Street medics are not a new concept. Originally seen during the African-American Civil Rights Movement and the protests against the Vietnam War, street medics are volunteer activists who attend political actions equipped with the knowledge and inventory necessary to give medical aid to protesters and civilians in need. As social movements gain momentum and attract attention, they become increasingly likely to come up against those who would maintain the status quo, rather than allow meaningful change —in short, the State. Metropolitan police represent the most immediate physical threat to those who attempt to change the system, even via peaceful means. A demand as simple as “please stop shooting unarmed citizens on public transit platforms” can and will be met with violent resistance from the state and its police force.
Into this volatile situation, where there exists a real threat of violence perpetrated against protest movements, come street medics. This guide hopes to serve as both a basic primer for those hoping to take a medical role in situations of civil unrest, as well as a set of guidelines for anyone wishing to identify as an Anon Medic.
The amount of training one seeks out before becoming a street medic varies, depending on the duties one intends to perform during political action. Don’t mislead other activists about your level of medical training or competency—be upfront with them about your supplies and abilities. It is better that they call for outside medical assistance immediately, rather than wait to find you, only to hear that you cannot treat them. That said, one need not do more than carry water for other protesters, or bandages, or sunscreen, to make a difference. Even this minor effort can mean the difference between activists staying in the street, or having to go home for water, food, or medical treatment.
When a potential medic decides to start offering protest support, they should consider taking a professional first aid/CPR course. Learning proper treatment techniques for cuts, bruises, and other injuries is important, as inexperienced attempts at administering aid can potentially worsen an injury and leave the wounded worse off than they would have been without your intervention. This is another reason it’s extremely important to be honest with yourself and your fellow protesters about your level of medical ability.
Further study can include training as an Emergency Medical Technician, Wilderness First Responder, or Paramedic. These require increasing levels of time and financial investment, so use your own judgment about how much time and money you can expend. Potential medics employed by institutions that may take issue with their involvement in political action (such as ambulance crews, government organizations, and so on) would do well to disguise themselves as fully as possible before being seen and photographed taking part in any activism.
Street medicine is an inherently defensive action, as it is a direct response to offensive violence by the police. Medics should equip themselves accordingly. Inventory should be dictated by potential opposition, which can vary widely when confronting a heavily-armed, paranoid police force. Equipping oneself on the side of caution is advisable, as one well-protected medic can do far more good than three medics who fell to tear gas. Below is a guideline inventory list for a well-equipped medic. Add or remove from this list as personal weight limit, resources, expected challenges, and range of motion dictates.
Clothing that covers as much skin as possible, without being overly hot or restrictive. Remember: you may have to run. SF Anon Medics wear black clothing with red medical crosses, to make themselves easy to find in crowds. Nylon will dissipate heat and sweat easily, as well as protect the skin (to some degree) against chemical agents. DO NOT WEAR CONTACT LENSES. Tear gas or pepper spray can become trapped between the contact lenses, and your eyes. Cargo pants or BDUs with accessible pockets can come in handy, as can hip bags, utility belts or tackle vests.
Gas mask, tested to be sure of a good seal. Something recently-manufactured with a 40mm threading will be the most reliable and compatible with easily-found filters. Israeli civilian gas masks are inexpensive and easy to find. Check websites like Sportsmansguide.com for military surplus supplies.
Unbroken NBC (Nuclear, Biological, Chemical) gas mask filter.
Protective shoes that will still allow quick movement. No open toed, strappy, or high-heeled shoes. You may need to run, and your toes will be stepped on in crowds.
Ace (or equivalent) bandages for strains and splinting.
Wound closure strips
Tape (paper or plastic, not electrical)
Sterile examination gloves (vinyl or nitrile, to avoid latex allergies)
Stick-on bandages (various size and type)
Isopropyl alcohol (strongest concentration you can find)
Antihemorrhagic agent (Most of these are only available to military or law enforcement, but QuikClot has a "sport" version that will do the trick)
Sunblock with UVA and UVB protection (water or alcohol-based, as oil-based sunblock can trap teargas or pepper spray against your skin and compound their effects)
Bandage shears (blunt tip is important, as a sharp tip can be deliberately misinterpreted as a weapon by the police, and used to charge you with crimes)
Clean bandanas, and/or bandanas soaked in apple cider vinegar, for handing out to other protesters as tear gas masking. These should be carried in ziplock bags until needed, to avoid evaporation.
Instant ice packs
Messenger bag or MOLLE pouches that can be easily accessed without the medic having to stop and take them off. Backpacks can be difficult to access while you’re walking, running, or otherwise trying to keep up with your fellow activists, who may be marching, or running from danger.
