix” an injury that
needs an ambulance does no more good than no
care at all, which makes it extremely important to
recognize when an injury is beyond your abilities.”
• THE PAPER REVOLUTION COLLECTIVE STREET MEDIC GUIDE. (2018). THE
PAPER REVOLUTION COLLECTIVE. http://www.paperrevolution.org/wp-
content/uploads/2018/03/Street-Medic-Guide-Paper-Revolution-v6.pdf

31. A table is filled with supplies for injured protesters at an apartment complex that became the central command for Denver's
street medics on June 1. LJ Dawson for KHN
https://www.npr.org/sections/health-shots/2020/06/10/873375919/street-medics-fight-covid-19-and-tend-to-protesters-wounds

32. Examples of Treatment
Acute Treatment
• Minor First Aid
• Simple Splinting
• Carrying Patients
• Bleeding Control
• TQs
• Hemostatic Agent
• Dressings
• Irrigation of Eyes with Saline/Contact
Solution for Debris
• CS/OC treatment
• Irrigation + LAW Solution for eyes
• Water + Law Rinse for oral exposure
• Topical Solution for Skin
Preventative Care
• Sunscreen
• Hydration
• Rehydration Solutions
• Pre-Protest “training”
• Establishment of CCP

33. Protest Medics may
be there for the
patient but may not
feel compelled to
help EMS.

34. LAW Solution
• Liquid Antacid and Water
• 50/50 mixture of water and an antacid
containing either Magnesium Hydroxide
or Aluminum Hydroxide.
• Products like milk of magnesia and
pepto bismol are NOT recommended
because of MINT content
• Falling out of favor
• Milk and Dairy liquids used as an
alternative
• Different “Protocols” to include Saline
/Water irrigation first followed by a few
drops of LAW
L.A.W. (liquid antacid and water). (2018). Medic Wiki.
https://medic.wikia.org/wiki/L.A.W._(liquid_antacid_and_wate
r)

35. Rehydration Solution
• 50/50 Mixture of Water and Sports Drink
• “Red Dye” supposed to be avoided
A Homemade Cure for Dehydration | PreppingToSurvive.com.
(n.d.). Retrieved July 27, 2020, from
https://preppingtosurvive.com/2012/07/03/a-homemade-
cure-for-dehydration/

36. Street Tip:
kindness goes a
long ways to
cooperation

37. Whats the
point of all
this?

38. References
• A Homemade Cure for Dehydration | PreppingToSurvive.com. (n.d.). Retrieved July 27, 2020, from https://preppingtosurvive.com/2012/07/03/a-homemade-cure-for-dehydration/
• Best Practices for EMS and Fire Response to Incidents During Civil Unrest. (n.d.). Retrieved July 27, 2020, from https://www.iafc.org/topics-and-tools/resources/resource/best-practices-for-ems-and-fire-
response-to-incidents-during-civil-unrest
• By-Sa, C., & By-Sa, C. (n.d.-a). The contents of this book are public domain under a Creative Commons Zero 1.0 Universal license. However, individual images may have other copyrights, so check carefully
before reusing any of them. 466.
• By-Sa, C., & By-Sa, C. (n.d.-b). The contents of this book are public domain under a Creative Commons Zero 1.0 Universal license. However, individual images may have other copyrights, so check carefully
before reusing any of them. 466.
• CNN, R. P. (n.d.). Street medics brave danger to treat wounded protesters. CNN. Retrieved July 27, 2020, from https://www.cnn.com/2020/06/05/health/street-medic-protests-wellness/index.html
• George Floyd Rally Turns Chaotic in Downtown Denver | Westword. (n.d.). Retrieved July 27, 2020, from https://www.westword.com/news/george-floyd-rally-turns-chaotic-in-downtown-denver-11718095
• June 3 George Floyd protest news. (n.d.). Retrieved July 27, 2020, from https://www.cnn.com/us/live-news/george-floyd-protests-06-03-20/h_ee515964f1c7dac5a470d3519d4abd3d
• L.A.W. (liquid antacid and water). (2018). Medic Wiki. https://medic.wikia.org/wiki/L.A.W._(liquid_antacid_and_water)
• McGeehan, C. (2011). Dubious medics [Photo]. https://www.flickr.com/photos/cjeam/6338452135/
• Responding to Student Demonstrations and Protests in Schools and School Districts. (n.d.). FACT SHEET, 8.
• Situational awareness: EMS response to civil unrest. (n.d.). Retrieved July 27, 2020, from https://www.ems1.com/scene-safety/articles/scene-safety-and-responding-to-civil-unrest-LBvjj6IQVJqr87fP/
• sterry@starbeacon.com, S. T. (n.d.). Protesters from every perspective fill Cleveland, remain mostly civil as RNC opens. The Tribune-Democrat. Retrieved July 27, 2020, from
https://www.tribdem.com/news/protesters-from-every-perspective-fill-cleveland-remain-mostly-civil-as-rnc-opens/article_3c5227d7-cf52-5f88-8fd8-a098f079ddc5.html
• “Street Medics” Fight COVID-19 And Tend To Protesters’ Wounds. (n.d.-a). NPR.Org. Retrieved July 27, 2020, from https://www.npr.org/sections/health-shots/2020/06/10/873375919/street-medics-fight-
covid-19-and-tend-to-protesters-wounds
• “Street Medics” Fight COVID-19 And Tend To Protesters’ Wounds. (n.d.-b). NPR.Org. Retrieved July 27, 2020, from https://www.npr.org/sections/health-shots/2020/06/10/873375919/street-medics-fight-
covid-19-and-tend-to-protesters-wounds
• The apps of the riots. (2020, June 12). Impactscool Magazine. https://magazine.impactscool.com/en/future-society/le-app-della-rivolta/
• THE PAPER REVOLUTION COLLECTIVE STREET MEDIC GUIDE. (2018). THE PAPER REVOLUTION COLLECTIVE. http://www.paperrevolution.org/wp-content/uploads/2018/03/Street-Medic-Guide-Paper-
Revolution-v6.pdf
• Varner, D. (2020, June 11). NHTSA OEMS & USFA Best Practices – EMS & Fire Response to Civil Unrest. Central Shenandoah EMS Council. https://www.csems.org/nhtsa-oems-usfa-best-practices-ems-fire-
response-to-civil-unrest/