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Non-Fatal Gunshot Wounds Among Military Police in Rio De Janeiro: Health As a Field of Emergency Against the Naturalization of Violence

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Non-Fatal Gunshot Wounds Among Military Police in Rio De Janeiro: Health As a Field of Emergency Against the Naturalization of Violence DOI: 10.1590/1413-81232021265.19412019 1911 Ferimentos não fatais por arma de fogo entre policiais militares TEM A do Rio de Janeiro: a saúde como campo de emergência contra a S LIV naturalização da violência R ES F Non-fatal gunshot wounds among military police in Rio de Janeiro: R health as a field of emergency against the naturalization of violence EE THEMES Adriane Batista Pires Maia (https://orcid.org/0000-0001-6081-707X) 1 Simone Gonçalves Assis (http://orcid.org/0000-0001-5460-6153) 1 Fernanda Mendes Lages Ribeiro (https://orcid.org/0000-0002-3766-9758) 1 Liana Wernersbach (https://orcid.org/0000-0003-1928-9265) 1 Abstract This article discusses health problems Resumo Esse artigo aborda a ocorrência de agra- due to firearm injuries suffered on duty military vos à saúde decorrentes de ferimentos por arma de police officers in the metropolitan region of Rio fogo (FAF) que atingiram policiais militares da de Janeiro (RJ). Medical records analysis was con ativa na Região Metropolitana do Rio de Janei- ducted referring to military police officers who ro (RJ). Pesquisa documental, por meio de aná- were treated at the Military Police’s Central Hos lise de prontuários médicos de policiais militares pital (MPCH) due to gunshot wounds from June atendidos no Hospital Central da Polícia Militar 2015 to December 2017 according to profession- (HCPM) em decorrência de FAF, no período de ju- al profile, the characteristics of the event and the nho de 2015 a dezembro de 2017 segundo variáveis le sion, the spatial distribution of the incidents relativas ao perfil profissional, às características do in volving gunshot wounds, and the healthcare evento e da lesão, à distribuição espacial dos FAF units involved in their care. Firearms injured e às unidades de saúde envolvidas no atendimen- four hun dred seventy-five military police offi- to. No período investigado, 475 policiais militares cers: 98.3% were male, 77.3% were in service, sofreram ferimentos por armas de fogo: 98,3% do 97.9% were soldier personnel. As to the anatom- sexo masculino, 77,3% encontravam-se em servi- ical location of the wounds, the most affected re- ço, 97,9% eram praças. Quanto à localização ana- gions were: lower (41.1%) and superior (33.1%) tômica dos ferimentos, as regiões mais acometidas limbs, the head neck-face region (23.5%), and foram: membros inferiores (41,1%) e superiores thorax-abdomen (3%). The areas in the metro- (33,1%), região da cabeça-pescoço-face (23,5%) e politan area of Rio de Janeiro with the highest tórax-abdome (17,3%). As áreas na Região Me- occurrence of firearm morbidity are program ar- tropolitana do Rio de Janeiro onde foram encon- eas 3 and 1 and the Baixada Fluminense. There tradas as maiores ocorrências de morbidade por is a correlation between police morbidity rates arma de fogo foram as áreas de planejamento 3 e due to firearm injuries in the municipalities of 1 e a Baixada Fluminense. Constatou-se correla- 1 Departamento Estudos the metropolitan region and demographic den- ção entre as taxas de morbidade policial por armas de Violência e Saúde Jorge sity (p = 0.024). de fogo dos municípios da região metropolitana e Careli, Escola Nacional Key words Morbity, Police, Public safety, Gun- densidade demográfica (p = 0,024). de Saúde Pública Sergio Arouca, Fundação Oswaldo shot wound, Occupational health Palavra-chave Morbidade, Polícia, Segurança Cruz. Rua Leopoldo Bulhões pú blica, Ferimentos por arma de fogo, Saúde ocu- 1480, Manguinhos. 21041- pacional 210 Rio de Janeiro RJ Brasil. [email protected] 1912 et al. Maia ABP Maia Introdução poucos estudos têm buscado investigar e descre- ver a localização desses ferimentos e os impactos O Brasil é um país marcado pela violência, no na saúde do policial tanto para o desempenho entanto, no imaginário social, existe o mito de profissional quanto em sua vida social1,9. Isso se que somos um país pacífico1. Nos últimos 35 deve ao fato de que, no Brasil, não há um sistema anos, apesar da retomada dos direitos civis e do nacional integrado que registre a morbimortali- restabelecimento do estado democrático de direi- dade dos agentes de segurança pública9-11. tos, indicadores de violência social permanecem Atualmente, os relatórios sobre a mortalida- elevados e até mesmo crescentes, a reboque da de entre os profissionais de segurança pública no globalização e da urbanização. A despeito de não Brasil, quando existem, são fragmentados e in- vivermos conflitos armados de cunho religioso, completos, e reune dados fornecidos por alguns étnico, territorial ou político, entre 1980 e 2014 Institutos de Segurança ou Secretarias Estaduais morreram 967.851 pessoas em virtude de feri- de Segurança Pública. no Estado do Rio de