Glucose tablets, honey packets, cake icing, or other emergency sugar supply, to treat diabetes-related hypoglycemia.
Apple cider vinegar (for tear gas, see below)
LAW mixture (see below)
Rehydration mixture (see below)
Ear plugs for yourself and others in case of sound-based police weapons.
Lemons ( "At the absolute least, bring a scarf to cover your mouth and nose in the case of tear gas, and ideally, a cut lemon to suck on and wipe your eyes with if you get gassed. Lemons work against CS gas, which is what the police use against protesters in Chile. Lemons provide some relief from the burning. A gas mask for fine particles is also useful, and works much better than a scarf, which will give you only a few clean breaths. Practice putting the mask on in a jiffy for when you see or hear that gas has been detonated." - http://matadornetwork.com/abroad/how-to-prepare-for-a-protest/)
Leave your contacts at home. You expose yourself to more risk with contact lenses. Wear tight-fitting shop glasses or goggles. Like the gas mask, practice putting these on quickly. In my case, I have to put on the gas mask before the goggles to get the right fit. You should practice this at home as well.
What is LAW mixture?
Liquid Antacid and Water. A 50/50 mixture of water and an antacid containing either Magnesium Hydroxide or Aluminum Hydroxide. Used on eyes and skin in the event of a tear gas or pepper spray attack. A small amount applied directly to the affected area should be sufficient to reduce pain once the afflicted person has been moved to a safe location. Application of LAW mixture (especially under the eyelids) can be difficult, and it is advisable for a medic to attend training sessions by established street medic groups. If LAW mixture is not available, milk can be used as a stopgap in the event of a tear gas or pepper spray attack.
What is Rehydration Mixture?
Hydration in a high-energy environment is extremely important, and often overlooked. A medic's most important job will often be to make sure participants in civil action do not wear themselves out early. Side effects of heat exhaustion can include euphoria, rage, “wooziness”, irritability, panting, red flushing of the skin, and “spaciness”. These symptoms can also lead to poor decision making, violence, and an inability to judge danger or to retreat from dangerous areas. Untreated heat exhaustion can turn into the more serious condition of heat stroke. A 50/50 mixture of water and a sport drink (or fruit juice) will be sufficient. A small pinch of salt should be added to the mixture, to replace sodium lost through sweat. Fill and label several small bottles with this mixture to pass out to those in need. If using sport drink for your mixture, avoid sport drinks with Red 5 food dye, as there is research to suggest that it can trigger manic episodes in people with certain conditions such as ADHD or Bipolar Disorder. The number of bottles carried should vary, depending on the medic’s weight limit. See more on the treatment of heat exhaustion below.
3. How to Treat Various Common Protest Injuries
Please note that this section, for the most part, does not cover injuries and treatment methods typically covered in most first aid courses. This section is specifically for injuries and ailments more specifically sustained during protest action.
The most important thing to note about tear gas is that it is a tool to create fear, more than a weapon to cause damage. The loud sound of exploding canisters and the sight of a rolling cloud of gas serves to cause panic before the chemical effects even have a chance to take hold, and it is on this panic that the police rely. The most important thing to do in the event of a tear gas attack is to keep a level head. As a medic, it will be your duty to get others away from the gas, then treat them to the best of your abilities. Though banned from military use by the Chemical Weapons Convention, tear gas is legal for domestic use despite a long list of documented harmful or deadly effects.
Tear gas is often propelled by special fitted charges which, when detonated, can sound extremely similar to gunfire. Don’t panic. Look up to try to spot the arc of white smoke, and attempt to warn any protesters within the anticipated blast radius. Tear gas canisters, once detonated, become extremely hot and are not safe to handle without protective gloves. This is one reason that it is important to bring or wear protective gloves to protests. Police officers using tear gas will be outfitted to protect against its effects, so throwing or kicking an active canister back into police lines should not be considered a violent or harmful action, merely a defensive one. Spotting police in these outfits can also serve as advance warning of an impending tear gas attack, allowing you to warn your fellow protesters before the canisters have actually been fired.
The initial effects of tear gas, which if left untreated will persist for up to half an hour after exposure, usually include pain in the eyes, nose, mouth and skin, profuse watering of the eyes and nose, blindness, difficulty breathing, disorientation, and panic. Again, tear gas is not intended as a weapon so much as an agent to disperse protesters and create fear among them, making it possible for an affected party to remain within the cloud so long as they maintain a clear head. Once removed from the area of the gas, the symptoms will subside on their own within approximately thirty minutes, but it is still important to act quickly to ensure the well-being of the afflicted party, if you wish them to be able to continue normally.
