Medical Management of the Traumatic Consequences of Civil Unrest Incidents

Abstract

In the context of this review, civil unrest is defined as disharmony, expressive dissatisfaction and/or disagreement between members of a community, which leads to a situation of competitive aggression that may find expression as disruption of organisation, conflicts, damage to property and injuries. Such a breakdown of harmonious relationships, which may result in property damage and human injuries that may be threatening to life, varies in magnitude from participation of a very few individuals up to the involvement of large crowds of people, which may evolve into a full-scale riot. It is the latter situation often involving demonstrators, opposing groups and law enforcement personnel that can result in multiple casualties and present a very significant challenge to the resources of local healthcare institutions. The causation of civil unrest incidents is multifactorial and has generic, specific and potentiating elements. With the current national and international societal, political and discriminatory problems, it is likely that civil unrest incidents on both small and large scales will continue to occur at a high and possibly increasing rate on a worldwide basis, and for these not infrequent incidents, the medical community should be in a state of informed preparation. The circumstances of civil unrest incidents are very variable with respect to causation, overall magnitude, frequency, timing, geographical location, numbers of persons involved, demographics of participants, influence of extremists, confrontation with opposing groups and control measures used by law enforcement agencies. Methods used by police and security forces for the control of civil unrest incidents, if advanced negotiations with organisers and verbal warnings have failed, fall basically into two categories: physical and chemical measures. Physical methods include restraint holds, truncheons, batons, mounted horses, projectiles (such as bean bags, plastic and rubber bullets), water cannons, tasers and (rarely) live ammunition. All of these physical measures are associated with pain and immobilisation, and there is a high potential for soft tissue and bone injuries. Some of the more severe physical methods, including plastic and rubber bullets, may cause lethal injuries. The basis for using chemicals in civil unrest incidents is that they cause distraction, transient harassment and incapacitation, temporary impairment of the conduct of coordinated tasks and cause a desire to vacate the area of unrest. Although screening smokes and malodors have sometimes been employed, the major group of chemicals used are peripheral chemosensory irritants (PCSIs), which reversibly interact with sensory nerve receptors in exposed skin and mucosal surfaces, resulting in the production of local uncomfortable sensations and associated reflexes. Major effects are on the eye, respiratory tract and (to a lesser degree) skin. Thus, the induced transient pain and discomfort in the eye, respiratory tract and skin, together with associated lacrimation, blepharospasm...

Perfuração facial incomum por projétil de borracha: Relato de caso

“…A endoscopia nasossinusal pode ser utilizada para remoção da bala de borracha dos seios da face, fornecendo um acesso menos invasivo e excelente visualização.O acesso de Caldwell-Luc e etmoidectomia externa são descritas para remoção de corpos estranhos alojados no seio maxilar e etmoidal, respectivamente. (Ballantyne, 2006) Deve-se ter cautela na remoção da bala de borracha alojada no seio esfenoidal. Estruturas nobres como a artéria carótida interna e nervo óptico estão próximos ao local e podem ser lesionados, bem como, o possível extravasamento de líquido cefalorraquidiano.…”

Effect of dibenz(b,f)-1,4-oxazepine aerosol on the breathing pattern and respiratory variables by continuous recording and analysis in unanaesthetised mice

“…The potency of a chemical to cause sensory irritation can be used by a mouse bioassay for assessing the concentration-dependent decrease in the respiratory rate (50 % respiratory depression; RD 50 ) [ 13 , 21 ]. A riot control agent should by a peripheral chemosensory irritant with reversible effect, produce temporary incapacitation and should be effective as vapour or aerosol [ 1 ]. The chemical irritant should be non-corrosive and should cause reversible change at the contact site [ 22 ].…”

“…Controlling civil unrest is necessary and important for avoiding property damage and human injury. This can be done either by physical methods which cause pain, immobilization and can be fatal, or by chemical methods which cause distraction, incapacitation and force the individuals to leave the place [ 1 ]. The chemicals used are peripheral chemosensory irritants and are known as riot control agents or tear gases.…”

Conflict and Disease: A Complex Relationship

“…Aside from the burden placed on the medical system by physical injuries resulting from violent conflict (Ballantyne, 2006), various underlying consequences of social unrest indirectly impair health. Firstly, the displacement of individuals from their home regions as a result of local conflict is often associated with an increased incidence of infectious disease.…”