Rubber bullet injury: case report with autopsy observation and literature review

Assessment of injuries patterns produced by a 9mm P.A.K "rubber ball" blank firing weapon: porcine model

The use of less lethal weapons aims to mitigate civilian casualties caused by firearm use. However, due to numerous cases in which these weapons caused serious injuries, even lethal injuries, both legislation and the forensic field are interested in characterizing and regulating them better. In the forensic field, there is a lack of strong research about injury patterns of these weapons which makes it difficult to identify the type of weapon employed. In this study, the main objective was to characterize the injury pattern produced by the impact of the 9 mm P.A.K. projectile. A porcine model was used. Four different distances were studied: firm contact, 10 cm, 60 cm and 110 cm, using 3 of the more representative anatomical sites: the head, the hind leg and the ribs. The average measurement of the entrance orifice varied according to the anatomical site, being 6.67 mm wide and 6.25 mm long in the thorax, 7.3 mm wide and 8.8 mm long in the hind legs, and 7.62 mm wide and 7.54 mm long in the head. The variation in width and length measurements was not found to be directly related to the shot distance. The gunshot residues had similar characteristics to those of conventional lead projectiles, however there was more unburned powder deposit near the wounds, with a less dense soot and more dense powder tattoo. Depth varied widely regardless of tissue and firing distance, although loss of penetrating power and injury is observed as one moves away from the target.

A new biomechanical FE model for blunt thoracic impact

In the field of biomechanics, numerical procedures can be used to understand complex phenomena that cannot be analyzed with experimental setups. The use of experimental data from human cadavers can present ethical issues that can be avoided by utilizing biofidelic models. Biofidelic models have been shown to have far-reaching benefits, particularly in evaluating the effectiveness of protective devices such as body armors. For instance, numerical twins coupled with a biomechanical model can be used to assess the efficacy of protective devices against intense external forces. Similarly, the use of human body surrogates in experimental studies has allowed for biomechanical studies, as demonstrated by the development of crash test dummies that are commonly used in automotive testing. This study proposes using numerical procedures and simplifying the structure of an existing biofidelic FE model of the human thorax as a preliminary step in building a physical surrogate. A reverse engineering method was used to ensure the use of manufacturable materials, which resulted in a FE model called SurHUByx FEM (Surrogate HUByx Finite Element Model, with HUByx being the original thorax FE model developed previously). This new simplified model was validated against existing experimental data on cadavers in the context of ballistic impact. SurHUByx FEM, with its new material properties of manufacturable materials, demonstrated consistent behavior with the corresponding biomechanical corridors derived from these experiments. The validation process of this new simplified FE model yielded satisfactory results and is the first step towards the development of its physical twin using manufacturable materials.

Review of Mechanisms and Research Methods for Blunt Ballistic Head Injury

Head injuries account for 15% to 20% of all military injuries and pose a high risk of causing functional disability and fatality. Blunt ballistic impacts are one of the threats that can lead to severe head injuries. This review aims to examine the mechanisms and injury risk assessment associated with blunt ballistic head injury (BBHI). The review further discusses research methods and instrumentation used in BBHI studies, focusing on their limitations and challenges. Studies on the mechanisms of focal and diffuse brain injuries remain largely inconclusive and require further efforts. Some studies have attempted to associate BBHIs with head mechanics, but more research is required to establish correlations between head mechanics and injury severity. Limited access to experimental models and a lack of instrumentation capable of measuring the mechanics of brain tissue in-situ are potential reasons for the lack of understanding of injury mechanisms, injury correlations and injury tolerance levels specific to this loading regime. Targeted research for understanding and assessing head injuries in blunt ballistic impacts is a necessary step in improving our ability to design protection systems to mitigate these injuries.

Death and non-lethal weapons: A case of homicide by penetrating injury without projectile

Herein, we report the death of a man, approximately thirty years old, victim of a short-range shot to the thorax from a PIEXON JPX4, a hand weapon classed category D in France, said to be non-lethal. External examination of the lesion revealed characteristics similar to those of ballistic injuries. The autopsy found an intercostal wound that reached the pulmonary parenchyma and the pulmonary artery, with severe hemothorax. By the end of the autopsy, no projectile had been found in the body, nor any exit orifice. Death was caused by the effects of hemorrhagic shock. The PIEXON JPX4 has four cartridges, projecting a capsaicin gel that is designed to irritate the ENT area (ear nose throat) to incapacitate an assailant. The manufacturer recommends not to use it at distances of less than 1.5 m. Experimental shots were performed on gelatine blocks at point-blank range and at distances of 5, 10, 20, 30, 50, 100 and 150 cm to evaluate the distance necessary for the jet of gel to have a penetrating effect. Shots at 5-30 cm penetrated the structure. None of the other shots were penetrating. The autopsy and experiment data therefore show the penetrating potential of the jet of gel. Herein, we report the first death due to use of the PIEXON JPX4. From a forensic investigation viewpoint, we add a new exception to the "bullet rule". (The odd and even bullet rule states that if the number of gunshot wounds of entrance and exit found in the body is even, the presumption is that no bullet is lodged in the body. If the number of gunshot wounds of entrance and exit is odd, the presumption is that one or more bullets have been lodged in the body.).

