Gas, Beans and Other Unpleasantries: Less Lethal Weapon...

UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH

Gas, Beans and Other Unpleasantries: Less Lethal Weapon Injury Patterns

Michael Lohmeier, MD, FACEP Assistant Professor of Medicine, University of Wisconsin School of Medicine and Public Health

Medical Director, Dane County Sheriff TEMS Medical Director, Madison Fire Department

Medical Director, Dane County EMS

• Disclosures

– I have no financial disclosures

• Outline

– Background

– Less Lethal Basics

– Chemicals

– Mechanical / Kinetic Energy

– Conducted Electrical Devices

Less Lethal Weapon Injury Patterns

• Background

– EMS Fellowship, Washington University in Saint Louis

• Area of Concentration in Tactical Medicine

– Faculty, University of Wisconsin-Madison

• Emergency Medicine Physician

• City of Madison

• Dane County

• State of Wisconsin

Less Lethal Weapon Injury Patterns

• August 9, 2014

• March 4, 2014

Less Lethal Weapon Injury Patterns

• March 6, 2015

– Less Lethal Training

• May 12, 2015

Less Lethal Injury Patterns

• Less Lethal Basics

– Defined

• Categories of Less Lethals

– Electro-Magnetic Weapons

– Electrical Weapons

– Chemicals

– Audio

– Mechanical / Kinetic Energy

Less Lethal Weapon Injury Patterns

http://www.nato.int/docu/pr/1999/p991013e.htm

• Chemicals

– Phenacyl Chloride (aka CN or Mace)

• Developed during World War I

• Irritant smoke

• Injuries

– Corneal Epithelial Damage

– Chemosis

– Cutaneous Irritating Outbreaks

– Death

• Replaced by OC and CS gas

Less Lethal Weapon Injury Patterns

• Chemicals

– 2-chlorobenzalmalononitrile (aka CS gas)

• Powder or Solution

• Irritation and inflammation

• Insoluble

• Injuries

– Severe Erythema and Skin Vesication

– Contact Dermatitis

– Hypoxia

Less Lethal Weapon Injury Patterns

• Chemicals

– 2-chlorobenzalmalononitrile (aka CS gas)

• Treatment

– Move to Free Flowing Fresh Air

– Eye Flush

– Remove contaminated clothing

Less Lethal Weapon Injury Patterns

• Chemicals

– Oleoresin Capsicum (aka Pepper Spray)

• Burning Sensation to the skin, eyes and mucous membranes

• Coughing, gagging, shortness of breath and inability to speak

• Symptoms resolve in 10-15 minutes

• Injuries

– Corneal abrasions in 7-8.6% of all exposures

– Fatalities reported

Less Lethal Weapon Injury Patterns

Brown L, et al. Corneal abrasions associated with pepper spray exposure. Am J Emerg Med 2000;18:271. Watson WA, et al. Oleoresin capsicum (Cap-stun) toxicity from aerosol exposure. Ann Pharmacother

1996; 30:733.

• Chemicals

– Oleoresin Capsicum (aka OC or Pepper Spray)

• Injuries

– Consider mode of delivery!

• Treatment

– Leave the immediate area

– Eye flush

– Remove contaminated clothing

– Wash skin with a cleansing solution

Less Lethal Weapon Injury Patterns

• Electrical Weapons

– Electric Stun Devices

• Incapacitating electrical shock

• Two probes that conduct through the skin

• Pain, spasm

• Injuries

– Stiffness and Pain

– Local Burns

– Swelling and Edema

• Treatment

– Supportive Care

Less Lethal Weapon Injury Patterns

Burdett-Smith, P. Stun Gun Injury. J Accid Emerg Med. 1997 Nov; 14(6): 402-404.