Though it is called a gas, tear gas is actually an aerosolized acidic powder. Designed to cause fear and pain, its acidic nature makes it relatively easy to counter with the use of a mild alkaline solution, and the powder form is easy to wash off. The easiest method in this circumstance is to use the LAW mixture, noted above. After removing the affected party to a safe location outside the field of effect, a squirt of liquid on the skin and in the eyes should serve to both neutralize the acid and wash the dust itself away completely. A mouthful of solution, swirled and spat, will serve to quickly clear the mouth. Care should be taken not to swallow, as tear gas introduced into the digestive system could have potentially harmful effects. To clear the nose, strong exhalation should be enough. The LAW mixture is not a cure-all, and will not instantaneously remove harmful effects. Remember: Tear gas is a compound specifically designed for this purpose, and countering it will always be a challenge.
To further compound matters, once a person has been coated with tear gas their clothing is contaminated until it can be washed. It will continue to be harmful to wear or handle, and should be removed and quarantined as quickly as possible to avoid causing more damage. A mild castile soap (like Dr. Bronner’s), which contains fewer chemicals to potentially interact with the acid, will be enough to clean the contaminated clothing and make it suitable for future use. Instruct all affected parties to avoid touching their face or eyes until they have had a meticulous shower.
The effects of tear gas can be avoided to some extent by covering the mouth with a bandana soaked in vinegar. Apple cider vinegar will be the easiest to breathe, and several such bandanas can be prepared in advance and kept in a plastic bag to be handed out to those nearby. This method is useful only for purposes of escape, and a medic should not attempt to enter a tear gas cloud without wearing a fitted and filtered military-grade gas mask.
2. Pepper Spray
Pepper spray, like tear gas, is a lachrymatory agent—a compound designed, usually for riot control or self defense, to cause extreme pain, blindness, and disorientation. Pepper spray is often deployed at protests in areas where the police cannot risk the use of tear gas, such as heavily populated areas. It is usually contained in handheld canisters, though a mode of deployment known as the “pepperball” has become increasingly common in recent years. The pepperball consists of a load of capsaicin (the active ingredient in pepper spray) combined with a powder dye, packed into a small hard ball which is fired from a device not unlike a paintball gun. The ball breaks and explodes on contact, causing both the immediate pain of being shot with a projectile with the debilitating effects of pepper spray. This allows the police to use pepper spray from much longer distances, as well as mark individuals (via the powder dye) for later arrest.
Though not as common, another documented method for deploying pepper spray is a thick pepper foam, deployed from a device like a fire extinguisher. It is currently unknown how widespread these devices are. Further deployment methods include backpack dispensers, explosive aerosol canisters, and helicopter drops.
Treatment methods for pepper spray exposure are largely the same as those for tear gas, and the LAW mixture will serve you approximately as well as anything else. However, because of its concentration and the way it directly attacks nerve endings, pepper spray can continue to have an effect for up to two hours after initial exposure, even with treatment.
3. Environmental Illness
Environmental factors are always a serious consideration when one intends to undergo hours of strenuous outdoor activity. Hypothermia, frostbite, exhaustion, and heat stroke are all possibilities depending on the weather, and a medic should take care to amend their equipment accordingly. Keeping an eye on one’s fellow protesters for signs of illness should usually be enough, and gentle suggestions to take some water, or to temporarily remove themselves to more agreeable climates, will usually be appreciated.
3a. Signs of Heat Illness
Heat illness (a general term encompassing a variety of heat-related ailments) is an extremely common problem in civil action, due to the long periods of exertion protesters put themselves through with little to no hydration. Body fluids are lost through sweat and respiration, and if they are not replaced, the core body temperature can rise dangerously. Frequent rest and rehydration are usually enough to prevent symptoms, but be on the lookout in the event that they are not:
Rapid breathing or “panting”
Muscle cramping or spasms
Skin irritation, “flushing”, or rash
Heat illness is not difficult to prevent, provided one pays sufficient attention to the body’s needs. It will often be a medic’s job to pay attention on behalf of other protesters, as they will likely be preoccupied. The United States Occupational Safety and Health administration provides the following guidelines for preventing heat stress:
Know the signs and symptoms of heat illness
Block out direct sun and other heat sources
Rest regularly, use cooling systems
Drink sufficient water
Wear lightweight, loose-fitting clothes in light colors
Avoid alcohol, caffeinated drinks, or heavy meals.