Ocular foam round injury: A case report and literature review

Purpose

To report the case of a 25-year-old male who sustained significant ocular trauma from a confirmed foam round. To review the scientific literature on kinetic impact projectiles and legislation currently proposed to regulate their use.

Observations

A 25-year-old male presented to the emergency department with acute pain and vision loss in his left eye after being struck by a foam round. Initial exam showed significant periorbital ecchymosis, multiple eyelid lacerations, microhyphema, and vitreous hemorrhage. Computed tomography revealed fractures of the inferior and medial orbital walls. Optical coherence tomography also demonstrated full-thickness macular hole. Microhyphema resolved after 15 days with steroid and mydriatic drops. Vision at 60 days after injury stabilized at 20/60. Repeat OCT at this time revealed closure of the macular hole. Care for the patient is ongoing.

Conclusions and Importance

Foam rounds can cause a pattern of vision-threatening ocular trauma similar to that of rubber bullets with the additional risk of chemical injury. During the George Floyd protests, isolated reports of significant foam round-related ocular injuries have been reported in the press, but systematic epidemiologic and clinical data on the subject remains lacking. While accurate identification of the causative weapon is not required in the management of ocular trauma, it may impact advocacy efforts undertaken by physicians and the subsequent legislative efforts they inspire. Current state and federal law does not adequately protect individuals from these munitions. Multiple proposals in Congress aptly recognize the significant risk of blinding injury and mortality posed by all kinetic impact projectiles.

Biomechanically Based Correlate for Localized Lung Contusion From Nonlethal Blunt Impact Projectiles

INTRODUCTION

Injury mechanics of blunt impact projectiles differ from those experienced in whole body motor vehicle collisions because the effects are localized around the point of impact, and thus, injury thresholds based upon gross chest kinematics (e.g., force, velocity) may not be applicable across impact types. Therefore, knowledge of biomechanically based tissue injury correlates for blunt impact projectiles are needed to better guide design and development of protective systems as well as assess injury risks from blunt impact projectile weapons.

MATERIALS AND METHODS

In this study, subject-specific swine finite element models were used to quantify the tissue-level stresses and strains resulting from high speed projectile impact. These tissue-level injury doses were correlated to pathology injury outcomes to produce injury risk curves for lung contusion. Details of the pathology data and finite element results are provided in Appendix 1. Survival analysis regression methods were applied to develop lung injury regression curves and a number of statistical methods were used to evaluate several biomechanical metrics as correlates to lung contusion. Uncertainty and sensitivity analyses were used to further confirm the selection of the correlate.

RESULTS

Statistical analysis revealed that normalized strain-energy density was the best correlate for prediction of lung tissue damage. Going further, normalized strain-energy density also proved to be suitable for prediction of the percentage of contused lung volume, a more meaningful medical diagnosis. As expected, peak strain-energy density is most sensitive to muscle-skin properties, as quantified through a comprehensive uncertainty and sensitivity analysis over three sets of projectile weights and speeds.

CONCLUSIONS

Normalized strain-energy density was found to be the best correlate for prediction of lung tissue damage and correlate well to extent of contused lung volume.

Less-Lethal Weapons Resulting in Ophthalmic Injuries: A Review and Recent Example of Eye Trauma

Introduction

Prior reports have highlighted the dangers of crowd control weapons such as rubber bullets, paintball guns, and pepper spray. Many of these reports were written decades ago and outside of the USA. We summarize a review of the literature and discuss a contemporary case of a ruptured globe and facial trauma secondary to a projectile weapon. This case serves to highlight the severity of eye trauma caused by less-lethal weapons; severe morbidity or even mortality can occur.

Clinical Description

A civilian presented after a projectile weapon reportedly fired by Denver law enforcement struck his face during one of the recent protests in May 2020 in Denver. Upon ophthalmic examination, we observed no light perception (NLP) vision, periorbital ecchymosis, and devastating globe trauma.

