The Science of Gunshot Wounds: Understanding Ballistics, Trauma, and Medical Treatment
Since I have to deliver training on this subject to my church safety team and an Armed Women of America chapter in the coming months, while I was updating my slide deck I thought this would be a good topic for a podcast episode. So, today we're diving into a topic that's both fascinating and crucial to understand: The Science of Gunshot Wounds. From the physics of ballistics to the medical treatment of trauma, we'll explore the complexities of this subject and shed light on some important aspects that often go unnoticed. So, let's get to it.
When we hear about gunshot wounds in the news or movies, it's often depicted as a simple event with clear-cut consequences. However, the reality is far more intricate. To truly understand gunshot wounds, we need to delve into the science behind them.
Gunshot wounds have the potential to affect victims in two ways, psychologically and physiologically. The psychological impact isn’t a certainty. Where the victim is struck, their tolerance to pain, whether or not they’re under the influence of drugs, being just plain pissed off, and a host of other things can minimize or even stop the victim from even realizing they’ve been shot. We’ve all seen the picture of the Marine in Iraq being helped out of a building by fellow Marines. Shot multiple times in the legs, arms, and abdomen, he is still on his feet, clutching his pistol in one hand and flipping the bird in the direction of those who shot him. Him being shot just seemed to make him madder.
My time in ambulances as an EMT in Milwaukee and Chicago, as well as my time as a cop in North Carolina, gave me ample occasions to see the real-world effects of gunshot wounds on people’s psyches. I had people die from completely survivable peripheral hits, and others survived truly horrendous injuries. I firmly believe that if the victim told him or herself “Well, I’m shot, I guess I’ll die”, they convinced themselves that it was the end and just let go. The ones who hung in there just refused to give up.
Physiologically, the victim doesn’t have a choice. This is the body saying “You know what, these parts of me just got injured or destroyed, so things aren’t going to be working well.” Regardless of what your mindset is, if vital organs have been damaged or compromised, you’re going to shut down eventually.
When we talk about gunshot wounds, the term "ballistics" often comes up. You have to understand what ballistics is and how it relates to wound severity. When a firearm is discharged, it sets off a chain of events that involves the projectile, the target, and the surrounding environment. The study of these interactions is what we call ballistics.
One of the fundamental principles of ballistics is the concept of terminal ballistics, which deals with the behavior of a projectile upon impact with a target. When a bullet strikes a surface, whether it's flesh, bone, or another material, it undergoes a series of transformations that are governed by the laws of physics.
Factors such as bullet velocity, mass, shape, and composition all influence the extent of tissue damage and the severity of the resulting injury. For instance, a high-velocity bullet is more likely to cause extensive tissue disruption through cavitation, whereas a slower-moving projectile might produce less dramatic effects. Bullet weight is like mass – a heavier bullet carries more energy and tends to create a cleaner, straighter wound path. Velocity, or speed, also matters. A faster bullet deposits its energy more rapidly, creating a temporary cavity – a larger area of tissue disruption – alongside the permanent wound channel.
A critical aspect of gunshot wounds is the concept of temporary and permanent cavitation. When a bullet penetrates tissue, it creates a temporary cavity around its path due to the transfer of kinetic energy. This temporary cavity rapidly collapses, leading to tissue displacement and damage. Hollow-point bullets, for example, are designed to expand upon impact, transferring more energy and stopping power within the target, potentially minimizing the risk of over-penetration and injury to bystanders. So, a slower, heavier bullet might pass through cleanly, while a lighter, faster bullet might cause more internal damage
Additionally, some bullets are designed to expand or fragment upon impact, which can further exacerbate tissue damage and increase the likelihood of severe injury. Understanding these mechanisms is crucial for medical professionals tasked with treating gunshot victims.
This brings us to the medical treatment of gunshot wounds. Treating gunshot injuries is a multifaceted process that requires expertise in various medical disciplines, including emergency medicine, trauma surgery, and critical care. Obviously, some of the treatments are beyond what we as concealed carriers can deliver in the field, due to a combination of lack of skills and lack of equipment.
We can minimize to a small degree the impact of lack of equipment. We carry guns that can make holes, so is it not logical that we should carry equipment with which to plug them? There are any number of pocket-sized “blow-out kits” on the market that are inexpensive, easy to carry, and give you just enough equipment to treat a gunshot wound until EMS arrives on the scene.
Whether or not you use your kit to treat someone you shot is a moral decision left up to you. It certainly won’t hurt you in court, as it displays your commitment to stopping the threat and not just outright killing your opponent. Then again, if you exacerbate an injury due to something you did beyond the scope of your training you may end up in hot water in a civil case. Let your conscience and your attorney decide what your best course of action will be.
