Table 2 Study summaries
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 |