Journal of Emergencies, Trauma, and Shock
Home About us Editors Ahead of Print Current Issue Archives Search Instructions Subscribe Advertise Login 
Users online:722   Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size   


 
 Table of Contents    
EDITORIAL  
Year : 2013  |  Volume : 6  |  Issue : 3  |  Page : 153-154
What's new in emergencies, trauma and shock? Pellets, rubber bullets, and shotguns: Less lethal or not?


Trauma and Trauma ICU: Inkosi Albert Luthuli central hospital and Department of Surgery: University of KwaZulu-Natal, Durban, South Africa

Click here for correspondence address and email

Date of Submission27-Aug-2012
Date of Acceptance28-Aug-2012
Date of Web Publication20-Jul-2013
 

How to cite this article:
Hardcastle TC. What's new in emergencies, trauma and shock? Pellets, rubber bullets, and shotguns: Less lethal or not?. J Emerg Trauma Shock 2013;6:153-4

How to cite this URL:
Hardcastle TC. What's new in emergencies, trauma and shock? Pellets, rubber bullets, and shotguns: Less lethal or not?. J Emerg Trauma Shock [serial online] 2013 [cited 2020 Apr 2];6:153-4. Available from: http://www.onlinejets.org/text.asp?2013/6/3/153/115315


The article entitled, "Pattern, presentation and management of vascular injuries due to pellet and rubber bullets in a conflict zone" [1] published in this issue of the journal illustrates an interesting and less common group of vascular injuries, at least in terms of mechanism of injury. The article does require some clarification to ensure that the reader is not in any quandary about the topic under discussion.

There are four distinct sets of weapon that may be included in the group of "police arms for civil unrest," and in particular there appears to be some measure of uncertainty in the description of the pellet injuries in particular. The one group of "weapons" used by police utilize electronic or chemical methods and are not for discussion at this time. The traditional sharp-point ammunition standard gun (hand-gun or rifle) is obviously used for self-defence and apprehension of violent perpetrators and is designed for lethal force. What does require comment is the different types of "nonlethal" weapons used in riot situations.

Pellet guns are most often air-driven rifles that utilize compressed air to rapidly discharge a single pellet at fairly low energy and velocity toward the intended target. Many are sold as "toys" and as such are thought of as "less lethal." Injuries due to these weapons are not uncommon, may damage individual organs (especially the eyes) and the injuries have been well described in the literature. [2],[3] These guns are seldom used by police today and are not the type of pellet referred to in this article, but the point is made for completeness sake. In similar, vein are the "toy" BB guns that fire plastic pellets. These are also not used by law enforcement for police action, but also have the potential to cause injury, with the additional challenge of not being radioopaque, thus making detection of the pellets more challenging.

The other type of pellet is the type most commonly used in police shotgun cartridges, which are discharged with the use of gunpowder detonation and vary from buck-shot (usually about 12 pellets of a larger size per round) and bird-shot (up to 150 small metal pellets around 1-2 mm in diameter per round). The latter is more commonly used in control of civil disobedience by police services, by shooting these pellets into the ground in front of protesters aiming for ricochet effect and dispersing the crowd. The pellet injuries from these weapons include a spectrum from superficial peppering of the soft-tissue to contusion of vessels, when used at close range, to perforation of bowel or other organs, transection of blood vessels, and even cases of embolization to distant organs being described. [4],[5] While considered "less lethal" when used as described above, the risk of serious injury from shotgun wounds is well-known when used at close range.

Thirdly, the most common projectile used in police crowd control is the rubber bullet, usually a solid round or cylindrical projectile of a heavy plastic or rubber, without a sharpened tip, although a number of different types exist - something which is not clearly stipulated in the article under discussion is the type of projectile used in Kashmir. Commonly two rounds are combined with a cartridge fired from a 12-bore shotgun. These weapons are very effective in causing pain and the projectile may penetrate, but more often causes blunt injury, which may include vascular contusions or intimal injuries. Severe injury is far more common when the weapon is fired from closer than 20 m and without the use of indirect action (ricochet). These injuries have been previously described, and it is therefore not surprising that the most common injury in the 35 patients in this series are from these rounds. [6],[7]

Modern trauma vascular surgery includes the use of "novel" approaches, in addition to traditional procedures such as fasciotomy, including early vascular shunting and temporary external fixation, to reduce the amputation or stroke rate and stabilize fractured bones prior to intricate vascular repair. The shunts that are used could be available commercially procured items, or be fashioned by making use of items readily available locally, such as the use of pieces of either drip tubing, nasogastric tubes or chest tubes, depending on the vessel diameter. Temporary external fixation has become well established as a form of either initial, or even definitive, orthopedic fracture care and the use thereof with early shunting is associated with improved limb survival. While not specifically mentioned in this study, these techniques are promoted as forms of vascular "Damage control." [8]

In conclusion, less "lethal" weapons do cause serious injury, thus a high index of suspicion and low threshold for intervention, including early fasciotomy when required, remain the key to early and successful limb and life-salvage.

 
   References Top

1.Wani ML, Ahangar AG, Ganie FA, Wani SN, Lone GN, Dar AM, et al. Pattern, presentation and management of vascular injuries due to pellet and rubber bullets in a conflict zone. J Emerg Trauma Shock, 2013;6:155-8.  Back to cited text no. 1
    
2.James T. Pellet gun injuries. S Afr Med J 1973;47:2298-300.  Back to cited text no. 2
[PUBMED]    
3.Ghouri M. Air gun injuries: A growing problem in the UK. Br J Hosp Med (Lond) 2008;69:417.  Back to cited text no. 3
[PUBMED]    
4.Mushtaque M, Mir MF, Bhat M, Parray FQ, Khanday SM, Dar RA, Malik AA. Pellet gunfire injuries among agitated mobs in Kashmir. Ulus Travma Acil Cerrahi Derg 2012;18:255-9.  Back to cited text no. 4
    
5.Sandler G, Merrett N, Buchan C, Biankin A. Abdominal shotgun wound with pellet embolization leading to bilateral lower limb amputation: Case report and review of the literature of missile emboli over the past 10 years. J Trauma 2009;67:E202-8.  Back to cited text no. 5
[PUBMED]    
6.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. Lancet 2002;359:1795-800.  Back to cited text no. 6
[PUBMED]    
7.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 J Emerg Surg 2009;4:26. Available from: http://www.wjes.org/content/4/1/26 [Last accessed on 2012 Aug 24].  Back to cited text no. 7
    
8.Boffard KD, editor. Chapter 9, In: Manual of Definitive Surgical Trauma Care. 3 rd ed. London: Hodder-Arnold; 2011.  Back to cited text no. 8
    

Top
Correspondence Address:
Timothy C Hardcastle
Trauma and Trauma ICU: Inkosi Albert Luthuli central hospital and Department of Surgery: University of KwaZulu-Natal, Durban
South Africa
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.115315

Rights and Permissions




 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed2058    
    Printed68    
    Emailed0    
    PDF Downloaded16    
    Comments [Add]    

Recommend this journal