Death, injury and disability from kinetic impact projectiles in crowd-control settings: a systematic review

Abstract

ObjectiveWe conducted a systematic review of the available literature on deaths, injuries and permanent disability from rubber and plastic bullets, as well as from bean bag rounds, shot pellets and other projectiles used in arrests, protests and other contexts from 1 January 1990 until 1 June 2017.Data sourcesPubMed, Scopus, JSTOR and grey literature.Data synthesisWe report on descriptive statistics as well as data on injury severity, permanent disability and death. We analysed potential risk factors for injury severity, including the site of impact, firing distance and access to medical care.ResultsOf 3228 identified articles, 26 articles met inclusion criteria. These articles included injury data on 1984 people, 53 of whom died as a result of their injuries. 300 people suffered permanent disability. Deaths and permanent disability often resulted from strikes to the head and neck (49.1% of deaths and 82.6% of permanent disabilities). Of the 2135 injuries in those who survived their injuries, 71% were severe, injuries to the skin and to the extremities were most frequent. Anatomical site of impact, firing distance and timely access to medical care were correlated with injury severity and risk of disability.ConclusionsKinetic impact projectiles (KIPs), often called rubber or plastic bullets, are used commonly in crowd-control settings. We find that these projectiles have caused significant morbidity and mortality during the past 27 years, much of it from penetrative injuries and head, neck and torso trauma. Given their inherent inaccuracy, potential for misuse and associated health consequences of severe injury, disability and death, KIPs do not appear to be appropriate weapons for use in crowd-control settings. There is an urgent need to establish international guidelines on the use of crowd-control weapons to prevent unnecessary injuries and deaths.

COVID-19 Era Impacts on the American Academy of Ophthalmology

“…On May 31, the AAO released a statement entitled “Statement on Death of George Floyd and Its Aftermath” that concluded, “There is no place for racism.” 7 On June 4, after reports by numerous ophthalmologists of blinding injuries secondary to kinetic impact projectiles (so-called rubber bullets), the AAO issued a statement calling for a halt to their use “to control or disperse crowds of protesters.” 8 It later noted that a large published study demonstrated these so-called less lethal projectiles result in death in 3% of cases and debilitating injury or disfigurement in more than 15%. 9 These policy statements were the indirect result of COVID-19 and the societal disruptions that accompanied it. They address societal and public health issues with a direct impact on membership and a less obvious, but very real, impact on our profession.…”

Ocular trauma by kinetic impact projectiles during civil unrest in Chile

“…Crowd-control weapons (CCWs) are less-lethal weapons used by law enforcement agencies as a method of limiting the escalation of a conflict to minimize the number of casualties. Since its introduction in 1970 [ 1 ], the use of kinetic impact projectiles (KIPs), a type of CCW designed to incapacitate individuals by inflicting pain or sublethal injury [ 2 ], has been reported in a growing number of countries where social protests have arisen, including France, Spain, Hong Kong, Lebanon and Argentina [ 3 – 7 ]. Even though the COVID-19 pandemic has reduced mobility in general, the killing of George Floyd in the United States has resulted in massive protests and at least 20 reported cases of ocular trauma [ 8 ].…”

“…Despite its intention to inflict only superficial painful injuries, KIPs can cause significant morbidity and mortality, much of it from penetrative injuries and head, neck and torso trauma, including severe ocular trauma [ 2 ]. Previous studies have described injuries arising from long-term periods of civil unrest in Northern Ireland in 1970–1975 [ 1 , 11 ] and Israel and the Palestinian Territories in 1987–1993 and 2000 [ 12 – 14 ].…”

Propiedades balísticas de perdigones antidisturbios “menos letales” y su relación con trauma ocular severo en Chile

“…A lo largo del país, en el periodo comprendido entre el 19 de octubre y el 8 de noviembre de 2019, los impactos de balines antidisturbios se han visto involucrados en 135 casos de herida penetrante ocular (HPO), estallido ocular, cuerpos extraños intraorbitarios y trauma ocular contuso (Rodríguez et al, 2019). Puesto en contexto, durante el periodo de 1990-2017 el uso de municiones "no letales" o "menos letales" estuvo involucrado en al menos 310 casos de lesiones oculares en todo el mundo (Haar et al, 2017). Chile está pronto a superar esta cifra en tan solo meses.…”