Exposure to pepper spray in an urban shopping complex resulted in 13 casualties being treated at a tertiary public hospital emergency department (ED). This report describes the ED's organisation in response to the disaster, and clinical management of those affected. Results: Thirteen casualties − 11 acute, 2 delayed − presented with symptoms ranging from ocular, respiratory and skin irritation to nausea, vomiting and giddiness. The culprit agent was determined basing on the index patient's

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... ry and physical findings. All cases were decontaminated at the ED's on-site Hospital Decontamination Station. Nine adults were monitored overnight in the Emergency Observation Ward under the Toxic Inhalation Protocol and discharged well. The index case was treated symptomatically with improvement, but discharged against medical advice three hours later. No ED re-attendances were recorded. Conclusions: The effects of pepper spray exposure are brief and self-limiting, but ED management can pose challenges in a mass casualty situation. (Hong Kong j.emerg.med. 2010;17:352-359) 13 13 11 2 9 3