Riot control agents: the tear gases CN, CS and OC-a medical review.

INTRODUCTION: 2-Chloroacetophenone (CN), o-chlorobenzylidene malonitrile (CS) and oleoresin capsicum (OC) are common riot control agents. While serious systemic effects are uncommon, exposure to high concentrations may lead to severe complications and even death. The aim of this narrative review is to summarise all main aspects of the riot control agents CN, CS and OC toxicology, including mechanisms of toxicity, clinical features and management. METHODS: OVID MEDLINE and ISI Web of Science were searched for terms associated with CN, CS and OC toxicity in humans and those describing the mechanism of action, clinical features and treatment protocols. RESULTS: CN, CS and OC are effective lacrimating agents; evidence for toxicity, as measured by the threshold for irritation, is greatest for CN, followed by CS and OC. Typically, ocular and respiratory tract irritation occurs within 20-60 s of exposure. Ocular effects involve blepharospasm, photophobia, conjunctivitis and periorbital oedema. Following inhalation, effects may include a stinging or burning sensation in the nose, tight chest, sore throat, coughing, dyspnoea and difficulty breathing. Dermal outcomes are variable, more severe for CN and include dermal irritation, bulla formation and subcutaneous oedema. Removal from the contaminated area and fresh air is a priority. There is no antidote; treatment consists of thorough decontamination and symptom-directed supportive care. Ocular exposure requires thorough eye decontamination, an eye exam and appropriate pain management. Monitoring and support of respiratory function is important in patients with significant respiratory symptoms. Standard treatment protocols may be required with patients with pre-existing respiratory conditions. Dermal exposures may require systemic steroids for patients who develop delayed contact dermatitis. CONCLUSIONS: CN, CS and OC are effective riot control agents. In the majority of exposures, significant clinical effects are not anticipated. The irritant effects can be minimised both by rapid evacuation from sites of exposure, decontamination and appropriate supportive care.

Pellet gunfire injuries among agitated mobs in Kashmir.

BACKGROUND: Pellet gunfire injuries inflicted while controlling agitated mobs has been studied. METHODS: A total of 198 patients admitted to the Accident and Emergency Department with pellet gun injuries were studied in terms of anatomic site, severity and type of injury, treatment, and outcomes. RESULTS: 72.7% of patients were aged 16-25 years. The most common sites of injury were the extremities (47.9%), abdomen (36.3%) and chest (31.3%). 59.5% of patients were found to have minor injuries. Of the 80 patients admitted to the hospital for their injuries, 43 (53.7%) required an operative procedure. Six deaths (3.03%) were observed. CONCLUSION: While the pellet wound itself may seem trivial, if not appreciated for the potential for tissue disruption and injuries to the head, chest, and abdomen, there can be catastrophic results. Patients should be evaluated and managed in the same way as those sustaining bullet injuries.:

¿Cómo influye la violencia colectiva en la salud? Modelo conceptual y diseño del estudio ISAVIC / How does collective violence shape the health status of its victims? Conceptual model and design of the ISAVIC study

Objetivos: La investigación epidemiológica de la violencia colectiva (con fines políticos, sociales o económicos)es muy incipiente a pesar de su creciente reconocimiento como un problema de salud pública.Este artículo describe el modelo conceptual y el diseño de una de las primeras investigaciones realizadas en España para medir el Impacto en la SAlud de la VIolencia Colectiva (estudio ISAVIC).Métodos: A partir de una amplia revisión no sistemática de la literatura se describe el alcance global de dicho impacto y se propone un marco teórico que describe la relación. La revisión identifica las posibles consecuencias de la violencia colectiva en las dimensiones física, emocional y social de la salud. El modelosirve de base para establecer el diseño del estudio y sus instrumentos de medida.Resultados: Se describe el conjunto de posibles secuelas producidas por la violencia colectiva y se propone un marco relacional y temporal. El modelo considera el efecto en víctimas primarias y secundarias, y surelación con el medio social. Se diseña un estudio empírico con una metodología mixta para estimar lamagnitud y la naturaleza de la posible afectación de la salud por la violencia colectiva. Conclusiones: El estudio ISAVIC señala la coherencia del modelo dise˜nado, apoyando que la violencia colectiva puede afectar a las principales dimensiones de la salud en relación con el marco social donde opera. Es necesario validar estos resultados con nuevos estudios (AU)

