Ophthalmology and “Rubber Bullets”

Risks and regulation of rubber scattershot in Switzerland: a narrative review

Multiple kinetic impact projectiles (KIPs) are responsible for most eye injuries by crowd-control weapons. This review aims to outline an underreported, ongoing series of eye injuries by rubber scattershot in Switzerland, and to relate current knowledge about thresholds for lasting visual loss to the energy limits set on KIPs in crowd control, by way of a retrospective compilation of cases from publicly available records and a review of the pertinent literature. Scattershot can cause irreversible visual loss. Since 1980, there have been 36 known cases of eye injuries by rubber pellets in Switzerland. In 2023, the incidence was higher here than at the peak of protests in France. KIPs were originally cleared for use in crowd control at kinetic and area-normalised energies assumed to lie below the threshold for ocular penetration. However, closed globe injuries suffice to cause permanent visual loss. Lower energy thresholds for lasting damage have been confirmed by the newer literature on paintballs, airbags, air guns and toys. These values may differ in vivo versus in vitro, and in humans versus in animals. There is no clear consensus on how best to predict loss of vision. Underreporting the risks of crowd-control weapons may contribute to their prolonged and increasingly liberal use. Regulations should consider what is known on energy thresholds for permanent visual loss. It is critical for ophthalmologists to be involved in the evaluation and monitoring of eye injuries caused by projectiles, including KIPs and toys. An interdisciplinary approach could help to elucidate damage thresholds.

Lethal head ballistic trauma with a «nonlethal» projectile: A case report and review of the literature

Forensic investigations of cranioencephalic ballistic trauma involve several aspects, including the study of terminal ballistics. This includes the analysis of projectiles and the damage they cause. Although some projectiles are considered "non-lethal", serious injuries and deaths secondary to the use of this type of ammunition have been reported. We report the case of a 37-year-old man who died from ballistic head trauma after the use of "Gomm Cogne" ammunition. A post-mortem computed tomography (CT) showed a right temporal bone defect and seven foreign bodies. Three of these were located in the encephalic parenchyma, which showed diffuse hemorrhagic changes. External examination indicated that this was a contact entry wound and confirmed encephalic involvement. This case illustrates the potential lethality of this type of ammunition with CT and autopsy with similar features to single projectile firearm injuries.

Testicular rupture following rubber bullet trauma case report

Following civil unrest during 2020, physicians began to notice a variety of injuries resulting from crowd control weapons. While prior research emphasized ocular trauma, genitourinary complications of injuries have yet to be investigated. A previously healthy 27-year-old male presented to the emergency department due to sudden onset of severe left testicular pain following rubber bullet trauma. Physical exam showed extreme tenderness, abrasion, contusion, and edema of the left testicle with normal right testicle. Doppler ultrasound showed minimal blood flow to the superior pole with irregularity of the tunica albuginea. Surgery confirmed testicular rupture with a large tunical violation and extruded spermatic tubules. The testicle was thoroughly irrigated, non-viable tubules were debrided, and intraoperative ultrasound confirmed restoration of blood flow. Patient was discharged and instructed to follow-up should he face any fertility concerns in the future. Current crowd control guidelines state projectiles should be aimed at the lower abdomen or extremities; however, projectiles can cause testicular trauma which may lead to hypogonadism, infection, and psychological impact. Until there are changes to methods of crowd control, attendees should consider the use of athletic cups.

Executions and Police Conflicts Involving Children, Adolescents and Young Adults

Police violence in the United States represents a pressing public health crisis impacting youth, particularly youth of color. This article reviews the recent epidemiology of police executions and conflicts involving children, adolescents, and young adults. The roles of social determinants of health and centuries-long history of white supremacy and racism as root causes of adverse policing are emphasized. The article summarizes the evidence as to how direct and vicarious experiences of police violence impact youth academic, behavioral, and health outcomes. Recommendations are provided for pediatricians to address this public health crisis through clinical practice, education, advocacy, and research.