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      Health impacts of chemical irritants used for crowd control: a systematic review of the injuries and deaths caused by tear gas and pepper spray

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          Abstract

          Background

          Chemical irritants used in crowd control, such as tear gases and pepper sprays, are generally considered to be safe and to cause only transient pain and lacrimation. However, there are numerous reports that use and misuse of these chemicals may cause serious injuries. We aimed to review documented injuries from chemical irritants to better understand the morbidity and mortality associated with these weapons.

          Methods

          We conducted a systematic review using PRISMA guidelines to identify injuries, permanent disabilities, and deaths from chemical irritants worldwide between January 1, 1990 and March 15, 2015. We reviewed injuries to different body systems, injury severity, and potential risk factors for injury severity. We also assessed region, context and quality of each included article.

          Results

          We identified 31 studies from 11 countries. These reported on 5131 people who suffered injuries, two of whom died and 58 of whom suffered permanent disabilities. Out of 9261 total injuries, 8.7% were severe and required professional medical management, while 17% were moderate and 74.3% were minor. Severe injuries occurred to all body systems, with the majority of injuries impacting the skin and eyes. Projectile munition trauma caused 231 projectile injuries, with 63 (27%) severe injuries, including major head injury and vision loss. Potentiating factors for more severe injury included environmental conditions, prolonged exposure time, and higher quantities of chemical agent in enclosed spaces.

          Conclusions

          Although chemical weapons may have a limited role in crowd control, our findings demonstrate that they have significant potential for misuse, leading to unnecessary morbidity and mortality. A nuanced understanding of the health impacts of chemical weapons and mitigating factors is imperative to avoiding indiscriminate use of chemical weapons and associated health consequences.

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          Most cited references43

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          Adverse drug reactions in elderly patients.

          Many studies from around the world show a correlation between increasing age and adverse drug reaction (ADR) rate, at least for some medical conditions. More than 80% of ADRs causing admission or occurring in hospital are type A (dose-related) in nature, and thus predictable from the known pharmacology of the drug and therefore potentially avoidable. Frail elderly patients appear to be particularly at risk of ADRs and this group is also likely to be receiving several medicines. The toxicity of some drug combinations may sometimes be synergistic and be greater than the sum of the risks of toxicity of either agent used alone. In order to recognize and to prevent ADRs (including drug interactions), good communication is crucial, and prescribers should develop an effective therapeutic partnership with the patient and with fellow health professionals. Undergraduate and postgraduate education in evidence-based therapeutics is also vitally important. The use of computer-based decision support systems (CDSS) and electronic prescribing should be encouraged, and when problems do occur, health professionals need to be aware of their professional responsibility to report suspected adverse drug events (ADEs) and ADRs. "Rational" or "obligatory" polypharmacy is becoming a legitimate practice as increasing numbers of individuals live longer and the range of available therapeutic options for many medical conditions increases. The clear risk of ADRs in this situation should be considered in the context that dose-related failure of existing therapy to manage the condition adequately may be one of the most important reasons for admission of the elderly to hospital. Thus, age itself should not be used as a reason for withholding adequate doses of effective therapies.
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            Who is sensitive to the effects of particulate air pollution on mortality? A case-crossover analysis of effect modifiers.

            Populations susceptible to the effects of particulate matter have begun to be characterized, but the independent contributions of specific factors have not been explored. We used a case-crossover study to examine PM10-associated mortality risk during 1988-1991 among 65,180 elderly residents of Cook County, Illinois, who had a history of hospitalization for heart or lung disease. We assessed how the effect was independently modified by specific diagnoses and personal characteristics. We found a 1.14% (95% confidence interval [CI] = 0.44% to 1.85%) increased risk of death per 10 microg/m3 increase in ambient PM10 concentration. Persons with heart or lung disease-but no specific diagnosis of myocardial infarction, diabetes, congestive heart failure, chronic obstructive pulmonary disorder, or conduction disorders-were at 0.74% (-0.29% to 1.79%) increased risk. Persons with a history of myocardial infarction had a 2.7-fold higher risk (CI = -2.1 to 7.4). Those with diabetes carried a 2.0-fold higher risk (CI = -1.5 to 5.5). Risk appeared to decrease with age among elderly men and increase with age among elderly women, but the estimated 3-way interaction was not precise enough to exclude the null. We found no indication that susceptibility varied by group-level socioeconomic measures. Among a frail population, individuals diagnosed with myocardial infarction or diabetes were at greatest risk of death associated with high concentrations of PM10. These results suggest that their susceptibility may derive from prior vascular damage to the heart.
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              A Social Movement Generation

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                Author and article information

                Contributors
                732-668-9259 , rohinihaar@berkeley.edu
                702-767-8237 , viacopino@phrusa.org
                650-380-0184 , nikhil.ranadive@emory.edu
                415-314-0665 , Sheri.Weiser@ucsf.edu
                415-476-4824 , madhavi.dandu@ucsf.edu
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                19 October 2017
                19 October 2017
                2017
                : 17
                : 831
                Affiliations
                [1 ]ISNI 0000 0001 2181 7878, GRID grid.47840.3f, University of California, ; 3136 College Avenue, Berkeley, CA 94705 USA
                [2 ]ISNI 0000 0001 2110 1589, GRID grid.475613.2, Physicians for Human Rights, ; 256 W 38th Street, 9th Floor, New York, NY 10018 USA
                [3 ]ISNI 0000 0001 0941 6502, GRID grid.189967.8, Emory University School of Medicine, ; 100 Woodruff Circle, Atlanta, GA 30322 USA
                [4 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Division of HIV, ID and Global Medicine, Department of Medicine, , University of California, ; 533 Parnassus, Box 1031, San Francisco, CA 94143 USA
                Article
                4814
                10.1186/s12889-017-4814-6
                5649076
                29052530
                4ca884ce-ad2a-4538-9dbc-acd504a01be6
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 20 June 2016
                : 3 October 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Public health
                crowd control,less lethal weapons,tear gas,pepper spray,protests,demonstrations,2-chlorobenzalmalonitrile (agent cs),oleoresin capsicum (agent oc),pelargonic acid vanillylamide or capsaicin ii (pava)

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