The authors inform there is no confict of interest.

CARACTERÍSTICAS DAS LESÕES PROVOCADAS POR DISPAROS COM MUNIÇÃO MENOS LETAL: UMA VISÃO HISTÓRICA

Orlando Victorino de Moura Junior (1)

http://lattes.cnpq.br/5368323540973280 – https://orcid.org/0000-0003-0125-2587

Ivan Dieb Miziara (2)

http://lattes.cnpq.br/3120760745952876 – https://orcid.org/0000-0001-7180-8873

(1) Universidade de São Paulo, Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, São Paulo-SP, Brasil. (autor principal)

(2) Universidade de São Paulo, Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, São Paulo-SP, Brasil. (orientador) E-mail: orlando.moura@hc.fm.usp.br; ivan.miziara@usp.br

ABSTRACT

introduction: In the early 1970s, a new type of firearm was introduced into the military arsenal, with a format and function identical to those that had been used for centuries by forces from different countries, but now fed with rubber or plastic ammunition, whose use was intended to contain the targets without causing lethal damage. Until the present-day firearms with less lethal projectiles are used by police forces. objectives: This article aims to expose the characteristics of the injuries caused by this type of ammunition, which parts of the body are most affected, in addition to finding out which are the most frequent sequelae and whether there is a risk of death in its use. methods: A literature review was performed on PubMed and all articles and case reports involving injuries in live humans caused by this type of ammunition were analyzed. results: 37 articles were included in the present study and, together, they exposed a total of 932 injuries, of which 612 could be classified as simple blunt or perforated contusion. discussion: Shots by less-lethal ammunition, despite being known as “non-lethal ammunition”, can result in death or serious impairment by damaging organs, sense or function, especially when they reach more sensitive regions of the human body, such as the face or eyes. conclusion: Of the injuries that could be classified, 60% were blunt and 40% perforated-contuse. The head was the most affected region. The eyes accounted for 32% of the total number of injuries, which justifies visual loss as the most frequently reported sequelae. The risk of death exists; 26 people died from gunshot wounds.

Keywords: Gunshot wounds; firearms; nonpenetrating wounds; blunt injuries.

