Lethal Weapons

Non-Lethal Weapon Injuries in the Emergency Department: Mini-Review

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          “Non-lethal” or “Less-lethal” weapons are becoming more frequently used by law enforcement agencies and knowledge of the associated injuries is useful for emergency medicine providers. Aside from chemical irritants such as “Pepper Spray” and the “Taser” some departments are now using “non-lethal” projectiles. These “bean bag rounds” also known as a “Flexible Baton Rounds” are frequently cased in a shotgun shell, and fired by a standard 12 gauge shotgun. A more broad term for these weapons are “Impact Munitions”. They are designed to stun or temporarily incapacitate a suspect so they can be arrested with less danger to both the suspect and officer. Other options are foam rubber projectiles or wooden dowels.

          In 2004 the institute of justice assembled a collection of incident reports to better understand their effect. Over 373 incidents were investigated where 969 projectiles were fired. These incidents were voluntarily submitted by over 100 different law enforcement agencies. Over half of the incidents involved “emotionally disturbed persons” demonstrating suicidal intent, and nearly all were men. They were used more often against suspects wielding cutting weapons or clubs. Suspects were mostly often shot in the abdomen (34%), Chest (19%), and legs (15%). Only 2% were shot in the head, and 1% in the groin. 80% of impact munitions discharged resulted in “injury”. 80% of these injures were bruising and abrasion that did not require medical treatment. Eight individuals were killed by the munitions and two additional deaths resulted from officers mistakenly firing real bullets, believing them to be impact rounds. The resulting mortality was found to be 2.7%. Three of the deaths occurred from broken ribs that “pierced the heart or lungs”. Mechanism of other deaths or serious injuries was not reported. Distance was found to be a “Key” factor in prediction of serious injury. They suggest that being hit by a round fired from less than 10 feet caused more “broken bones” but they offer no statistics to support this. The study described above was non-medical and very poor on multiple levels. It does however offer some interesting themes.

          There are sporadic case reports of fatalities from “non-lethal” weapons in the pathology literature. Specifically there were 3 case reports of death from impact munitions, in all 3 cases the subject was shot in the chest and died from severe cardiopulmonary injury. In one case the round penetrated the chest cavity causing a pulmonary artery laceration. It is highly likely that these weapons may be capable of causing splenic or other solid organ injuries.

          As use of these weapons become more frequent it is important for emergency department staff to be familiar with this police tactic and appropriately triage patients who may be seriously injured.

Question!

Does anyone have experience treating these injures in their ED? Let us know below by commenting!

References

Kobayashi M, Mellen PF. “Rubber bullet injury: case report with autopsy observation and literature review” Am J Forensic Med Pathol. 2009 Sep;30(3):262-7.

Chowaniec C, Kobek M, Jabłoński C. “Case-study of fatal gunshot wounds from non-lethal projectiles.” Forensic Sci Int. 2008 Jul 4;178(2-3):213-7.

Kalebi A, Olumbe AK. “Death following rubber bullet wounds to the chest: case report” East Afr Med J. 2005 Jul;82(7):382-4.

Hubbs, Ken, and David Klinger. “Impact Munitions Use: Types, Targets, Effects.” US Department of Justice (Oct 2004)

 

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