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Table 2 Study summaries

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

Reference Country Study Design Context Type Chemical Agent Deployment Type People Exposed People Injured Deaths Perm Injuries All injuries
High quality studies
Adang, O.M.J., Mensink, J., 2004. Pepper spray: An unreasonable response to suspect verbal resistance. Policing 27, 206–219. doi:10.1108/13639510410536823 Netherlands Prospective Cohort Arrest/police duty OC hand-held spray 465 78 0 0 78
Anderson, P.J., Lau, G.S., Taylor, W.R., Critchley, J.A., 1996. Acute effects of the potent lacrimator o-chlorobenzylidene malononitrile (CS) tear gas. Hum Exp Toxicol 15, 461–465. Hong Kong Retrospective Cohort Detention Center/Prison CS aerosol 184 184 0 0 391
Arbak, P., Başer, I., Kumbasar, Ö.O., Ülger, F., Kılıçaslan, Z., Evyapan, F., 2014. Long term effects of tear gases on respiratory system: analysis of 93 cases. ScientificWorldJournal 2014, 963,638. doi:10.1155/2014/963638 Turkey Retrospective Cohort Protest CS and OC aerosol 93 93 0 23 219
Breakell, A., Bodiwala, G.G., 1998. CS gas exposure in a crowded night club: the consequences for an accident and emergency department. J Accid Emerg Med 15, 56–57. UK Case Series law enforcement use on non-protest crowd CS aerosol 23 11 0 0 15
Brown, L., Takeuchi, D., Challoner, K., 2000. Corneal abrasions associated with pepper spray exposure. Am J Emerg Med 18, 271–272. USA Retrospective Cohort Arrest/police duty OC hand-held spray 100 47 0 0 47
Euripidou, E., MacLehose, R., Fletcher, A., 2004. 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). Emerg Med J 21, 548–552. doi:10.1136/emj.2003.012773 UK Retrospective Cohort multiple settings CS hand-held spray 152   0   319
Kearney, T., Hiatt, P., Birdsall, E., Smollin, C., 2014. Pepper spray injury severity: ten-year case experience of a poison control system. Prehosp Emerg Care 18, 381–386. doi:10.3109/10903127.2014.891063 USA Retrospective Cohort multiple settings OC hand-held spray 3671 3671 0 0 5261
Khan, S., Maqbool, A., Abdullah, N., Keng, M.Q., 2012. Pattern of ocular injuries in stone pelters in Kashmir valley. Saudi J Ophthalmol 26, 327–330. doi:10.1016/j.sjopt.2012.04.004 India Retrospective Cohort Protest CS projectile canister 2 2 0 2 2
Koul, P.A., Mir, H., Shah, T.H., Bagdadi, F., Khan, U.H., 2014. Effects of pepper grenade explosions on non-combatant bystanders. J Public Health Policy 35, 499–505. doi:10.1057/jphp.2014.15 India Retrospective Cohort Protest OC aerosol 294 294 0 0 1230
Lee, R.J., Yolton, R.L., Yolton, D.P., Schnider, C., Janin, M.L., 1996. Personal defense sprays: effects and management of exposure. J Am Optom Assoc 67, 548–560. USA Prospective Cohort law enforcement training or activity OC hand-held spray 22 22 0 0 26
Nathan, R., Wood, H., Rix, K., Wright, E., 2003. Long-term psychiatric morbidity in the aftermath of CS spray trauma. Med Sci Law 43, 98–104. UK Retrospective Cohort law enforcement use on non-protest crowd CS hand-held spray 30 23 0 14 23
Parneix-Spake, A., Theisen, A., Roujeau, J.C., Revuz, J., 1993. Severe cutaneous reactions to self-defense sprays. Arch Dermatol 129, 913. France Case Series Arrest/police duty CS hand-held spray 11 11 0 5 25
Payne-James, J.J., Smith, G., Rivers, E., O’Rourke, S., Stark, M., Sutcliffe, N., 2014. Effects of incapacitant spray deployed in the restraint and arrest of detainees in the Metropolitan Police Service area, London, UK: a prospective study. Forensic Sci Med Pathol 10, 62–68. doi:10.1007/s12024-013-9494-7 UK Prospective Cohort Arrest/police duty CS and OC hand-held spray 99 93 0 0 319
Sharma, A.K., Shah, D.N., Shrestha, J.K., Thapa, M., Shrestha, G.S., 2014. Ocular injuries in the people’s uprising of April 2006 in Kathmandu, Nepal. Nepal J Ophthalmol 6, 71–79. doi:10.3126/nepjoph.v6i1.10775 Nepal Retrospective Cohort Protest CS projectile canister 3 3 0 2 3
Thomas, R.J., Smith, P.A., Rascona, D.A., Louthan, J.D., Gumpert, B., 2002. Acute pulmonary effects from o-chlorobenzylidenemalonitrile “tear gas”: a unique exposure outcome unmasked by strenuous exercise after a military training event. Mil Med 167, 136–139. USA Retrospective Cohort law enforcement training or activity CS aerosol 38 9 0 0 45
