Lilun Li is a head and neck surgery resident at George Washington University Hospital in Washington.

My patient locked eyes with a police officer in D.C.'s Lafayette Square around 6:30 p.m. on Monday. Moments before, law enforcement officers sprayed him with tear gas as they aggressively cleared the area of peaceful demonstrators to make way for President Trump’s arrival at St. John’s Episcopal Church. While trying to wash out his eyes, my patient saw a series of rubber bullets fired at the bodies of fellow protesters. Looking up, he saw the police officer seven feet away aiming straight at him. That’s when the rubber bullet struck him in the face.

After recovering from the initial shock of his injury, he noticed he was bleeding from his chin. He walked to the closest emergency room, George Washington University Hospital, where a trauma protocol was activated. His initial evaluation revealed an actively bleeding gaping wound through his chin and lip, exposing his jaw bone. CT imaging demonstrated multiple ballistic fragments embedded within the soft tissue of his face.

As a head and neck surgeon, I have treated many facial trauma patients, including gunshot wound victims. Even I was surprised at the extent of my patient’s injury sustained from a supposedly “benign” rubber bullet. I spent hours cleaning his wound, extracting numerous pieces of plastic and metal that were embedded in his lip and chin and removing tissue that was no longer viable because of the injury. Despite his fear of needles, my patient remained calm and cooperative, allowing me to put in the multiple layers of sutures required to cover the exposed bone and close the complex lip and chin wound.

Rubber bullets are touted as a “safe alternative” to firearms. They are considered non-lethal weapons designed to generate blunt rather than penetrating trauma, and they are widely used to control protests around the world. However, a 2002 study published in the Lancet found that close to 40 percent of rubber bullets used by Israeli police to control riots by Israeli Arabs in 2000 caused penetrating injuries, and improper aiming and range resulted in severe injury and death. A separate literature review of rubber bullet injuries spanning from 1975 to 2016 shows that the face is the most vulnerable part of the body to penetrating wounds by rubber bullets, with injuries leading to irreversible consequences, such as blindness and neurological damage due to bullet penetration through the brain. A recent study of the yellow-vest protesters in France in 2018 further illustrates the prevalence of facial and dental fractures, lip wounds and blindness from rubber bullet use.

The classification of rubber bullets as “non-lethal” is misleading and inaccurate. Anyone who has access to these weapons, as well as the public, should know of their ability to inflict significant trauma and death. The potential benefit of clearing crowds with rubber bullets must be heavily weighed against the risk of severe injury and even death, especially in the context of peaceful political protesting. Law enforcement should also consider the extensive medical care required to treat severe injuries from these weapons, which will strain an already overwhelmed health-care system during the covid-19 pandemic.

The substantial facial injury that my patient sustained while peacefully demonstrating shows just how serious and extensive a rubber bullet injury can be. Despite the lengthy procedure to extract the bullet and close the wound, he was able to return home safely and recover the same night. Others may not be so lucky. As protests continue in Washington and across the country, it is imperative that those who use rubber bullets understand their consequences and seriously evaluate whether they are needed.

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