DOI: 10.1590/1413-81232021265.19412019 1911 Non-fatal gunshot wounds among military police FREE THEMES in Rio de Janeiro: health as a field of emergency against the naturalization of violence 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 due to firearm injuries suffered on duty military police officers in the metropolitan region of Rio de Janeiro (RJ). Medical records analysis was con ducted referring to military police officers who were treated at the Military Police’s Central Hos pital (MPCH) due to gunshot wounds from June 2015 to December 2017 according to profession- al profile, the characteristics of the event and the le sion, the spatial distribution of the incidents in volving gunshot wounds, and the healthcare units involved in their care. Firearms injured four hun dred seventy-five military police offi- cers: 98.3% were male, 77.3% were in service, 97.9% were soldier personnel. As to the anatom- ical location of the wounds, the most affected re- gions were: lower (41.1%) and superior (33.1%) limbs, the head neck-face region (23.5%), and thorax-abdomen (3%). The areas in the metro- politan area of Rio de Janeiro with the highest occurrence of firearm morbidity are program ar- eas 3 and 1 and the Baixada Fluminense. There is a correlation between police morbidity rates due to firearm injuries in the municipalities of 1 Departamento Estudos the metropolitan region and demographic den- de Violência e Saúde Jorge sity (p = 0.024). Careli, Escola Nacional Key words Morbity, Police, Public safety, Gun- de Saúde Pública Sergio Arouca, Fundação Oswaldo shot wound, Occupational health Cruz. Rua Leopoldo Bulhões 1480, Manguinhos. 21041- 210 Rio de Janeiro RJ Brasil. [email protected] 1912 et al. Maia ABP Maia Introduction the police’s health and social life1,9, since there is no integrated national system in Brazil that reg- Brazil is a country marked by violence. However, isters the morbidity and mortality of public se- in the social imagination, there is the myth that curity agents9-11. we are a peaceful country1. Despite the resump- Currently, reports on mortality among pub- tion of civil rights and the restoration of a dem- lic security professionals in Brazil, when they ocratic state of rights in the past 35 years, social exist, are fragmented and incomplete, gathering violence remains high and even increasing in data provided by some Security Institutes or the wake of globalization and urbanization. Al- Public Security State Secretaries. In the State of though we do not experience armed conflicts of Rio de Janeiro, the latest Police Victimization Re- a religious, ethnic, territorial, or political nature, port was published in 2015; however, it did not between 1980 and 2014, 967,851 people died address the morbidities produced by firearms due to gunshot wounds (GW), which places us among these professionals12. among the ten countries with the highest rate of The health care provided by military police firearm homicide in the world. Among the fatal officers in Rio de Janeiro has particularities that victims of firearms, there is a majority profile of differ from other SUS users, as they have the pos- men between 15 and 29 years of age and blacks. sibility of adhering to a corporate health plan Victimization by firearms among the black pop- funded by financial resources raised from the ulation is 2.6 times greater than among whites2-4. voluntary contribution of the police professional Phebo5 concluded that among deaths from ex- (active and inactive), their dependents and pen- ternal causes, those caused by firearms exceeded sioners, which make the Corporation’s Health those caused by traffic accidents, becoming the System work. The Central Hospital of the Mili- first cause among homicides, generating an ad- tary Police is currently the reference hospital for ditional impact on the cost of hospitalizations urgent and emergency care for military police in the accredited network of the Unified Health officers and their dependents in the state of Rio System (SUS). de Janeiro. This type of social violence has also affect- This study aims to identify the profile and ed officers in the country. Rio de Janeiro was health care of military police officers in the state the state that had the highest absolute number of Rio de Janeiro affected by non-fatal firearm of police officers killed in 20166. However, the injuries treated at the Military Police’s Central numbers of firearm morbidities among this class Hospital. of workers are not known, making it difficult to understand the real magnitude of this prob- lem. Ehikhamenor and Ojo7 concluded that in- Method juries among security professionals differ from the characteristics found in civil practice, both A survey was carried out regarding the military from an epidemiological point of view and in the police who were attended at the MPCH due to treatment. GW, defined as any type of non-fatal physical In a systematic review survey of public secu- injury by firearms, regardless of the severity of rity professionals affected by gunshot wounds, it the injury caused. Describes the frequency and was found that this lethal object was the main in- distribution of firearm attacks in the universe of jury mechanism in service among police officers, police officers in the metropolitan region of Rio more frequent among male security profession- de Janeiro who did not die immediately due to als, with about 31 years of age. The circumstanc- the injury and who were taken to the hospital. es of most significant risk were: arrest actions in The search was carried out in the MPCH response to demands for verification of distur- Firearms Injury Officers’ Reports, covering from bance to the order and situations of war8. June 2015 to December 2017. The collection was In Brazil, the escalation of this type of injury made in the MPCH’s Emergency Department occurs due to the illegal penetration of weapons (ED), which registers, since 2014, information with a high potential for destruction, affecting about every police officer with GW. From July not only the civilian population but also public 2014 to May 2015 was excluded due to the lack security professionals, becoming a public health of proper filing of records, which led to data problem2. Despite this, few studies investigate loss. Information from medical records and Re- and describe the location of these injuries, the ports was accessed in 2018. Medical records are impacts on the professional’s performance, and generated from the ED’s Patient Entry Form. 1913 Ciência & Saúde Coletiva, 26(5):1911-1922, 2021 26(5):1911-1922, Coletiva, & Saúde Ciência Simultaneously, the Reports are fed by the day’s The research was submitted to and approved officer, the military physician responsible for the by the Research Ethics Committee of the Nation- emergency that releases in a brochure the in- al School of Public Health / Fiocruz. formation of each military wounded by firearm projectiles. This brochure is sent every two days to the MPCH secretariat, where a military police Results officer transcribes the information from the bro- chure to a form called “Report of Officers Served Four hundred seventy-five records of active mil- by Projectiles with Firearms.” After filling out this itary police attended at the MPCH emergence notification form, it is filed with the secretary on department due to GW were included. As for the paper and has never been digitized. profile of active military police officers served, Variables were analyzed regarding: a) profile 98.3% are male, with 8 cases of female police of the professionals: sex, police rank/graduation, officers with gunshot wounds. Performing the and battalion; b) characteristics of the events and temporal distribution of individuals who suf- injuries: date and place of the occurrence, GW fered GW, it is observed that between June and occurred on duty or day off, anatomical location, December 2015, 78 occurrences were found; in classification of the patient’s health status in good, 2016, there were 172 occurrences; and in 2017, regular or severe, length of hospital stay, if he died there was an increase in this type of violence, or no during hospitalization, revictimization (yes reaching 222 cases. There was no substantial dif- or no) and the number of surgeries performed ference between the months of the year. There urgently at the MPCH due to the injury; c) the was an increase in this morbidity between July geographical distribution of GW: location of the 2015 and December 2017 (Table 1). event in the city of Rio de Janeiro, according to Among the 470 cases analyzed, in only five, Planning Areas; for the Baixada Fluminense, it was not possible to identify whether the police Niterói and São Gonçalo region, the district in- officer was on duty or day off at the time of the volved was considered; and d) spatial distribution injury, and these were excluded from the analy- of the health services involved in the attendance: sis. Among the 470 cases analyzed, we saw that information on the hospitals involved in the pri- a significant part of the visits made occurred in mary care of the military police officers shot and service (77,2%), resulting from work activity identification of the metropolitan region of Rio through the exercise of ostensive policing and de Janeiro where they were located. police operations with armed confrontation in The collected data were inserted into the Ep- the city (349) and accidental shots (14).