References
Wound ballistics: exploring the wounding potential of penetrating projectile injury
Abstract
Within the civilian pre-hospital environment, penetrating projectile injury may be caused by an extremely broad range of firearms and explosive propellants. Despite a great variance in the potential for injury however, a basic knowledge of how penetrating projectiles behave and interact with living tissues is likely to assist emergency healthcare professionals with making informed decisions, as well as establishing priorities for treatment and transportation. Amoung such important considerations is the transference of kinetic energy from a projectile to the tissues, itself influenced by factors such as the area of presentation, deformation, fragmentation, mass and velocity. Projectile retardation, along with correlating levels of energy transference, will also be influenced by the density of the affected tissues, and the permanent disruption caused by the stretching and shearing forces of temporary cavitation will be largely dictated by the elastic tolerance of the tissues and their capacity to expand. The presence and location of entrance and exit wounds, if they exist, can offer some clue to the nature of the projectile/tissue interaction, though caution is required when interpreting such signs. Focussing upon the civilian pre-hospital environment, this article will seek to highlight some of the key features of wound ballistics, and explore some of the misconceptions that can exist concerning the impoprtance of projectile velocity, as well as the dangers of drawing potentially erroneous clinical conclusions based solely upon the nature of the firearm involved, or visible signs of injury.
While penetrating wounds caused by frearms or explosions are mercifully rare within the UK civilian pre-hospital environment, the provision of optimum care is likely to depend upon emergency responders having an appreciation of the unique nature of such injuries. Understanding some of the basic elements of ballistic injury is also an important factor in determining the potential damage caused by different kinds of frearms and propellants. During 2009–2010, recorded frearms offences involved 2,115 injuries (including 40 fatalities) caused by the discharging of a variety of weapons, a majority of which were inficted by handguns, athough shotguns, rifes and air weapons also featured (Eder, 2011). For each of these different weapon types, a specifc wound profle will have been produced, the pattern that will have been determined by the occurring circumstances, and nature of the tissues involved.
The science of wound ballistics incorporates the interaction between human tissues and projectiles such as ‘bullets and fragments from explosive weapons’, and is a feld in which many healthcare professionals have only limited experience (Mahoney et al, 2005; ICRC, 2008). Even though the study and analysis of wound ballistics is ostensibly based upon objective physical properties, there has also been considerable controversy suggested by the relevent literature that many authors consider to be misleading for those responsible in managing such injuries (Fackler, 1987; Ryan et al, 1997). In order to understand the mechanisms and patterns of injury associated with wound ballistics, and to make sense of any potentially conficting guidance on the subject, it will be helpful to obtain a basic knowledge of how kinetic energy is transferred from the projectile to tissues within the body, and the resulting risk of damage to them, as well as the location of the injury upon the body and the velocity, mass and fight characteristics of the penetrating projectile.
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