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      • Record: found
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      Is Open Access

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

      systematic-review

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          Abstract

          Objective

          We 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 sources

          PubMed, Scopus, JSTOR and grey literature.

          Data synthesis

          We 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.

          Results

          Of 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.

          Conclusions

          Kinetic 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.

          Related collections

          Most cited references42

          • Record: found
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          • Article: not found

          Gunshot wounds: 1. Bullets, ballistics, and mechanisms of injury.

          The nature and severity of a bullet wound depend on the characteristics of the bullet and of the tissues through which it travels. In addition to the mass and velocity of the bullet, its orientation and whether it fragments or deforms affect the nature of the wound. Two major mechanisms of wounding are described: crushing and stretching of tissue. Understanding the mechanisms by which bullets disrupt tissue can help physicians to evaluate and treat wounds.
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            • Record: found
            • Abstract: found
            • Article: not found

            Ballistics reviews: mechanisms of bullet wound trauma.

            The location of an entrance wound (bullet placement) and the projectile path are the most important factors in causing significant injury or death following a shooting. The head followed by the torso are the most vulnerable areas, with incapacitation resulting from central nervous system (brain or cord) disruption, or massive organ destruction with hemorrhage. Tissue and organ trauma result from the permanent wound cavity caused by direct destruction by the bullet, and also from radial stretching of surrounding tissues causing a temporary wound cavity. The extent of tissue damage is influenced by the type of bullet, its velocity and mass, as well as the physical characteristics of the tissues. The latter includes resistance to strain, physical dimensions of an organ, and the presence or absence of surrounding anatomical constraints. Bullet shape and construction will also affect tissue damage and bullets which display greater yaw will be associated with increased temporary cavitation. Military bullet designs do not include bullets that will expand or flatten as these cause greater wound trauma and are regulated by convention.
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              • Record: found
              • Abstract: found
              • Article: not found

              The injury pattern of a new law enforcement weapon: the police bean bag.

              This case series describes the injury pattern of the police bean bag, a new weapon adopted by US law enforcement agencies.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2017
                5 December 2017
                : 7
                : 12
                : e018154
                Affiliations
                [1 ]departmentSchool of Public Health, Division of Epidemiology , University of California , Berkeley, California, USA
                [2 ]Physicians for Human Rights , New York, New York, USA
                [3 ]Emory University School of Medicine , Atlanta, Georgia, USA
                [4 ]departmentDepartment of Medicine , University of California , San Francisco, California, USA
                [5 ]departmentDivision of HIV, ID and Global Medicine, Department of Medicine , University of California , San Francisco, California, USA
                Author notes
                [Correspondence to ] Dr Rohini J Haar; rohinihaar@ 123456berkeley.edu
                Article
                bmjopen-2017-018154
                10.1136/bmjopen-2017-018154
                5736036
                29255079
                36381cae-70d6-4bcd-a58d-41445f17c1d4
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 08 June 2017
                : 22 September 2017
                : 28 September 2017
                Categories
                Public Health
                Research
                1506
                1724
                Custom metadata
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                Medicine
                rubber bullets,plastic bullets,crowd control,riot,less lethal weapons,protests
                Medicine
                rubber bullets, plastic bullets, crowd control, riot, less lethal weapons, protests

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