Exposure to the Riot Control Agent CS and Potential Health Effects: A Systematic Review of the Evidence

Abstract

o-Chlorobenzylidene malononitrile (CS) is one of the most extensively used riot control agents. Our aim was to conduct a systematic review of the potential health effects related to CS exposure. We searched for papers in English between 1991 and 2014. Thirty five (35) studies (25 case reports, seven descriptive studies and three analytical studies) were included in the review. In the twenty five case reports/series 90 cases of exposure to CS and their clinical effects are presented. Their mean age was 25.7 years and 62.0% were males. In addition, 61% of the cases described dermal, 40% respiratory, 57% ocular clinical effects. Life threatening situations as well as long-term health effects were found and were related with exposure to confined/enclosed space. Descriptive and analytical studies have shown attack rates ranging from 12% to 40%. Subjects who were sprayed by the police more often needed special treatment and reported adverse health effects. Apart from transient clinical effects, CS could have lasting and serious effects on human health. Better surveillance of the subjects exposed to CS and completion of cohort studies among exposed populations will illuminate the spectrum of the health effects of exposure to CS.

ELLMAN'S REAGENT FOR ANALYSIS OF o-CHLOROBENZYLIDENE MALONONITRILE (CS RIOT CONTROL AGENT) IN SOLID SAMPLES

“…Concerning the fact that Ellman's reagent is highly sensitive to reduction substances 20 , sulphides, sulphites and thiols proved to have the highest interference recorded. On the other hand, the method proved to be highly resilient against the interference of commonly used riot control agents chloroacetophenone (CN) and dibenz[b,f] [1,4]oxazepine (CR). The list of the selected interferences is given in the Table 1.…”

“…The persistence in terrain differs from several days to weeks depending on a contaminated material (soil, brickwork, etc.). The specially adjusted formulations (CS2) can contaminate the terrain for a long period [1][2][3] .…”

Tear gas: an epidemiological and mechanistic reassessment

“…There is a significant amount of research examining the acute effects of RCA exposure among small samples of healthy individuals in controlled conditions, but little information has been gathered on the consequences of exposure in the field. A review on exposure to the CS tear gas agent attempted to compile case reports on the basis of PubMed and Scopus literature searches . The real‐world conditions in which tear gas is used make it difficult to discriminate between the effects of different RCAs and to conduct effective epidemiological investigations .…”

“…The appearance of clinical cutaneous symptoms varies widely from a few minutes to several weeks. A summary of dermal clinical symptoms following CS tear gas exposure and latency periods has been published …”

“…A review on exposure to the CS tear gas agent attempted to compile case reports on the basis of PubMed and Scopus literature searches. 54 The real-world conditions in which tear gas is used make it difficult to discriminate between the effects of different RCAs and to conduct effective epidemiological investigations. 16 It is often not possible to ascertain the exposure concentration and duration among exposed individuals, and weather or terrain factors can further complicate analysis.…”