Primary Diagnosis, Interventions, and Outcomes

Further examination revealed a severely ruptured globe with extensive hemorrhage and extrusion of intraocular contents. Attempts to repair the ruptured globe failed because of the lack of remaining scleral tissue and expulsion of intraocular contents. Postoperatively, the visual acuity remained NLP and the eye was unable to hold pressure. Subsequently, the patient elected for enucleation.

Conclusion

Despite the purported safety advancements of less-lethal weapons, we continue to see high levels of morbidity and mortality. Permanent vision loss, loss of the eye, and death caused by these weapons have been reported. We hope that this information will serve as an example to help promote judicious use of these weapons by the proper authorities. Additionally, protesters and bystanders should be aware of these dangers and utilize high-quality eye protection.

[«Dieseling» of airguns as a factor in the differential diagnosis of pneumoshot and gunshot damage]

The purpose of study is an objective solution to the issue of gunshot nature of the injury and its differential diagnosis from other injuries caused, for example, by shots from airguns. 11 objective morphological signs of firearms were established (X1-11), which allow categorically solving the question of gunshot nature of the injury and its difference from damage caused, for example, by shots from airguns. The phenomenon of "dieseling" of airguns is considered as a factor in the differential diagnosis of pneumoshot and gunshot injuries.

Suicidal shot in the mouth with rubber bullets

Rubber bullets weapons can have tragic consequences when used at short range and on vulnerable body areas. A man in his forties was found deceased at his house, covered in blood. A "non-lethal" firearm was found near the bed: the «SAPL GC27». This is a single shot handgun with mini Gomm Cogne ammunition: 12 rubber spherical pellets, 7.4 mm in diameter. The findings were consistent with an intra buccal shot, and an ingestion-inhalation of blood and projectiles. Cause of the death was linked to both the hemorrhage due to mouth and aero digestive crossroad trauma, responsible of a mechanical asphyxia, and blood absorption in lungs. This case insists on the deadly potential of this weapon if misused. Fortunately, the term "non-lethal" has been progressively replaced, but sometimes still can be seen, especially in gunsmith and webstores. It should be deleted to avoid confusion among inexperienced people, and at best, this weapon should be restricted to certain professions.

Pattern of rubber bullet injuries in the lower limbs: A report from Kashmir

PURPOSE

Rubber bullets are considered a non-lethal method of crowd control and are being used over the world. However the literature regarding the pattern and management of these injuries is scarce for the forensic pathologist as well as for the traumatologist. The objective of this report was to add our experience to the existing literature.

METHODS

From June 2008 to August 2010 the Government Hospital for Bone and Joint Surgery Barzulla and the Department of Orthopaedics, SKIMS Medical College/Hospital Bemina Srinagar received 28 patients for management of their orthopaedic injuries caused by rubber bullets. We documented all injuries and also recorded the management issues and complications that we encountered.

RESULTS

All patients weremales with an age range of 11e32 years and were civilians who had been hit by rubber bullets fired by the police and the paramilitary forces. Among them, 19 patients had injuries of the lower limbs and 9 patients had injuries of the upper limbs. All patients were received within 6 h of being shot.

CONCLUSION

Our findings suggest that these weapons are capable of causing significant injuries including fractures and it is important for the surgeon to be well versed with the management of such injuries especially in areas of unrest. The report is also supportive of the opinion that these weapons are lethal and should hence be reclassified.

From military to civil loadings: Preliminary numerical-based thorax injury criteria investigations

Effects of the impact of a mechanical structure on the human body are of great interest in the understanding of body trauma. Experimental tests have led to first conclusions about the dangerousness of an impact observing impact forces or displacement time history with PMHS (Post Mortem human Subjects). They have allowed providing interesting data for the development and the validation of numerical biomechanical models. These models, widely used in the framework of automotive crashworthiness, have led to the development of numerical-based injury criteria and tolerance thresholds. The aim of this process is to improve the safety of mechanical structures in interaction with the body. In a military context, investigations both at experimental and numerical level are less successfully completed. For both military and civil frameworks, the literature list a number of numerical analysis trying to propose injury mechanisms, and tolerance thresholds based on biofidelic Finite Element (FE) models of different part of the human body. However the link between both frameworks is not obvious, since lots of parameters are different: great mass impacts at relatively low velocity for civil impacts (falls, automotive crashworthiness) and low mass at very high velocity for military loadings (ballistic, blast). In this study, different accident cases were investigated, and replicated with a previously developed and validated FE model of the human thorax named Hermaphrodite Universal Biomechanical YX model (HUBYX model). These previous validations included replications of standard experimental tests often used to validate models in the context of automotive industry, experimental ballistic tests in high speed dynamic impact and also numerical replication of blast loading test ensuring its biofidelity. In order to extend the use of this model in other frameworks, some real-world accidents were reconstructed, and consequences of these loadings on the FE model were explored. These various numerical replications of accident coming from different contexts raise the question about the ability of a FE model to correctly predict several kinds of trauma, from blast or ballistic impacts to falls, sports or automotive ones in a context of numerical injury mechanisms and tolerance limits investigations.

