Head and Neck Trauma From Less Lethal Weapons

Introduction: The head and neck is particularly vulnerable to penetrating rubber-bullet injury. Our aim is to evaluate injury patterns, injury severity, long and short-term outcomes associated with less-lethal weapons used for crowd control by law enforcement during the George Flyod protests.

Methods: We conducted a retrospective analysis including patients of any age who underwent medical evaluation at Hennepin County Medical Center Emergency Department for head and neck injuries sustained from less-lethal weapons deployed during the George Floyd protests from May- June 2020. International Classification of Diseases, 10th Revision, codes S00 through T59 was used to identify the appropriate patient population. Data points collected include mechanism of injury, injury classification, medical and surgical intervention(s), length of hospital stay, expected payment source, total charges, discharge status, number of subsequent follow-ups related to injuries, and secondary procedures/interventions needed.

Results: Of the 887 medical records identified during the initial search, ICD 10 codes revealed that 14 met the study criteria with matches for projectiles, police baton injuries, and chemical irritants. Review of these medical records confirmed that 12 (86%) patients reported injuries from rubber bullets, one from a police baton, and one from a tear gas canister (both 7%). Eleven patients (79%) sustained head and neck lacerations. Five (36%) sustained eye trauma. Three (21%) sustained orbital fractures. Two (14%) patients were admitted from the emergency department. Nine (64%) required bedside procedures and one (7%) emergency surgery. Six (48%) were recommended for outpatient follow-up but only four (29%) presented for follow-up.

Conclusions: Rubber bullets are not an appropriate alternative to lethal weapons as a means of crowd control due to the severity of head and neck injuries sustained from their use. Weapon training agencies and The United Nations instruct law enforcement agents to aim for the lower extremities or center of body mass due to the potential to cause severe injury to the head and neck.