Pattern Of Injuries Due To Rubber Bullets In A Conflict Zone

摘要

Background: The low velocity rubber bullets were used in Indian Administered Kashmir by Indian police since May 2008 to control anti India protests. Our hospital received all kinds of injuries be they due to conventional bullets or tear gas shells or rubber bullets. We included injuries only due to rubber bullets and specifically studied pattern of injuries caused by them.Methods: We analysed 100 patients who had sustained rubber bullets from May 2008 -july2010 and were received by our hospital. We assessed severity of injury in relation to range from which the bullet was hit, anatomical region of the injury and final outcome. Severity of injury was established by injury severity score (ISS). Findings: 100 patients 95 males and 5 females were included in the study who were proven to have sustained rubber bullet injuries. Average age ranged 12-60 years. Injuries were distributed randomly all along the body , the majority 80 patients (80%) had injuries in the limbs but those to head and neck 5 patients (5%), chest 8 patients (8%), abdomen 4 patients (4%) , back 3 patients (3%). 7 patients sustained injuries in multiple anatomic regions. 65 Patients (65%) had blunt injuries and 35 patients(35%) had penetration. Severity of injury was defined by the ballistic features of bullet, firing range and anatomic site of impact.Interpretation: The severity of injury whether blunt or penetrating caused by these rubber bullets is determined by resistance of body at the anatomic site of impact. Improper ranging with inaccuracy of rubber bullets with improper aiming can result in severe injuries sometimes ending in death. So this type of ammunition should never be considered safe in mob control. Introduction Rubber bullets were fired for the first time in Northern Ireland by British forces in riots control. In between 1970-1975 more than 55,000 rubber bullets were fired. The estimated death rate was estimated to be one death per 18,000 rounds fired. Since then rubber bullets are frequently used to control crowd in riots. The aim of using these rubber bullets is to inflict superficial painful injuries and controlling the demonstrators from further hostile activities but at the same time avoid serious injuries and deaths caused by conventional firearm injuries. These rubber missiles are cylindrical and blunt nosed with a muzzle velocity of 73m/s with a muzzle kinetic energy of 402J. The recommended safety fire range of these rubber missiles is >40m so as to avoid infliction of serious injuries. But inaccuracy of these rubber bullets makes it impossible to avoid hitting head, neck and chest region. Children and teenagers have been reported to sustain more severe injuries than adults particularly skull fractures and along with trunk injuries to lungs liver and spleen.The State police also used these rubber bullets in Kashmir to control the crowd involved in anti India protests since May 2008 besides using conventional bullets, tear gas shells and pellet guns. We in this study studied only pattern of rubber bullet injuries. These rubber bullets have a tiny pointed tip with muzzle velocity of 73m/s. We studied 100 patients from May 2008 –July 2010 who were received by our hospital and who had sustained these rubber bullet injuries to establish the determining factors which generate these blunt and penetrating injuries and injury severity. We observed that the severity of these injuries is determined by elastic limit (resistance at the site of impact). Inaccuracy and instability of these rubber bullets along with improper aiming and range produces more severe injuries. Patients and Methods 100 consecutive patients who sustained rubber bullet injuries and presented to our emergency department at Bone and Joint Hospital Government Medical College Srinagar were taken up for study.The patients were assessed in relation to age, sex, anatomic location of injury, type of injury sustained (blunt or penetrating), injury severity by Abbreviated Injury Scale a