As protesters filled the streets of downtown San Jose, Calif., recently, the police fired munitions known as rubber bullets into the crowd — a common technique to disperse throngs.
Breanna Contreras’s head jerked back from the impact as a black projectile “roughly the size of an extra-jumbo marshmallow” struck her temple, near her eye. “I instantly felt my head just starting to throb, blood poured down my face,” Ms. Contreras, a 21-year-old student, said.
A bystander who used her face mask to help stop the bleeding was also struck. “There were so many rubber bullets being fired, I wanted to think how to protect my eyes,” said Peter di Donato, 75, a veteran of anti-Vietnam War protests, who was hit in the leg. Derrick Sanderlin, 29, a community organizer, approached a line of police officers to ask them to stop. But he got hit too — in the groin — and had to have emergency surgery. He said his doctors have told him he may not be able to have children as a result of the injury.
The rubber bullets — as well as tear gas, flash-bangs and beanbag rounds — that protesters around the country have faced in marches against racial injustice, have been deemed “nonlethal weapons” by law enforcement officials and the military, who use them regularly around the world. But research increasingly shows they can seriously injure and disable people — and sometimes even kill.
A 2017 analysis published in the British Medical Journal of several decades of the use of rubber bullets, beanbag rounds and other projectiles during arrests and protests found that 15 percent of people who were injured were left with permanent disabilities and 3 percent of those who were injured died. Of those who survived, 71 percent had severe injuries, with their extremities most frequently impacted.
“The reality is, even though they were designed as nonlethal, we sadly know that over time there have been some fatalities linked to these devices,” said Dr. Jeffrey M. Goodloe, who is a member of the board of directors for the American College of Emergency Physicians and the chief medical officer for the Emergency Medical Services System for Metropolitan Oklahoma City and Tulsa.
“Instead of calling them nonlethal, we now call these weapons ‘less lethal’, and that is in comparison to a standard bullet,” Dr. Goodloe said.
In Austin, Texas, the experiences of two severely injured students have been the centerpiece of an intense public backlash over the use of less-lethal munitions — an uproar that led the city’s police chief last week to say the department will no longer use beanbag ammunition in crowds.
Eleven people were taken to the hospital over a four-day period after being struck with police-fired beanbag rounds — small fabric pillows filled with lead and fired from shotguns — including Justin Howell, 20, a college student who sustained a skull fracture and brain damage.
Brad Levi Ayala, 16, a student who stopped to watch a peaceful protest as he was headed home from his job at a sandwich shop, was shot in the forehead with a beanbag round, an incident that was captured on video and spread widely online. He was rushed to the hospital where he underwent seven hours of surgery, said his brother, Edwin Sanchez, 22.
“It created this huge gaping hole in his head, a huge wound,” Mr. Sanchez said.
Doctors told the family the lead-filled bag had dented the skull into the brain, damaging the prefrontal cortex, according to Mr. Sanchez.
Now recovering at home, Mr. Ayala is still in a lot of pain and struggling with the trauma of the experience, Mr. Sanchez said. “He has this huge wave of emotions, extreme sadness, extreme anxiety.”
Interviews with doctors and emergency medical workers who have treated patients injured by these weapons show the extent of their risk.
Wesley Hopkins was the on-the-ground chief for a team of medics from the Austin-Travis County Emergency Medical Services that treated people injured by beanbag rounds at a recent protest.
One, an 18-year-old man, was struck on the top of the head. “You could look down into the wound and see fractured skull fragments,” Mr. Hopkins said.
Another beanbag ripped the cheek and broke the jaw of a 20-year-old man. “He could only talk out of one side of his mouth,” Mr. Hopkins said. “He was angry and scared.”
A 40-year-old woman was hit with such velocity that it left an open wound and exposed a broken rib, raising fears among the medical team that she could develop severe breathing problems. “We were laser-focused on her because these patients deteriorate so rapidly,” Mr. Hopkins said.
Ernesto Rodriguez, chief of the Austin-Travis County Emergency Medical Services, said even the term “less lethal” was misleading.
