Medical problems and criteria regarding the use of tear gas by police

An investigation into the short term and medium term health impacts of personal incapacitant sprays. A follow up of patients reported to the National Poisons Information Service (London)

OBJECTIVES

The aim of this study is to describe the pattern of ill health after personal incapacitant spray (PIS) exposures reported to the National Poisons Information Service-London (NPIS-L) and the Chemical Incident Response Service and to evaluate the relation between sub-categories of PIS exposure and adverse health effects.

METHODS

Case series study of patients reported to the NPIS-L, by attending medical personnel during the period 16 January to 31 September 1998. Data collected by questionnaire sent to these medical personnel.

RESULTS

Several "adverse" symptoms, particularly dermatitis and blisters were reported for cases exposed to police PIS. These cases were more frequent than in those people exposed to non-police PIS. Adverse effects occurring more than six hours after exposure were also observed, which is in conflict with the recorded immediate, short lived, and self limiting symptoms that PIS are designed to cause. Most patients with persisting symptoms required further treatment.

CONCLUSIONS

These findings suggest that the formulation of CS (o-chlorobenzylidine malononitrile) with MiBK (methyl iso-butyl ketone) used by the police is more harmful that has been previously assumed. If confirmed then the continued use of this formulation should be reviewed because of longer duration of adverse effects. Less concentrated formulations may reduce the severity or persistence of the adverse effects.

Formation of 2-chlorobenzylidenemalononitrile (CS riot control agent) thermal degradation products at elevated temperatures

2-Chlorobenzylidenemalononitrile (CS riot control agent) has been shown to produce a number of thermal degradation products when dispersed at high temperature. We hypothesized that these CS-derived compounds are formed by energy input from heating during the dispersion process. Here we identified organic CS-derived compounds formed from purified CS subjected to temperatures ranging from 300 to 900 degrees C in an inert atmosphere with analysis of tube furnace effluent by gas chromatography and mass spectrometry. We conclude that the production of many CS-derived compounds previously observed during high-temperature dispersion is likely to be heat related.

CS exposure--clinical effects and management

The number of people exposed to CS spray presenting to accident and emergency departments is on the increase. Its effects, though usually minor and short lived, involve several systems and can occasionally be life threatening. It is therefore important that staff are able to manage these patients and know when and how to protect themselves and others from further contamination.

Occupational contact dermatitis due to 2-chloracetophenone tear gas

2-Chloracetophenone (CN) is widely used as tear gas by police and civilians for self-defence. It may affect the eyes, respiratory system and skin, sometimes causing serious injuries. Both irritative and allergic contact dermatitis have been described. We report three police officers who experienced accidental escape of CN from their professional tear gas canisters. All of them showed localized dermatitis at the site of contact to CN, while widespread lesions appeared after 4 days in one case. Patch tests with the original involved tear gas dissolved in acetone (at 0.1-0.0001%) indicated an allergic reaction in two patients and an irritative reaction in the third. Occupational contact dermatitis due to CN seems to occur among police officers more often than is generally known. Infrequently, extensive health problems may be caused by CN when lesions spread over the integument. Therefore, an improvement of safety measures in occupational CN gas use is needed, especially aiming at avoidance of accidental leakage of canisters.

Delayed pulmonary edema and bronchospasm after accidental lacrimator exposure

Clinical manifestations of lacrimator exposure can be immediate or significantly delayed. In both phases, the sequelae can be severe and life-threatening. As personal protection devices, these agents have become readily available to the public in many areas of the country. Emergency physicians should gain a firm understanding of the presentation, management, and disposition of the lacrimator-exposed patient. A case of accidental prolonged lacrimator exposure inducing pulmonary edema and bronchospasm is presented.

The fatalities of the Intifada (uprising): the first five years

The uprising of the Palestinian population (Intifada) against the Israeli occupation of the Gaza Strip and the West Bank, which erupted in December 1987, has resulted in the deaths of hundreds of Israeli citizens and Palestinian residents. The data on dead victims, as reported by two civil rights organizations of opposite political orientation and by the official military authority, are analyzed and compared with the information obtained from post-mortem examinations of some 65% of the victims carried out over the period 1987 to 1992. The agencies' reports were found to differ, sometimes markedly, from the official autopsy data in respect of number of deaths, their cause and manner. The study indicates a generally downward trend in the number of Palestinians killed by the Israeli Defence Forces, which could be the result of the wider use of rubber and plastic bullets, and a steady continuous increase in Israeli victims killed by the Palestinians, possibly accounted for by a shift from the use of "cold weapons" in favour of firearms, and an escalation in violence. It is suggested that the post-mortem examination should be an essential tool for the detection and documentation of possible abuse and bodily harm.

CS gas--implications for the anaesthetist

Although the use of CS gas is illegal in the UK, an occasional patient exposed to its effects may be seen. We report the problems experienced with the anaesthetic management of such a patient.