• Electrical Weapons

– Conductive Energy Devices (TASER)

• Thomas A Swift Electric Rifle

• Barbed Probes

• Pain, Spasm and Shocks Throughout Body

• Injuries

– Related to the Probe

– Falls

– Diffuse Electrical Current

– Intoxication

Less Lethal Weapon Injury Patterns

• Electrical Weapons

– Conductive Energy Devices (TASER)

• Treatment

– Treat injuries resulting from falls

– Consider cardiac monitoring along with full VS

– Evaluate and treat for Hypotension

– Wounds from Barbs

Less Lethal Weapon Injury Patterns

• Mechanical / Kinetic Energy

– Barriers, Entanglements and Impact Projectiles

– Impact Projectiles

• Pain, Irritation, Minimal Injury

• Flexible and Non-Flexible

• Injuries

– Penetrating Traumatic Injuries

– Head and Neck

– Chest

– Abdomen

– Extremity

Less Lethal Weapon Injury Patterns

Khonsari RH, Fleuridas G, "Severe Facial Rubber Bullet Injuries: Less Lethal But Extremely Harmful Weapons". Injury, Int J Care Injured 41(2010); 73-76.

• Preferred Shot Placement

Less Lethal Weapon Injury Patterns

• Conclusions

– Less Lethal Weapons

• Reduced Mortality ≠ SAFE

– Scene Safety is Priority #1

• Public, Law Enforcement, Medical Responders

• Situational Awareness Regarding Deployment

– Chemical, Conducted Electrical Devices

• Consider Underlying Structures

• Remember Mode of Dispersal

Less Lethal Weapon Injury Patterns

• References – Cahill CP, Jardeleza MSR, “Penetrating Injury from Taser”, Austin J Ophthalmol 2015;2(2): 1047

– Shooting of Tony Robinson. N.d. In Wikipedia. Retrieved October 20, 2015.

from https://en.wikipedia.org/wiki/Shooting_of_Tony_Robinson

– Shooting of Michael Brown. N.d. In Wikipedia. Retrieved October 20, 2015.

from https://en.wikipedia.org/wiki/Shooting_of_Michael_Brown

– Worthington E, Nee PA. “CS Exposure – Clinical Effects and Management”, J Accid Emerg Med. 1999 May; 16(3): 168-170.

– Strote, J., Campbell, R., Pease, J., Hamman, M.S. and Hutson, R. (2005), "The role of tasers in police restraint-related deaths", Annals of Emergency Medicine, Vol. 46 No. 3, p. s85.

– Burdett-Smith, P. “Stun Gun Injury”, J Accid Emerg Med. 1997 Nov; 14(6): 402-404.

– Brown L, et al. Corneal abrasions associated with pepper spray exposure. Am J Emerg Med 2000;18:271.

– Watson WA, et al. Oleoresin capsicum (Cap-stun) toxicity from aerosol exposure. Ann Pharmacother 1996; 30:733.

– Smith, J. and Greaves, I. "The use of chemical incapacitant sprays: a review", Journal of Trauma, 2002 Vol. 52 No. 3, pp. 595-600.

– Blain, P.G. (2003), "Tear gases and irritant incapacitants. 1-chloroacetophenone, 2- chlorobenzylidene malononitrile and dibenz[b,f]-1,4-oxazepine", Toxicol Rev. 2003;22(2):103-10.

– Charles A, Asensio J, Forno, W, Petrone, P, "Penetrating bean bag injury: intrathoracic complication of a nonlethal weapon", J Trauma. 2002;53(5): 997-1000.

– Fish RM, Geddes, LA, "Effects of stun guns and Tasers", Lancet. 2001 Sept 1;358(9283):687-8.

– Khonsari RH, Fleuridas G, "Severe Facial Rubber Bullet Injuries: Less Lethal But Extremely Harmful Weapons". Injury, Int J Care Injured 41(2010); 73-76.

– Rezende-Neto J, Silva F, “Penetrating Injury to the Chest by an Attenuated Energy Projectile: A Case Report and Literature Review of Thoracic Injuries Caused by “Less-Lethal” Munitions”, World J

Emerg Surg 2009, 4:26.

– Ho JD, Miner JR, Lakireddy DR, Bultman, "Cardiovascular and physiologic effects of conducted electrical weapon discharge in resting adults", Acad Emerg Med. 2006 Jun;13(6):589-95.

– http://www.omegaresearchfoundation.org/assets/downloads/images/small%20-%20less%20lethal%20ammo.jpg

Less Lethal Weapon Injury Patterns

• Questions?

Less Lethal Weapon Injury Patterns

Less Lethal Weapon Injury Patterns