Bibliographical references

1. Domingues MO, Pina ME. As Primeiras Lesões por Armas de Fogo – novo paradigma para o cirurgião militar – Ambroise Paré. Revista Portuguesa de Cirurgia [Internet]. 2012 Dec 31 [cited 2023 Mar 1];0(23):77–84. Disponível em: http://revista.spcir.com/index.php/spcir/article/view/29
2. Coêlho BF. Histórico da medicina legal. Revista da Faculdade de Direito, Universidade de São Paulo [Internet]. 2010 Jan 1 [cited 2023 Mar 1];105:355–62. Disponível em: https://www.revistas.usp.br/rfdusp/article/view/67905
3. Chaves de Carvalho J. Evolução das armas de fogo. Def. Nac. [Internet]. 15º de junho de 2020 [citado 1º de março de 2023];51(603). Disponível em: http://www.ebrevistas.eb.mil.br/ADN/article/view/4941
4. Metress EK, Metress SP. The Anatomy of Plastic Bullet Damage and Crowd Control. International Journal of Health Services. 1987 Apr;17(2):333–42.
5. Millar R, Rutherford WH, Johnston S, Malhotra VJ. Injuries caused by rubber bullets: A report on 90 patients. British Journal of Surgery. 1975 Jun [citado 25 jul 2021]; 62(6):480-6. Disponível em: https://doi.org/10.1002/bjs.1800620613
6. Libya Main Armed Groups. 2013. Africa Research Bulletin: Political, Social and Cultural Series, 50(11), 19925B—19925C. 2015. [citado 25 jul 2021]. Global Non-Lethal Weapons Market 2015-2019. Disponível em http://www.reportlinker.com/p01911331-summary/Global-Non-lethal-Weapons-Market.html
7. Techinavio 2015. Global Non-Lethal Weapons Market 2015-2019. Disponível em http://www.reportlinker.com/p01911331-summary/Global-Non-lethal-Weapons-Market.
8. Haar RJ, Iacopino V, Ranadive N, et al. Death, injury and disability from kinetic impact projectiles in crowd-control settings: a systematic review. 2017. [citado 25 jul 2021] 7:e018154. Disponível em https://bmjopen.bmj.com/content/7/12/e018154
9. Paulo Sérgio, P. M. Bala de Borracha. Repositório institucional da UFSC [Internet]. 2015. [citado 25 jul 2021]. Disponível em: https://repositorio.ufsc.br/bitstream/handle/123456789/134575/baladeborracha.comautor.pdf?Sequence=1
10. Shaw J. Pulmonary contusion in children due to rubber bullet injuries. Br Med J. 1972 Dec 30 [citado 25 jul 2021]. 4(5843):764-6. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1787057/
11. Marrufo AS, Boyd WD, Leshikar DE. Minimally invasive surgical management of penetrating chest injury from kinetic impact bean bag projectile. Trauma Case Reports. 2019 Aug;22:100210.
12. Ifantides C, Deitz GA, Christopher KL, Slingsby TJ, Subramanian PS. Less-Lethal Weapons Resulting in Ophthalmic Injuries: A Review and Recent Example of Eye Trauma. Ophthalmology and Therapy. 2020 Aug 5;9(3):1–7.
13. Rodríguez Á, Peña S, Cavieres I, Vergara MJ, Pérez M, Campos M, et al. Ocular trauma by kinetic impact projectiles during civil unrest in Chile. Eye. 2020 Aug 24;
14. Elder MJ. Penetrating eye injuries in children of the West Bank and Gaza Strip. Eye 1993; 7: 429–432.
15. Lavy T, Asleh SA. Ocular rubber bullet injuries. Eye. 2003 Oct;17(7):821–4.
16. Amaral MBF, Bueno SC, Abdala IB, da Silveira RL. Facial fractures caused by less-lethal rubber bullet weapons: case series report and literature review. Oral and Maxillofacial Surgery. 2017 May 5;21(3):357–61.
17. Amelot A, Goutagny S, Ricome S, Peyre M. Penetrating craniocerebral injury caused by a rubber bullet questions the relative harmlessness of these weapons. The American Journal of Emergency Medicine. 2013 Mar;31(3):636.e5–7.
18. Best BG, Barros D’Sa AAB. Popliteal vessel injury caused by a plastic bullet. Injury. 1987 Nov;18(6):428–9.
19. Shaw J. Pulmonary Contusion in Children due to Rubber Bullet Injuries. BMJ. 1972 Dec 30;4(5843):764–6.
20. Czeslaw Chowaniec et al. Case study of fatal gunshot wounds from non-lethal projectiles. Forensic Science International 178 (2008) 213–217.
21. Contargyris C, Peytel E. Commotio cordis après impact précordial de Flashball®. Annales Françaises d’Anesthésie et de Réanimation. 2012 May;31(5):469–71.
22. Gonzalez SR, Loomba V, Obi-Osuagwu O, Al-Nowaylati A-R, Rahgozar P. Severe Craniofacial Morbidity from a Bean Bag Projectile. Plastic and Reconstructive Surgery – Global Open. 2021 May;9(5):e3589.
23. Hiss J, Hellman FN, Kahana T. Rubber and Plastic Ammunition Lethal Injuries: The Israeli Experience. Medicine, Science and the Law. 1997 Apr;37(2):139–44.
