Health impacts of chemical irritants used for crowd control: a systematic review of the injuries and deaths caused by tear gas and pepper spray

Nikhil Ranadive,Rohini J Haar,Vincent Iacopino,Sheri D Weiser,Madhavi Dandu

doi:10.1186/s12889-017-4814-6

Abstract

BackgroundChemical irritants used in crowd control, such as tear gases and pepper sprays, are generally considered to be safe and to cause only transient pain and lacrimation. However, there are numerous reports that use and misuse of these chemicals may cause serious injuries. We aimed to review documented injuries from chemical irritants to better understand the morbidity and mortality associated with these weapons.MethodsWe conducted a systematic review using PRISMA guidelines to identify injuries, permanent disabilities, and deaths from chemical irritants worldwide between January 1, 1990 and March 15, 2015. We reviewed injuries to different body systems, injury severity, and potential risk factors for injury severity. We also assessed region, context and quality of each included article.ResultsWe identified 31 studies from 11 countries. These reported on 5131 people who suffered injuries, two of whom died and 58 of whom suffered permanent disabilities. Out of 9261 total injuries, 8.7% were severe and required professional medical management, while 17% were moderate and 74.3% were minor. Severe injuries occurred to all body systems, with the majority of injuries impacting the skin and eyes. Projectile munition trauma caused 231 projectile injuries, with 63 (27%) severe injuries, including major head injury and vision loss. Potentiating factors for more severe injury included environmental conditions, prolonged exposure time, and higher quantities of chemical agent in enclosed spaces.ConclusionsAlthough chemical weapons may have a limited role in crowd control, our findings demonstrate that they have significant potential for misuse, leading to unnecessary morbidity and mortality. A nuanced understanding of the health impacts of chemical weapons and mitigating factors is imperative to avoiding indiscriminate use of chemical weapons and associated health consequences.

Highlights

Chemical irritants used in crowd control, such as tear gases and pepper sprays, are generally considered to be safe and to cause only transient pain and lacrimation
We undertook a systematic review of the literature to determine the burden, severity, and range of injuries from chemical irritants using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines
We tried to capture the diverse terms used for chemical irritants in the literature, including “tear gas,” “pepper spray,” and agents CS, CN, CR, Phosgene oxime (CX), Oleoresin capsicum (OC), and Pelargonic acid vanillylamide or capsaicin II (PAVA) (Table 1)

Summary

Introduction

Chemical irritants used in crowd control, such as tear gases and pepper sprays, are generally considered to be safe and to cause only transient pain and lacrimation. There are numerous reports that use and misuse of these chemicals may cause serious injuries. There are many reports, that the frequent use of chemical irritants, commonly referred to as tear gases or pepper sprays, can potentially undermine these freedoms by causing injuries, intimidating communities, and leading to escalations in violence on all sides [2–5]. The wide variety of chemical agents, concentrations, unit sizes, and delivery mechanisms used in crowd control complicates full understanding of the effects of these weapons. Research and manufacturer information suggest that chemical irritants can be utilized in a number of ways, but are generally deployed for crowd dispersal or to restrain an individual [13]. Canisters, munitions, grenades, and chemical mixtures within water cannons are deployed for crowd dispersal or incapacitation of a large group of people

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