Ballistics is the scientific study of the characteristics of projectiles (bullets or missiles), how they move in flight, and how they impart damage to tissue. Emergency clinicians play a critical role in the management of ballistic injuries. According to Centers for Disease Control and Prevention statistics, in 2007 there were over 31,000 firearms-related deaths in the United States, of which 40.5% were due to homicide and over 55% were due to suicides. Firearms-related injuries are much more common among men than women, and blacks are more than twice as likely to die from gun-related violence than whites.1
There has been much debate over the differences in the method of management for wounds from low- and high-velocity weapons. Based on the available literature, the traditional teachings may be flawed. Understanding of terminal ballistics (a projectile’s action on tissue) has been revolutionized in the last 40 years due to high-speed photography and the development of ballistic gelatin.2 High-speed photography allows scientists to evaluate an object with great clarity, frame by frame, as it strikes another object. Ballistic gelatin was developed in the 1940s, and has subsequently undergone studies validating its use as a tissue surrogate.3,4 Nonetheless, ballistic gelatin does not account for the effects of skin or the varying densities of different tissues within a given anatomic location (bone, vessels, etc), and it has been found to overestimate the size of the temporary cavity.5,6 The goal of this issue of Emergency Medicine Practice is to discuss the physics of ballistic injuries with respect to the differences between low-velocity weapons and high-velocity weapons and to discuss the emergency department (ED) management of gunshot wounds to various areas of the body.
David Bruner; Corey G. Gustafson; Catherine Visintainer
December 2, 2011