Morbidity and mortality of riot control agents exposure in several countries in the last 50 years: a systematic review.

Background: Riot Control Agents (RCA) can cause temporary paralysis when used in high concentrations. This effect may continue for a while, even after the exposure has ended, but these agents are typically not lethal. This study looks at how RCA exposure might be linked to injuries or deaths in those affected. This information is important for forensic professionals and policymakers because incidents with RCA sometimes lead to injuries or fatalities. Main body: We included cohort studies, case series, and case reports that examined human injuries resulting in death due to exposure to RCA (both active and non-active substances) across various event contexts. We conducted a literature search using the PubMed database, Wiley Online Library, Cochrane Library, ScienceDirect, and Google Scholar. Only research published in English between January 1974 and December 2023 was included. The risk of bias was assessed through a critical appraisal of all selected literature, utilizing critical appraisal tools from the Joanna Briggs Institute (JBI). Systematic review registration: PROSPERO CRD42024540345. We analyzed 24 studies (from 4,677 identified article titles to the remaining 25 studies that we managed to include) involving 840 victims (67 men) in 10 countries, with active substances RCA in the form of oleoresin capsicum (OC gas), 2-chlorobenzalmalononitrile (CS gas), and chloroacetophenone (CN gas), and non-active substance was tear gas canister (TGC). The eye is the organ that is most often injured compared to others. The severity of injuries was classified from negative-mild to death, with the highest mortality rate linked to TGC exposure. Exposure to RCA can lead to severe injuries influenced by factors such as concentration, discharge distance, location, administration, and not just the active substance itself. Conclusion: This study shows the benefits of understanding how injuries happen due to the release of RCA. It suggests future research to fill gaps in our knowledge. The findings aim to help law enforcement use RCA more effectively to prevent injuries and unexpected deaths. Additionally, the study informs the public that exposure to RCA can cause serious injuries or death in certain situations, reducing misunderstandings about similar cases in the future. Key points: This research illustrates that the use of RCA can cause injuries ranging from mild moderate, severe, to death. The part of the victim's body that experiences the most injuries due to RCA exposure is the eyes compared to others. Exposure to RCA can lead to serious injury influenced by factors such as concentration discharge distance, location, administration, and not just the active substance itself. The main causes of severe injuries to death are in fact, caused by something other than the RCA active substance itself, which is TGC. This research provides a framework for setting minimum operational standards for RCA use by authorities to prevent injuries and unexpected deaths. It also seeks to educate the public to minimize misunderstandings about similar cases in the future. [ABSTRACT FROM AUTHOR]