Ballistics for the EMS Provider How guns work, what they can do, and how to treat gun shot wounds

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Title: Ballistics for the EMS Provider How guns work, what they can do, and how to treat gun shot wounds Author: Jeffrey Brosius Last modified by
Title: Ballistics for the EMS Provider How guns work, what they can do, and how to treat gun shot wounds 1 Ballistics for the EMS Provider How guns work, what they can do, and how to treat gun shot wounds
  • Jeff Brosius,
  • 2 Basic Principles of Ballistics
  • Physics
  • Firearm mechanics
  • Bullet properties
  • Tissue response to force
  • Treatment
  • 3 Basic Principles of Physics
  • Kinetic Energy is a function of mass and velocity
  • Force is a function of mass and acceleration/deceleration
  • Energy can not be created or destroyed, only changed from one form to another
  • 4 Newtons Laws of Energy
  • Kinetic Energy ½ Mass x Velocity²
  • Force mass x G (where G Gravity Force
  • A body in motion will continue in motion until acted upon by an outside force (tissue, gravity, friction, solid object, etc.)
  • 5 Firearm Mechanics
  • All firearms share some basic principles.
  • There is a barrel, which functions to direct the projectile in a certain direction.
  • There is a pin, which causes the powder in the bullet to ignite.
  • There is a trigger, which causes the pin to strike the bullet.
  • 6 Firearm Mechanics, cont.
  • The bullet contains powder, which will burn rapidly, creating gas vapors.
  • These vapors expand inside the barrel, creating pressure.
  • The pressure forces the bullet out of the barrel.
  • The speed of the bullet depends on several factors (size, friction, etc.)
  • 7 Bullet Characteristics
  • Caliber of the bullet (.22, .45, .357, 9mm, etc.)
  • Blunt vs. Hollow vs. Pointed end
  • Casing (unjacketed/full metal jacket)
  • Density of material
  • 8 Handguns, by the Numbers Caliber Velocity Muzzle Energy Energy at 45 feet Ft/sec .25 810 73 60 .32 745 140 120 .357 1410 540 475 .38 855 255 255 .40 985 390 365 .44 1470 1150 875 .45 850 370 350 9 mm 935 345 315 9 Rifles, by the Numbers Caliber Velocity Muzzle Energy Energy at 300 ft .22 Hornet 3770 1735 1262 .243 3500 1725 1285 M-16 3650 1185 805 Uzi 1500 440 277 (150 ft) AK-47 3770 1735 1262 10 Tissue Response
  • Cavities temporary and permanent
  • Temporary is larger than the size of the bullet, and is caused by compression of air around the projectile.
  • Permanent is the destroyed tissue from the bullet itself.
  • 11 Cavities
  • The size of the cavity is not simply a factor of the bullet size. Other factors are important, but often unknown
  • Deflection
  • Yaw of bullet at impact
  • Speed of bullet at impact
  • Angle of impact
  • Range from gun to target
  • 12 Cavity Formation Tissue Temporary Cavity 13 M-16 Rifle Wound 14 NATO 7.62 Wound 15 .22 Long Rifle Wound 16 AK-74 Rifle Wound 17 .22 cal Hollow Point Wound 18 Tissue Response
  • Dense tissue will suffer more damage than hollow tissue. (Bone vs. lung)
  • Elastic tissue will suffer less damage than rigid tissue. (Muscle vs. liver)
  • Strong tissue will withstand damage better.
  • 19 Treatment Goals
  • Safety!!!!!!!!!!!!!!!!!!
  • ANY penetrating trauma should be treated with the utmost urgency.
  • A small hole on the outside might be hiding a large hole inside.
  • A large hole outside can mask massive internal damage.
  • 20 Treatment Goals
  • ABCs, as always.
  • Rapid scene times grab em and get moving to the hospital.
  • Airway support to include intubation (more often needed for thorax injuries.)
  • Ventilatory support as needed.
  • IV enroute, fluids as protocol/Med Control requests.
  • 21 Treatment Goals
  • Hemorrhage control if possible.
  • Occlusive dressings for sucking chest wounds.
  • Needle Thoracostomy as needed for tension pneumothorax.
  • Bilateral needle decompression ONLY in an intubated patient.
  • 22 Treatment Goals
  • Early notification of the hospital.
  • Constant reassessmentA GSW to the chest can cause the patients condition to change RAPIDLY. Be vigilant.
  • Again, rapid transport is the single best method for treating a gunshot victim.
  • Nothing else will be as helpful as a physician and hospital trauma care.
  • 23 Treatment Pitfalls
  • Wasting time looking for the bullet or shell casing.
  • Thinking that a small hole is not a major issue.
  • Wasting time trying to classify wounds as entrance or exit.
  • Closest facility vs. Closest appropriate facility.
  • Delaying transport for ANY reason, other than EMS crew safety.
  • 24 Controversial Issues
  • Cervical Spine Immobilization.
  • Large volumes of fluid replacement.
  • Traumatic cardiac arrest treatment.
  • 25 Pictures of injuries from firearms. 26 (No Transcript) 27 (No Transcript) 28 (No Transcript) 29 (No Transcript) 30 (No Transcript) 31 Acknowledgements
  • Andres M. Rubiano, MD
  • David H Livingston, MD, FACS
  • Manuel Sotelo, MD
  • Errington C. Thompson, MD
  • Eric D. Ladenheim, MD
  • M.L. Fakler, MD
  • Grady Memorial Hospital, Atlanta, GA
  • Emory University School of Medicine, Department of Surgery
  • 32 Web Sites
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  • http// ulations.html
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  • 33 Web Sites
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  • 34 Final Words.
  • Dont waste time. What you cant see will kill the patient.
  • Be safe.
  • Treat the patient.
  • Do not treat the bullet, and dont waste time on details that dont matter.
  • Understand that a .22 is just as lethal as a .357.
  • Dont waste time.
  • 35 Questions?
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