“We can call it ‘less lethal’ but maybe it needs a different name because it gives us a false sense of security, that it can be fired on people and it’s going to be OK, but what we’re finding out is sometimes it’s not OK,” he said. “Sometimes it does cause some pretty severe damage.”
He continued: “Honestly, I question their use in situations that are against unarmed people.”
Rubber bullets, one of the most common crowd-control munitions, are more than four times the diameter of typical bullets and weigh more than five times as much. They are usually fired from military grenade launchers and manufacturers say they are to be used for major muscle groups like buttocks or thighs, not aimed at the upper body or head.
Since they are cylinder-shaped, without the pointy tips of regular bullets, they are not designed to penetrate the body. Injuries from them can run from mild bruising to bone fractures and damage to important blood vessels or nerves, doctors said. There is also a risk of developing internal bleeding if vital organs are impacted by the force of the projectile, said Dr. Ian Wittman, chief of emergency medicine at NYU Langone Hospital-Brooklyn.
“Just like a real bullet, from a medical perspective a rubber bullet is what we describe as a missile,” Dr. Wittman said. “In this case the target is a human body, so it can still cause really significant injuries.”
Flash-bangs, or stun grenades, are also deployed by the police to disperse crowds, as they were by federal authorities in Washington to clear a park in front of the White House so President Trump could walk across it to a church for a staged photo op. They work by disorienting people with a loud noise or a brilliant flash of light. There is little medical research on the long-lasting effects of these types of weapons, but some case reports found that they can damage the eardrums, cause temporary deafness or leave people with prolonged ear pain and ringing, according to Physicians for Human Rights, a nonprofit organization that advocates against mass atrocities and human rights violations around the world.
The light from flash-bangs can harm the retina and temporarily blind a person. The pressure from the blast can propel rocks and other debris into the crowd, and blast injuries can lead to burns, respiratory issues, concussions and psychological trauma. A 2015 ProPublica investigation found that at least 50 people have been seriously injured, maimed or killed by flash-bangs in the United States since the year 2000.
The main effect of clouds of tear gas, mace or pepper spray — chemicals known as lacrimating agents that were also used to clear the park in Washington — is to cause watering of the eyes and irritate sensitive tissues in the nose, mouth and lungs. But if deployed in an enclosed space, tear gas and pepper spray have a more severe impact. Injuries can include chemical burns, blurred vision, corneal erosions, ulcers, nerve damage, abnormal growth of tissue on the eyes (which may need to be removed surgically) and permanent vision loss.
The chemical frequently used in pepper spray — oleoresin capsicum (OC) — is a natural oily resin found in hot peppers, including cayenne and other chili peppers. Because OC is often used in the foods we eat, it is considered by many to have minimal toxicity when used as a lacrimating agent.
That’s simply not accurate, said Dr. Mary K. Daly, chief of ophthalmology at the V.A. Boston Healthcare System. “There have been a number of reports of serious eye complications from OC,” Dr. Daly said. “It can cause permanent vision loss and chronic symptoms. The risks are not only to the eyes. There has also been a death reported in the literature, which was attributed to OC exposure in a person with asthma.”
People with asthma, emphysema, chronic bronchitis and other respiratory conditions may be particularly vulnerable to damage caused by inhaling the chemicals in pepper spray, mace and tear gas, which can inflame the airways, causing coughing and wheezing.
Doctors worry that lacrimating agents and gases may also increase the risk of spreading the coronavirus as protests occur during the pandemic. Yet the police in Seattle have reportedly sprayed a child in the face and New York City officers have yanked a young man’s protective face mask and pepper-sprayed him while he held his arms in the air.
A 2011 study of the use of tear gas in regular military trainings noted that exposure to the chemical could have long-term effects and recommended reducing personnel exposure to tear gas. Several health and human rights experts say the substance should also be removed from domestic law enforcement use.
“We want people to be safe in the process of exercising of their citizen rights,” Dr. Goodloe said.
Dan Levin, Mike Baker, John Ismay and Kitty Bennett contributed reporting.