Kinetic Impact Projectile

Aka: Kinetic Impact Projectile, Struck by Projectile, Rubber Bullet Injury, Nonlethal Projectile, Beanbag Round, Foam Tipped Round

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II. Definitions

  1. Kinetic Impact Projectile (e.g. Rubber bullet)
    1. Projectile missile used as a deterrent by law enforcement
    2. Intended to incapacitate targets via nonlethal measures (esp. pain)

III. Background

  1. Originally developed by British for use in northern Ireland
  2. Projectiles are fired from specialized platforms or launchers
  3. Initial projectile velocity 155 to 255 mph (250 to 360 kph)
    1. Projectiles rapidly lose velocity with distance due to large size and poor aerodynamics
  4. Nonlethal Projectiles are intended to target extremities at medium to long range distances
    1. Injuries are typically mild to extremities at target distances >100 feet
  5. Projectiles may cause life threatening or lethal injuries at closer range
    1. Highest risk with inuries to the head and neck (as well as trunk)
    2. Flight path is unpredictable at close range

IV. Types: Projectiles

  1. Rubber Coated Metal Bullets
  2. Pure Rubber Bullets
  3. Wooden Batons
  4. Small Pellets
  5. Large-bore Foam Tipped Rounds
  6. Beanbag Rounds (fabric filled with small lead shot)

V. Complications: Projectile Induced Serious Injury

  1. Background
    1. Serious injuries account for roughly 15% of those presenting with projectile injuries
    2. Most serious injuries involve the head, neck, chest and Abdomen
    3. Many require ICU care (~20%), maxillofacial surgery (40%), orthopedic surgery (20%), neurosurgery (13%)
  2. Lethal injury (2-3%, including both penetrating and blunt mechanisms)
  3. Eye Injury (e.g. blindness, Globe Rupture, Retrobulbar Hematoma)
    1. More common with Beanbag Rounds
  4. Maxillofacial Injury (e.g. Facial Fractures)
  5. Fractures
  6. Retained Foreign Body
  7. Head Injury
    1. Depressed Skull Fractures
    2. Subarachnoid Hemorrhage
    3. Intracerebral Hemorrhage
    4. Subdural Hematomas
    5. Epidural Hematoma

VI. Evaluation

  1. See Trauma Primary Survey
  2. See Trauma Secondary Survey
  3. See Eye Injury
  4. Exercise a low threshold in CT imaging injuries to the head, neck and torso

VII. Management

  1. Mild kinetic injuries to the extremities
    1. Symptomatic management
    2. Disposition home
  2. Head, neck or Torso injury
    1. See Trauma Primary Survey
    2. See Trauma Secondary Survey
    3. See Eye Injury
    4. Exercise a low threshold in CT imaging

VIII. References

  1. Vedula and Jasani (2025) Crit Dec Emerg Med 39(5): 4-14
  2. Haar (2017) BMJ Open 7(12):e018154 +PMID: 29255079 [PubMed]
  3. Fémy (2023) Am J Emerg Med 72:122-6 +PMID: 37523992 [PubMed]
  4. Pearl (2021) Clin Pract Cases Emerg Med 5(4):385-9 +PMID: 34813425 [PubMed]

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