Vesaluoma, M., Müller, L., Gallar, J., Lambiase, A., Moilanen, J., Hack, T., Belmonte, C., Tervo, T., 2000. Effects of oleoresin capsicum pepper spray on human corneal morphology and sensitivity. Invest. Ophthalmol. Vis. Sci. 41, 2138–2147. Finland Prospective Cohort law enforcement training or activity OC hand-held spray 10 10 0 0 51
Wani, A.A., Zargar, J., Ramzan, A.U., Malik, N.K., Qayoom, A., Kirmani, A.R., Nizami, F.A., Wani, M.A., 2010. Head injury caused by tear gas cartridge in teenage population. Pediatr Neurosurg 46, 25–28. doi:10.1159/000314054 India Prospective Cohort Protest CS projectile canister 5 4 1 1 4
Wani, M.L., Ahangar, A.G., Lone, G.N., Singh, S., Dar, A.M., Bhat, M.A., Ashraf, H.Z., Irshad, I., 2011. Vascular injuries caused by tear gas shells: surgical challenge and outcome. Iran J Med Sci 36, 14–17. India Prospective Cohort Protest CS projectile canister 18 18 0 13 50
Watson, K., Rycroft, R., 2005. Unintended cutaneous reactions to CS spray. Contact Derm. 53, 9–13. doi:10.1111/j.0105-1873.2005.00585.x UK Retrospective Cohort law enforcement training or activity CS hand-held spray 7 7 0 3 8
Watson, W.A., Stremel, K.R., Westdorp, E.J., 1996. Oleoresin capsicum (Cap-Stun) toxicity from aerosol exposure. Ann Pharmacother 30, 733–735. USA Retrospective Cohort Arrest/police duty OC hand-held spray 94 80 0 0 192
Zollman, T.M., Bragg, R.M., Harrison, D.A., 2000. Clinical effects of oleoresin capsicum (pepper spray) on the human cornea and conjunctiva. Ophthalmology 107, 2186–2189. USA Prospective Cohort law enforcement training or activity   OC Spray 47 47 0 0 208
Moderate Quality Studies
Atkinson, H., Sollom, R., 2012. Weaponizing Tear Gas: Bahrain’s. Physicians for Human Rights, Boston, MA. Bahrain NGO Report Protest CS aerosol 11 10 1 3 9
Dong, C., de la Garza, A., 2007. Chlorobenzylidenemalonitrile gas exposure from a novelty personal-protection gun. Cal J Emerg Med 8, 57–60. USA Case Series Accidental exposure CS aerosol 8 8 0 0 16
Hankin, S.M., Ramsay, C.N., 2007. Investigation of accidental secondary exposure to CS agent. Clin Toxicol (Phila) 45, 409–411. doi:10.1080/15563650701285438 UK Case Series Accidental exposure CS aerosol 34 21 0 0 147
Karagama, Y.G., Newton, J.R., Newbegin, C.J.R., 2003. Short-term and long-term physical effects of exposure to CS spray. J R Soc Med 96, 172–174. UK Retrospective Cohort law enforcement use on non-protest crowd CS hand-held spray 34 34 0 0 109
Kiel, A.W., 1997. Ocular exposure to CS gas: the importance of correct early management. Eye (Lond) 11 (Pt 5), 759–760. doi:10.1038/eye.1997.194 UK Case Series Accidental exposure CS aerosol 6 6 0 0 6
Oh, J.J., Yong, R., Ponampalam, R., Anantharman, V., Lim, S.H., 2010. Mass casualty incident involving pepper spray exposure: Impact on the emergency department and management of casualties. Hong Kong Journal of Emergency Medicine 17, 352–359. Singapore Retrospective Cohort Accidental exposure OC hand-held spray 13 11 0 0 38
Rasier, R., Kukner, A.S., Sengul, E.A., Yalcin, N.G., Temizsoylu, O., Bahcecioglu, H.O., 2014. The Decrease in Aqueous Tear Production Associated with Pepper Spray. Curr. Eye Res. 1–5. doi:10.3109/02713683.2014.930156 Turkey Retrospective Cohort Protest OC hand-held spray 96 25 0 0 25
Solomon, I., Kochba, I., Eizenkraft, E., Maharshak, N., 2003. Report of accidental CS ingestion among seven patients in central Israel and review of the current literature. Arch. Toxicol. 77, 601–604. doi:10.1007/s00204-003-0479-2 Israel/Palestine Case Series Accidental exposure CS aerosol 7 7 0 0 37
Unuvar, et al. 2013. HRFT Turkey NGO Report protest CS aerosol 269 247 0 0 266
Unuvar, U., Ozkalipci, O., Irencin, S., Sahin, U., Fincanci, S.K., 2013. Demonstration control agents: evaluation of 64 cases after massive use in Istanbul. Am J Forensic Med Pathol 34, 150–154. doi:10.1097/PAF.0b013e3182887b3c Turkey Retrospective Cohort Protest CS and OC aerosol 64 53 0 0 88