Experimental study of the coupling parameters influencing the terminal effects of thoracic blunt ballistic impacts

The objective of the study is to better understand how blunt projectile ballistic parameters and material properties influence the events leading to injuries. The present work focuses on lateral thoracic impacts and follows an experimental approach. The projectiles are made with a soft foam nose assembled with a rigid rear plastic part. The dynamic properties of the foams were first determined using the Split Hopkinson Pressure Bar (SHPB) system. The impact forces on a rigid wall were then measured to provide reference load data. Lastly, shots were made on isolated thoraxes of porcine cadavers to investigate the response in the vicinity of the impact (wall displacements, rib accelerations and strains, rib fractures). Results show that the severity of the response appears to be mainly correlated with the impulse and with the pre-impact momentum.

Risks of non-lethal weapon use: case studies of three French victims of stinger grenades

The development of non-lethal weapons started in the 1960s. In France, they have been used by the police for about 10 years. We relate the cases of three French women, victims of stinger grenades, non-lethal weapons recently adopted by the French law enforcement to distract and disperse crowds. The three victims presented serious injuries requiring emergency surgical care. One lost her eye. Based on these cases, we discuss the lethal character of these weapons and propose measures to be taken to prevent their dramatic consequences. Although the danger is obviously less than for firearms, stinger grenades are nonetheless potentially lethal and cause serious physical injuries.

Pulmonary contusion in a collegiate diver: a case report

Introduction

Pulmonary contusions typically occur after high-energy trauma and have rarely been reported as occurring during participation in sports. This is the first reported case of a pulmonary contusion occurring in a sport other than football.

Case Presentation

A 19-year-old Caucasian man impacted the water awkwardly after diving off a one-meter springboard. He complained of chest discomfort and produced immediate hemoptysis. Computed tomography confirmed the diagnosis of pulmonary contusion. The athlete recovered without complications and returned to activity one week after injury.

Conclusion

Immediate hemoptysis following blunt chest trauma during sports activity may indicate an underlying pulmonary contusion. No specific guidelines exist for return to athletic competition following pulmonary contusion, but a progressive return to activities once symptoms resolve appears to be a reasonable approach.

Blunt Criterion trauma model for head and chest injury risk assessment of cal. 380 R and cal. 22 long blank cartridge actuated gundog retrieval devices

BACKGROUND

Blunt ballistic impact trauma is a current research topic due to the widespread use of kinetic energy munitions in law enforcement. In the civilian setting, an automatic dummy launcher has recently been identified as source of blunt impact trauma. However, there is no data on the injury risk of conventional dummy launchers. It is the aim of this investigation to predict potential impact injury to the human head and chest on the basis of the Blunt Criterion which is an energy based blunt trauma model to assess vulnerability to blunt weapons, projectile impacts, and behind-armor-exposures.

METHODS

Based on experimentally investigated kinetic parameters, the injury risk of two commercially available gundog retrieval devices (Waidwerk Telebock, Germany; Turner Richards, United Kingdom) was assessed using the Blunt Criterion trauma model for blunt ballistic impact trauma to the head and chest.

RESULTS

Assessing chest impact, the Blunt Criterion values for both shooting devices were higher than the critical Blunt Criterion value of 0.37, which represents a 50% risk of sustaining a thoracic skeletal injury of AIS 2 (moderate injury) or AIS 3 (serious injury). The maximum Blunt Criterion value (1.106) was higher than the Blunt Criterion value corresponding to AIS 4 (severe injury). With regard to the impact injury risk to the head, both devices surpass by far the critical Blunt Criterion value of 1.61, which represents a 50% risk of skull fracture. Highest Blunt Criterion values were measured for the Turner Richards Launcher (2.884) corresponding to a risk of skull fracture of higher than 80%.

CONCLUSION

Even though the classification as non-guns by legal authorities might implicate harmlessness, the Blunt Criterion trauma model illustrates the hazardous potential of these shooting devices. The Blunt Criterion trauma model links the laboratory findings to the impact injury patterns of the head and chest that might be expected.