Janei- mentos por arma de fogo (FAF), o que nos coloca ro, o último Relatório de Vitimização Policial foi entre os 10 países com maior taxa de homicídio publicado em 2015, e não abordava, contudo, as por arma de fogo no mundo. Entre as vítimas morbidades produzidas por arma de fogo entre fatais, constata-se perfil majoritário de homens esses profissionais12. entre 15 e 29 anos de idade e negros. A vitimi- O atendimento em saúde dos policiais mi- zação por arma de fogo entre a população negra litares no Rio de Janeiro possui particularidades é 2,6 vezes maior que entre os brancos2-4. Phebo5 que os diferem dos demais usuários do SUS, já concluiu que entre as mortes por causas externas, que contam com a possibilidade de adesão a um aquelas causadas por arma de fogo ultrapassaram plano de saúde coorporativo custeado por recur- as ocorridas por acidentes de trânsito, tornando- sos financeiros captados a partir de contribuição se a primeira causa entre os homicídios, o que voluntária dos policiais ativos e inativos, seus de- gera impacto no custo das hospitalizações na rede pendentes e pensionistas, que viabilizam o fun- credenciada do Sistema Único de Saúde (SUS). cionamento do Sistema de Saúde da Corporação. Esse tipo de violência social também tem O Hospital Central da Polícia Militar (HCPM) é, atingido os policiais militares no país. O Rio de atualmente, o hospital de referência para atendi- Janeiro foi o estado que apresentou o maior nú- mento de urgências e emergências dos policiais mero absoluto de policiais militares mortos em militares e seus dependentes no estado do Rio de 20166, contudo não são conhecidos os números Janeiro. das morbidades por armas de fogo entre essa clas- Dessa forma, esse estudo tem como objetivo se de trabalhadores, o que dificulta a compreensão identificar o perfil e o atendimento em saúde dos da real magnitude desse problema. Ehikhamenor policiais militares do estado do Rio de Janeiro e Ojo7 concluíram que as características dos feri- acometidos por ferimentos não fatais por arma mentos entre profissionais de segurança diferem de fogo atendidos no Hospital Central da Polícia das características encontradas na prática civil, Militar. tanto do ponto de vista epidemiológico quanto nos caminhos para o seu tratamento. Em pesquisa de revisão sistemática sobre pro- Método fissionais de segurança pública acometidos por ferimentos com arma de fogo, constata-se que este Efetuou-se um levantamento referente aos poli- objeto letal foi o principal mecanismo de ferimen- ciais militares que foram atendidos no HCPM em to em serviço entre os policiais, mais frequente en- decorrência de FAF, definidos como qualquer tipo tre profissionais de segurança do sexo masculino, de lesão física não fatal por arma de fogo, indepen- com cerca de 31 anos de idade. As circunstâncias dente da gravidade da lesão provocada. Descreve- de maior risco foram: ações de prisão, em respos- se a frequência e a distribuição das agressões por tas a demandas para verificação de perturbação à arma de fogo no universo dos policiais da Região ordem e situações de guerra8. Metropolitana do Rio de Janeiro que não falece- No Brasil, a escalada da ocorrência desse tipo ram imediatamente em decorrência do ferimento de ferimento se dá em virtude da penetração ilegal e que foram levados para o referido hospital. de armas com elevado potencial de destruição, o A busca foi realizada nos Relatórios de Po- que afeta não só a população civil como também liciais Atendidos por Ferimento com Arma de os profissionais de segurança pública, tornando-se Fogo do HCPM, abrangendo de junho de 2015 a um problema de saúde pública2. A despeito disso, dezembro de 2017. A coleta foi feita no Setor de 1913 Ciência & Saúde Coletiva, 26(5):1911-1922, 2021 26(5):1911-1922, Coletiva, & Saúde Ciência Pronto Atendimento (SPA) do HCPM, que regis- por arma de fogo usando-se como numerador tra, desde 2014, informações sobre todo policial o quantitativo de policiais feridos (por municí- atendido com FAF. Foi excluído o período de ju- pio e, no caso do município do Rio de Janeiro, lho de 2014 a maio de 2015 em virtude da falta de também por área de planejamento) e como de- arquivamento adequado dos registros, que gerou nominador a população de policiais da referida a perda dos dados. As informações dos prontu- área. Como variáveis explicativas empregaram-se ários e Relatórios foram acessadas em 2018. Os o Índice de Desenvolvimento Humano Munici- registros dos prontuários médicos são gerados a pal (IDHM)13, o percentual da população viven- partir do Boletim de Entrada do paciente no SPA, do em aglomerados subnormais14 e a densidade já os Relatórios são alimentados inicialmente pelo demográfica das áreas14. Para esta análise empre- oficial de dia, médico militar responsável pela gou-se o coeficiente de correlação de Pearson. emergência, que lança em brochura as informa- A pesquisa foi submetida e aprovada pelo Co- ções referentes a cada militar ferido por projéteis mitê de Ética em Pesquisa da Escola Nacional de de armas de fogo.
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