24. Khan S, Maqbool A, Abdullah N, Keng MQ. Pattern of ocular injuries in stone pelters in Kashmir valley. Saudi Journal of Ophthalmology [Internet]. 2012 Jul 1 [cited 2023 Mar 1];26(3):327–30. Available from: https://www.sciencedirect.com/science/article/pii/S131945341200063X
25. Khonsari RH, Fleuridas G, Arzul L, Lefèvre F, Vincent C, Bertolus C. Severe facial rubber bullet injuries: Less lethal but extremely harmful weapons. Injury. 2010 Jan;41(1):73–6.
26. Kobayashi M, Mellen PF. Rubber Bullet Injury. American Journal of Forensic Medicine & Pathology. 2009 Sep;30(3):262–7.
27. Mahajna A, Aboud N, Harbaji I, Agbaria A, Lankovsky Z, Michaelson M, et al. Blunt and penetrating injuries caused by rubber bullets during the Israeli-Arab conflict in October, 2000: a retrospective study. The Lancet. 2002 May;359(9320):1795–800.
28. Biagioni RB, Miranda GC, Mota de Moraes L, Nasser F, Burihan MC, Ingrund JC. Femoral vessel injury by a nonlethal weapon projectile. Journal of Vascular Surgery Cases, Innovations and Techniques. 2018 Jun;4(2):175–7.
29. Kim HJ, Ali S, Kelly LD. Ocular foam round injury: A case report and literature review. American Journal of Ophthalmology Case Reports. 2021 Sep;23:101149.
30. Dhar SA, Dar TA, Wani SA, Maajid S, Bhat JA, Mir NA, et al. Pattern of rubber bullet injuries in the lower limbs: A report from Kashmir. Chinese Journal of Traumatology. 2016 Jun;19(3):129–33.
31. Millar R, Rutherford WH, Johnston S, Malhotra VJ. Injuries caused by rubber bullets: A report on 90 patients. British Journal of Surgery. 1975 Jun;62(6):480–6.
32. Missliwetz J, Lindermann A. Gunshot Wounds Caused by Fiocchi Anticrime Cartridges (Plastic Bullets). The American Journal of Forensic Medicine and Pathology [Internet]. 1991 Sep 1 [cited 2023 Mar 1];12(3):209. Available from: https://journals.lww.com/amjforensicmedicine/abstract/1991/09000/gunshot_wounds_caused_by_fiocchi_anticrime.8.aspx
33. Noel A, Castellant P, Gilard M, Mansourati J. Acute myocardial infarction due to left anterior descending coronary artery dissection after rubber bullet shooting. International Journal of Cardiology. 2015 Apr;184:653–4.
34. Phillips JG. Plastic bullet injury: A case report. British Journal of Oral Surgery [Internet]. 1977 Mar 1 [cited 2023 Mar 1];14(3):199–202. Available from: https://www.sciencedirect.com/science/article/pii/0007117X7790021X
35. Barnes AC, Hudson LE, Jain N. Rubber Bullet Ocular Trauma. Ophthalmology. 2020 Sep;127(9):1190.
36. Rezende-Neto J, Silva FD, Porto LB, Teixeira LC, Tien H, Rizoli SB. 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 Journal of Emergency Surgery. 2009;4(1):26.
37. Guenther TM, Gustafson JD, Wozniak CJ, Zakaluzny SA, Utter GH. Penetrating thoracic injury from a bean bag round complicated by development of post-operative empyema. Journal of Surgical Case Reports. 2020 Apr 1;2020(4).
38. Rocke L. Injuries caused by plastic bullets compared with those caused by rubber bullets. The Lancet. 1983 Apr;321(8330):919–20.
39. Soulat G, Puymirat E, Mousseaux E. Blunt Cardiac Injuries Due to Rubber Bullets. Circulation: Cardiovascular Imaging. 2020 Oct;13(10).
40. Guérant M, Vaz M-A, Peoc’h M, Gaillard Y, Boyer B. Suicidal shot in the mouth with rubber bullets. Legal Medicine. 2018 May;32:52–6.
41. Sutter FKP. Ocular injuries caused by plastic bullet shotguns in Switzerland. Injury. 2004 Oct;35(10):963–7.
42. Wahl P, Schreyer N, Yersin B. Injury pattern of the Flash-Ball®, a less-lethal weapon used for law enforcement: Report of two cases and review of the literature. The Journal of Emergency Medicine. 2006 Oct;31(3):325–30.
43. Wani ML, Wani S, Singh S, Ahangar A, Ganie F, Lone G, et al. Pattern, presentation and management of vascular injuries due to pellets and rubber bullets in a conflict zone. Journal of Emergencies, Trauma, and Shock [Internet]. 2013 [cited 2020 Jun 9];6(3):155. Available from: https://pubmed.ncbi.nlm.nih.gov/23960369/
44. Whitlock RIH, Gorman JM. Some missile injuries due to civil unrest in Northern Ireland. International Journal of Oral Surgery. 1978 Aug;7(4):240–5.
45. Yellin A, Golan M, Klein E, Avigad I, Rosenman J, Lieberman Y. Penetrating thoracic wounds caused by plastic bullets. The Journal of Thoracic and Cardiovascular Surgery [Internet]. 1992 Feb 1 [cited 2023 Mar 1];103(2):381–5. Available from: https://www.sciencedirect.com/science/article/pii/S0022522319350421
46. Burrows C. Operationalizing non‐lethality: A northern ireland perspective*. Medicine, Conflict and Survival. 2001 Jul;17(3):260–71.