Gunshot wounds are a result of firing of a projectile or a bullet from a firearm weapon. Firearm related gunshot wounds are increasing in the urban cities and have become a cause of concern. The overall rate of deaths occurring due to gunshot wounds has increased as compared to earlier days.
Apart from gunshots wounds related to military, in recent days, gunshot wounds have been noted in almost any common place like schools, post offices, public places like public roads, parks, shopping malls, railway stations and other transport modes. Criminal and terrorist activities are on the rise, while accidental and suicidal firings are also commonly seen.
Almost anybody can be a victim to such firing and sustain gunshot wounds of varying severity. While it is generally noted that gunshot wound to the head is the most fatal one, gunshot wound to the chest can be dangerous too. Other areas that are commonly involved and may have an undesirable outcome include intra-abdominal injuries involving internal organs and vascular structures in the abdomen.
Understanding of Ballistics
The ballistics science deals with the study of the weapon, bullets, their travel path and the impact on the body and it helps to determine the weapon and bullet characteristics. This can guide in analyzing gunshot wounds and injuries caused by the travelling bullet.
Bullets are usually made of lead alloy and may have pointed, flat, rounded or hollow tips. Bullets can be of high velocity, medium or low velocity, which can influence the outcome of injuries. On firing, a bullet speeds out along its projectile path and hits the target causing injury. Injury caused by bullets is mainly because of the energy transferred to the target on hitting.
Injury From Gunshot Wound
When a bullet hits the target, the first thing to come in its way, the tissue gets crushed. Depending on the bullet’s mass and velocity, some amount of energy is transferred on hitting, which causes damage to the tissue. Bullets with higher velocity may cause more damage to the tissues.
Mechanism- The main injuries and damage occur due to crushing and laceration of the tissue when the bullet strikes, followed by compression and tearing of the tissues and structures. Further injury can be caused by metal or bone fragments called secondary missiles, moving through the tissue leading to more destruction.
Following this, due to energy transfer, there is cavity formation called cavitation, which can cause more damage to inelastic tissues like liver and spleen. It can also affect the nerves, blood vessels and other surrounding structures. Bleeding is the most common result along with other presentation.
Additionally, more damage can be caused due to contamination of the tissue and can lead to infection or other complications. Lead bullets or pellets can cause injury and if allowed to remain in the body can cause further damage to the tissue and even result in lead intoxication.
Injuries caused due to gunshot wounds vary greatly in their nature, extent and severity and depend on certain factors determined by the ballistics science, victim’s condition, location of gunshot wound and the type of tissue penetrated.
Gunshot wounds commonly show a point of entry called the entry wound. Some bullets may pass through the body and travel out, showing another wound called the exit wound. In case where exit wounds are not found, there are chances of the bullet being lodged inside the body.
Gunshot Wound Management
Careful inspection along with necessary measures for assessment and resuscitation is warranted by the emergency medical team. Specific injuries and their management depend on the area of the gunshot wound.
Gunshot wounds to some of the common body areas include
The mortality rate of gunshot wound trauma to head is around 90% and in many cases, death occurs before reaching the hospital.
Gunshot wound to the chest is exigent as there are ribs, soft tissues and vital organs like lungs, heart and their structures including major blood vessels present in the area and most commonly open chest wounds or sucking wounds are noted.
Gunshot wounds to the abdomen are common and can prove to be fatal when involving abdominal structures like small intestine, colon, liver and other abdominal blood vessels.
Gunshot wound to the face can cause injuries and damage to the structures of the face, head and neck; hence should be managed carefully.
The shoulder joint has many structures involved and gunshot wounds can cause varying degrees of injury, especially to the joint, nerves in brachial plexus and main blood vessels.
While gunshot injuries to the hand may not always be life-threatening, the functional importance of the hands need to more attention.
The hip and pelvis region involves orthopedic structures, hip joint, spinal canal, blood vessels and important pelvic organs like abdominal and urogenital organs that are at a risk of damage.
The knee joint covers important structures like bone, soft tissues, muscles, ligaments, cartilages, nerves and vascular structures and gunshot wound to the knee or kneecapping gunshot wound can be very painful.