In colder environments, it will be your job to keep watch over your fellow protesters to ensure their safety against the elements. Hypothermia, much like heat exhaustion, is relatively easy to combat: Minor preventative actions can be taken to avoid it, but after it has taken hold the afflicted party can simply be moved to a more agreeable climate and given easy remedies. In this circumstance, the remedy can be as simple as a warm blanket. Medics should take care to look for the following symptoms, ordered according to increasing severity:
Heightened heart rate
Lack of coordination
Blue tinge to the extremities
Further lack of coordination
“Terminal burrowing” (though it is extremely unlikely any protester will ever get to this level of hypothermia, final-stage sufferers exhibit a tendency to “burrow” behind or under objects or into soft ground)
People showing any of the bottom two-thirds of this list should be removed to warmer environments immediately. Given time and warmth they should make a full recovery.
4. Basic Bandaging
Bandaging and wound treatment are taught in first aid courses. The following is extremely basic, common-sense advice but does not replace first aid training in any way. If you wish to offer serious flesh wound treatment to your fellow activists, please attend a first aid course before considering yourself capable of dressing wounds beyond a band-aid level.
Sterile bandages are ideal for this task, but in an emergency, any type of clean cloth will work. A variety of types of dressings and bandages are necessary to address injuries of different size and location, making a properly stocked first aid kit a priority for any medic.
Disinfect the wound using a splash of isopropyl alcohol
Cover the entire wound using a suitably-sized dressing, such as a gauze pad or nonstick pad
Depending on the size of the dressing required, secure it using either tape or a bandage
Tie or tape off the bandage if one is required
Do not over-tighten the dressing or bandage, as this can cause additional swelling
This method should be sufficient for most simple scrapes and scratches. More serious flesh wounds should be cleaned out with alcohol and wrapped to protect and stabilize them to the best of your ability, while you are getting the injured person to help and safety in the meantime. Wounds that look like they could require stitches (deep, gaping, or large wounds; wounds that don’t stop bleeding on their own within a couple minutes, and so on) should be disinfected and covered to the best of your ability, after you have ensured emergency services have been called.
Even if a protester has been seriously injured, it is entirely possible (and precedented) for the police to refuse emergency teams access past their lines into “unsecured areas”. Though street medics have been known to act as liaisons between protesters and police and negotiate passage for ambulances or injured persons, the possibility that advanced medical help could be denied to an injured party is always there.
4. Street Medic Philosophy
Street medics are not trauma surgeons, nor are they a viable replacement for emergency services, regardless of their level of experience. 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.
Street Medics vary in expertise and experience from rank amateurs with basic first aid kits, to Wilderness Rescuers, EMTs, and military medical professionals. We would remind activists of things they can do to take care of themselves:
-bring a snack
-if anticipating arrest, bring three days’ supply of any prescription medication you may be on, in the original prescription bottle, with a doctor’s note. If there is potential for an allergic reaction, activists should carry their own supply of epinephrine.
Street Medics are important not only because of the physical services they provide, but because of the moral and psychological boost that the presence of support personnel imbues in a group. It is important that the other protesters feel they can rely on you, even if it’s just for backup and encouragement. This is why it’s vital to be very clear about your level of competency and training: the worst case scenario is that you are expected to deal with an injury that you cannot handle, and then fail to do so, discouraging your fellow activists and losing trust in street medics generally. Do your best, but never bluff or bluster. Help people as much as possible, but never get in over your head. Keep your mobile phone handy in case you need to call emergency services—sometimes just being there with someone, able to calmly relay information about their location and condition to a dispatcher, is a service no one else can render.
WARNING: street medics are often targeted specifically by police. The police “disperse a crowd” via fear, injury, incapacitation, and arrest, and medics provide the means for protesters to get back up, and keep marching, even after tear gas or pepper spray attacks. This can make medics priority targets to police. During the April 2001 protest of the Free Trade Area of the Americas agreement in Quebec City, police shot chemical-weapons canisters directly at the medics themselves after they realized the medics were re-commissioning activists who’d been taken out with tear gas. Additionally, police departments make a point of publishing the names and photos of arrested protesters for reasons of shaming them, and discouraging new activists from joining future protests.
A note on arrest: being arrested in furtherance of a cause or for solidarity with one’s fellow protesters is, generally, a noble act. That being said, a medic who intentionally subjects themselves to arrest to prove a point only prematurely removes themselves from action, and deprives comrades of future treatment, should they become injured. In the event of your arrest, it is generally advisable to remain completely silent until you have the opportunity to request and speak with a lawyer. Writing the phone number for your organization of choice on your arm with a marker is also a sound course of action, as it is unlikely the police will facilitate your forgetfulness once you are in their custody, and strip searches and appropriation of clothing/personal items is common during arrests. Police are known for capriciously adding as many additional charges as they can for protesters who cause them trouble (that is to say, all of them), making struggling, threats, or false names ill-advised. Barring extenuating circumstances, one can expect to be cited out of jail within a matter of hours after their arrest.