And become familiar with the concept of self-aid. Know what is in your blow-out kit, what it does, how to use it, and learn to put it on yourself. Remember, a gunfight isn’t like going to the range and shooting targets. Bullets are going to be flying in both directions, and you just may be unlucky enough to be in the way of one that, while it may not have your name on it, the ones addressed to “to whom it may concern” are just as deadly.
The priority in treating a gunshot wound is to stabilize the patient and address any life-threatening injuries. This often involves controlling bleeding, managing airway and breathing, and assessing for other associated injuries. A good blow-out kit will have what you need in the moment until that big ambulance with the flashing lights shows up. I did a blog post on one that I carry. I’ll put a link to the post and a link where you can get it in the show notes. Offered by TacMed, the kit contains a tourniquet, your choice of compressed gauze or combat gauze, an elastic bandage, a chest seal, and a pair of rubber gloves. This is some quality equipment, put together by been-there-done-that types.
You can control bleeding with the tourniquet, gauze, and elastic bandage. Contrary to popular myth, applying a tourniquet to an extremity does not doom that limb to amputation. We’re not in the Civil War times. Joan Ndirangu, flight nurse and clinical nurse instructor victims with severed femoral arteries (that’s the big one in your leg) will exsanguinate, that’s drain completely of blood, in about seven minutes but some can die in as little as two to four minutes. So having a tourniquet handy can be a beautiful thing. I always have one on me, especially on a range with students or playing safety officer at a match. On this, pay particular attention when you holster a pistol. Be sure your finger is out of the trigger guard, safeties if any are applied, and there are no obstructions, like clothing, inside the holster. Remember that femoral artery.
The chest seal is used to treat sucking chest wounds. Our thoracic cavity is essentially a bellows, which is how we breathe. A bellows with a hole in it is pretty ineffective, and so is a chest with a hole in it. Having that little piece of plastic handy can mean the difference between life and death.
Once the patient is stabilized, the focus shifts to surgical intervention and wound management. Depending on the location and severity of the injury, surgical procedures such as debridement, exploration, and repair may be necessary to remove damaged tissue, repair internal organs, and restore function.
In cases where the bullet remains lodged in the body, surgeons may opt for either surgical removal or conservative management, weighing the risks and benefits of each approach based on the patient's clinical condition and anatomical considerations.
It's important to note that the prognosis for gunshot wound victims varies widely depending on a range of factors, including the location and trajectory of the bullet, the presence of associated injuries, and the timeliness and effectiveness of medical intervention. It's important to remember these are generalities – bullet performance can vary depending on the specific design and the tissues it encounters. However, understanding these principles helps dispel misconceptions about bullet lethality. A smaller caliber bullet fired from a handgun isn't inherently less dangerous than a larger caliber round. It all depends on the specific bullet and how it interacts with the body.
In recent years, advances in medical technology and techniques have led to significant improvements in the management of gunshot wounds, resulting in better outcomes for many patients. From the development of specialized surgical instruments to the refinement of resuscitative protocols, ongoing innovations continue to push the boundaries of what's possible in the field of trauma care.
Immediate medical attention is crucial after a gunshot wound, regardless of how severe it appears. Now, the severity of the injury also depends on the organs or structures hit. A bullet passing through muscle tissue might be less critical than one severing a major blood vessel or hitting vital organs like the heart or lungs.
How have things changed for gunshot victims in recent years? The progress has been remarkable. We have far better trauma resuscitation techniques, including blood transfusions, blood clotting agents, and advanced surgical procedures. Minimally invasive surgery through laparoscopy allows quicker intervention and reduces recovery times. Body armor technology has also improved significantly, saving countless lives for law enforcement and military personnel.
It's amazing to think that even with severe gunshot wounds, survival rates are much higher today. But it's important to remember that these advancements are crucial for maximizing a victim's chance of survival. They don't guarantee it. Every gunshot wound is unique, and the outcome depends on a multitude of factors.
It’s never a bad idea or a waste of time to take a first-aid course. You may never use the skills you use, but the one time you find yourself needing them you’ll be glad you took the time.
Well, that's it for today. I hope you found this episode insightful and informative. If you have any questions or topics you'd like us to cover in future episodes, feel free to reach out to us on social media or via email. Also, consider telling a like-minded friend about us. We’re in all the podcast directories, or you can listen at our website.
We still have a couple openings for the April 20th SC Concealed Weapons Permit Class. I’ll put a link to the registration site in the show notes.
I’ll be traveling to North Carolina this Saturday, instead of shooting in a Steel Challenge match like I normally do the second Saturday of the month. But I’m going to a cop reunion, so I’ll get to see a lot of friends I haven’t seen in years. Really, the only reason besides illness that would make me miss a match.
Until next time, shoot safe.