Objectives: Epidemiologic research on collective violence (violence exerted by and within groups in pursuit of political, social or economic goals) is very scarce despite its growing recognition as a major publichealth issue. This paper describes the conceptual model and design of one of the first research studies conducted in Spain aiming to assess the impact of collective violence in the health status of its victims(study known as ISAVIC, based on its Spanish title Impacto en la SAlud de la VIolencia Colectiva).Methods: Starting with a comprehensive but non-systematic review of the literature, the authors describe the sequelae likely produced by collective violence and propose a conceptual model to explain the nature of the relationships between collective violence and health status. The conceptual model informed the ISAVIC study design and its measurement instruments.Results: The possible sequelae of collective violence, in the physical, emotional and social dimensions of health, are described. Also, the review distinguishes the likely impact in primary and secondary victims,as well as the interplay with the social environment. The mixed methodological design of the ISAVIC study supports the coherence of the conceptual model described. Conclusions: The ISAVIC study suggests that collective violence may affect the main dimensions of the health status of its victims, in intimate relation to the societal factors where it operates. It is necessary to validate these results with new studies (AU)

Skin injuries caused by new riot control agent used against civilians on the West Bank.

A new riot control agent, used by the Israeli army against civilians protesting about the Separation Wall on the West Bank, has been reported as causing severe skin injuries. We obtained one of the munitions and have identified the contents as capsaicin with an inert carrier and a dispersal agent. This corresponds to the commercially available 'Pepperball Tactical Powder'. Skin injuries of the severity described have not previously been reported with this agent, and would be difficult to manage for clinicians who were unaware of the nature of the agent.

Ocular injuries caused by plastic bullet shotguns in Switzerland.

Five patients with blunt ocular trauma due to hard plastic shotguns used by police forces during riots presented to the Ophthalmology Department of University Hospital in Zurich, Switzerland, between December 2000 and May 2001. All five eyes suffered ocular concussion. Three of five eyes presented with severe damage to the anterior segment of the eye, two of these eyes showed combined involvement of the anterior and posterior segments. Two patients completely recovered their visual acuity in the injured eye, two reached a final visual acuity of 6/12 and in one case the injured eye was legally blinded. Three of the patients claimed to have been uninvolved bystanders at the riots. The theoretical probability of hitting the head/neck area or one of the two eyes for each shot fired at a person from different operational distances is calculated and ophthalmological and technical aspects of this special type of plastic bullet shotgun used in Switzerland are discussed.

When cooler heads prevail: peacemakers in a sports riot.

Male sports fans (N = 74) were asked to estimate the likelihood that they would intervene in a crowd disturbance in an attempt to stop the fighting. They also completed a battery of measures that included their attitude toward law and order, fight history, the false consensus effect, impulsivity, psychopathy, sensation seeking, anger, physical aggression and identification with their favorite team. Law and order, body mass, anger and the false consensus effect were positively related to peacemaking whereas sensation seeking was negatively related. A multiple regression analysis yielded a solution that accounted for 32.3% of the variance with anger and attitude toward law and order emerging as the best predictors.

The anatomy of plastic bullet damage and crowd control.

The plastic bullet was introduced into Northern Ireland as a riot control weapon in 1973. It became fully operational in 1975, replacing its predecessor the rubber bullet. The missile, which has been portrayed as a "minimum force," nonlethal weapon, has resulted in 13 deaths, including those of seven children, and scores of serious, permanent injuries and disabilities. Evidence regarding injury inflicted by the plastic bullet indicates that it is more dangerous than the rubber bullet that it replaced. It tends to cause more serious injuries to the skull and brain and therefore more deaths. An examination of the three rubber bullet and 13 plastic bullet deaths reveals that most victims were shot from distances much less than that determined to be "safe" and in a manner that contrasted with the rules of engagement. The data from numerous case studies seem to support allegations of abuse of the weapon by security forces.

Plastic bullet injuries of the face and jaws.

The plastic bullet or plastic baton round was introduced as an anti-riot weapon in 1976. It has evolved from the rubber bullet and wooden baton round. During the recent unrest in South Africa the plastic bullet was used in riot control. Five cases of facial injury are reported. One involved the middle third of the face and 4 the lower third. In all cases skin lacerations compounded facial fractures. Mandibular fractures ranged from a single displaced body fracture to severe comminuted fractures. The middle-third injury was sufficiently severe to result in blindness of one eye.