Commotio cordis as a result of neutralization shot with the Flash Ball™ less-lethal weapon

Severe craniocerebral trauma with sequelae caused by Flash-Ball® shot, a less-lethal weapon: Report of one case and review of the literature

“…3 For Scolan et al, the vital, functional and cosmetic prognosis of contused visceral injuries, associated or not with bone fractures, depends on the impact zone with the cephalic, cervical and thoracic regions being the most lethal ones, 13 The shooting distance also seems to be an important element to be taken into account. 17,27,28 In the present case, according to the witnesses at the scene, the shot had been fired 3-4 m away from the victim, whereas in the literature, the distance was 2-7 m. 1,3,19 We assume a shot, which strikes a body within 10 m, may cause several injuries, in particular to the head, thorax and abdomen. If Flash-Ball Õ is classified as a non-lethal weapon developed to incapacitate a violent or/and dangerous individual, the French National Commission of Business Ethic and Safety recommends it 'should not be used during demonstrations in public places, except on rare occasions wich have yet to be defined'.…”

“…One fatal case of Commotio Cordis in a healthy 43-year-old man due to a chest impact. 19 Pinaud et al describe an orbital and ocular trauma with loss of the internal half of the inferior eyelid, a rupture of the canthal tendon and inferior lachrymal duct, a conjunctival wound of the superior eyelid with loss of tissue exposing the levator muscle, a fracture of the upper jaw bone, a fracture with loss of bone of the orbital floor, a lesion of the infra orbital nerve and a ruptured ocular globe with burst contents. 1 Wahl et al report a case of a vasovagal syncope following multiple contusions of the abdominal wall and the thighs on a healthy 22-year-old man, and a case of severe contusion of the anterior chest wall associated with cardiac and pulmonary contusion on a healthy 25-year-old man.…”

“…1,23 This study reports that a close-range shot may result in severe wound injuries due to the potential penetration of the projectile. The low morbidity and mortality rates of these non-lethal weapons are questioned by publications reporting the field reality, 4,7,10,[12][13][14][15][16][17][18][19][20]24 and the terminology 'less-lethal' furthermore induces confusion, as it implies conventional weapons to be 'lethal'. 3 For Scolan et al, the vital, functional and cosmetic prognosis of contused visceral injuries, associated or not with bone fractures, depends on the impact zone with the cephalic, cervical and thoracic regions being the most lethal ones, 13 The shooting distance also seems to be an important element to be taken into account.…”

“…One fatal case of Commotio Cordis in a healthy 43-year-old man due to a chest impact. 19 Pinaud et al. describe an orbital and ocular trauma with loss of the internal half of the inferior eyelid, a rupture of the canthal tendon and inferior lachrymal duct, a conjunctival wound of the superior eyelid with loss of tissue exposing the levator muscle, a fracture of the upper jaw bone, a fracture with loss of bone of the orbital floor, a lesion of the infra orbital nerve and a ruptured ocular globe with burst contents.…”

Assessment of head injury risk caused by impact using finite element models

“…Since its incorporation, this rubber projectile has led to different injury scenarios [268,[273][274][275]. In a case report of 2006, Wahl et al [268] highlighted the lack of information provided by the manufacturer of this weapon regarding its characteristics and ballistics and later, Hiquet et al(2016) [273] suggested that a FlashBall ® impact could lead to severe lesions when fired at a distance lower than 10m.…”