The Impact of Crowd Control Weapons on Public Health & Safety

Erika Kaske, BS, Rachel Hardeman, PhD, MPH, David Darrow, MD, MPH University of Minnesota Medical School, Department of Neurosurgery University of Minnesota, School of Public Health

March 4th, 2021 Minneapolis City Council Public Health & Safety Committee Meeting Our Background:

Erika Kaske, BS Rachel Hardeman, PhD, MPH David Darrow, MD, MPH Medical Student Blue Cross Endowed Professor Faculty Neurosurgeon of Health and Racial Equity Assistant Professor Disclosures:

• None “The hill we climb, if only we dare, it’s because being American is more than a pride we inherit. It’s the past we step into and how we repair it.” Discussion Outline

• Presentation (15 minutes) – Terminology Overview – Study Findings • Case #1 • Case #2 • United Nations Guidelines – Current Policy & Recommendations – Public Health Implications • Q&A Terminology Overview Terminology Overview

• Kinetic Impact Projectiles: Terminology Overview • Chemical Irritants: – Colloquial Terminology: Pepper Spray, Tear Gas, Pepperball Study Findings

Clinical Picture: Next Slide A Pediatric Patient with a Depressed Skull Fracture after Rubber Injury

Clinical Picture: Next Slide

Clinical Picture: Next Slide A Concerning Pattern

Clinical Picture: Next Slide A Young Patient with a Blowout Fracture after Tear Gas Canister Injury

Paper Conclusions Current Policy Current Policy

• Crowd control weapons shall not be authorized for peaceful gatherings or assemblies (MPD 5-300). • Chief of Police authorizes the use of Kinetic Impact Projectiles in civil disturbances of assemblies, but may be used without prior authorization by officers in order to stop acts of violence. Current Policy

• Civil disturbance vs. Demonstration vs. Assembly • Civil disturbances and demonstrations may co-occur • United Nations and manufacturer guidelines still apply in all scenarios

– In any crowd scenario it is difficult to use these weapons correctly. • There may be discrepancies in the current policy that would allows these events to happen again. Policy Recommendations Recommendation #1: Consider limiting the use of Kinetic Impact Projectiles Background: Kinetic Impact Projectiles

0 – 10 m

Accurate shot, but can cause serious injury when fired at close range Background: Kinetic Impact Projectiles

50+ m

Less accurate shot Projectile may now hit the thin, vulnerable structure of the face, which requires less force to fracture. Serious injury may result Background: Kinetic Impact Projectiles

50+ m

In a crowd, hitting an unintended target is likely Distance Requirements for Kinetic Impact Projectiles

Protest Photos: Next Slide Distance Requirements for Kinetic Impact Projectiles

Protest Photos: Next Slide Distance Requirements for Kinetic Impact Projectiles Recommendation #1: Consider limiting the use of Kinetic Impact Projectiles

• Projectiles are inherently inaccurate • Inaccuracies are worsened in a crowd control setting • 57 people required professional medical care during the COVID-19 pandemic for kinetic impact projectile injuries – 40% of those injuries were head injuries • These results show that, a crowded environment does not permit for intended use of these weapons. Recommendation #2: Consider limiting the use of Chemical Irritants to Handheld Devices Background: Tear Gas Canister Launchers Background: Handheld Chemical Irritants Recommendation #2: Limit the use of Tear Gas to Handheld Devices • Tear gas canister are not meant to hit people and may be unlawful • We have documented 7 cases in Minneapolis of tear gas canister injuries • Our study only looked at injuries in the acute setting. – The US army also found that repeated exposure can results in long term respiratory health consequences which is concerning during the pandemic. – As many cities have banned the use of chemical irritants entirely based on these concerns, council may also consider this option.

Thank you

Samuel W. Cramer, M.D., Ph.D. Isabela Pena Pino, M.D. Truong H. Do, M.D. Bryan M. Ladd, M.D. Dylan T. Sturtevant, B.S. Aliya Ahmadi, B.A. Birra Taha, M.D. David Freeman, M.D., Ph.D. Joel T. Wu, J.D. Brooke A. Cunningham, M.D., Ph.D. David J. Satin, M.D. References

1. Kaske, E. A., Cramer, S., Pena, I., Do, T., Ladd, B., Sturtevant, D., Ahmadi, A., Taha, B., Freeman, D., Wu, J., Cunningham, B., Hardeman, R, Satin, D, and Darrow, D. (2021, Feb 24). Injuries from Less-Lethal Weapons during the George Floyd Protests in Minneapolis. New England Journal of Medicine. 10.1056/NEJMc2032052 2. Buchanan L, Bui Q, Patel JK. Black Lives Matter may be the largest movement in U.S. history. New York Times. July 3, 2020 (https://www.nytimes.com/interactive/2020/07/03/us/george-f loyd -protests-crowd-size.html). 3. Haar RJ, Iacopino V, Ranadive N, Weiser SD, Dandu M. Health impacts of chemical irritants used for crowd control: a systematic review of the injuries and deaths caused by tear gas and pepper spray. BMC Public Health 2017;17:831. 4. Haar RJ, Iacopino V, Ranadive N, Dandu M, Weiser SD. Death, injury and disability from kinetic impact projectiles in crowd-control settings: a systematic review. BMJ Open 2017; 7(12):e018154. 5. Olson KA, Haselden LE, Zaunbrecher RD, et al. Penetrating injuries from “less lethal” beanbag munitions. N Engl J Med 2020;383:1081-3. 6. United Nations human rights guidance on less-lethal weapons in law enforcement. Office of the United Nations High Commissioner for Human Rights, 2020 (https://www.ohchr.org/ Documents/HRBodies/CCPR/LLW_Guidance.pdf). 7. Hout et. al. o-Chlorobenzylidene Malononitrile (CS Control Agent) Associated Acute Respiratory Illnesses in a U.S. Army Basic Combat Training Cohort. Military Medicine, 2014. https://doi.org/10.7205/MILMED-D-13-00514 8. https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=26805&LangID=E 9. https://storymaps.arcgis.com/stories/29cbf2e87b914dbaabdec2f3d350839e 10. https://phr.org/news/u-s-law-enforcement-shot-at-least-115-people-in-the-head-with-crowd-control-weapons-during-the-first-two-months-of-george-floyd-protests- physicians-for-human-rights/ 11. https://news.un.org/en/story/2021/02/1085872 12. https://www.cnn.com/2020/10/29/us/philadelphia-city-council-protests-rubber--pepper-spray/index.html 13. http://www2.minneapolismn.gov/police/policy/mpdpolicy_5-300_5-300 14. https://www.aclu.org/fact-sheet/kinetic-impact-projectiles-fact-sheet 15. https://www.aclu.org/fact-sheet/chemical-irritants-fact-sheet 16. https://www.ojp.gov/pdffiles1/nij/grants/236950.pdf 17. https://www.usatoday.com/in-depth/news/2020/06/20/less-lethal-rubber-bullet-protester-pepper-ball-tear-gas-injured-blinded/5343717002/ 18. https://www.ojp.gov/pdffiles1/nij/grants/204433.pdf 19. https://www.defense-technology.com/wp-content/uploads/2020/08/40mm-eXact-iMpact-Sponge-Round-6325_Updated-Specs.pdf 20. https://www.defense-technology.com/wp-content/uploads/2020/06/40mm-Bean-Bag-Round-6025.pdf 21. https://www.defense-technology.com/wp-content/uploads/2020/06/40mm-Rubber-Baton-Round-6064.pdf Q&A