November 17th, 2006 07:07 AM
Milwaukee newspaper takes on ballistics and medicine
Click link for more stuff: photos, other related stories.
I especially liked the part that says a Glock 9mm does more damage than a .22. I guess Glocks throw better?
Medicine races to keep up with street weaponry
By JOHN FAUBER and JOHN DIEDRICH
Posted: Nov. 12, 2006
As it leaves the barrel of a gun at 1,200 feet per second, a bullet flies in roughly a straight line.
Paying the Price
In the violent summer of 2006, which began with 28 shootings on Memorial Day weekend, two reporters and a photojournalist from the Journal Sentinel were allowed unprecedented access to the system of emergency care that saves the lives of shooting victims in Milwaukee. This is what they found:
Until it strikes a human. Then a bullet does astounding, awful things.
A simple-sounding "shot to the arm" can turn into a blown-out shoulder - and eventual amputation - when the bullet slices into the bicep, ricochets off bone and heads north, exploding out of the back.
A shot to the head opens a momentary tunnel in the brain tissue that quickly collapses as the bullet exits and most often results in death.
A bullet in the abdomen may sever blood vessels or pierce intestines, spilling out the contents and ratcheting up the risk of infection. Or a slug can rip into muscle in the rear end and exit through that same soft tissue, resulting in a short hospital stay.
Chance will always play a role in gunshot injuries, but two trends are the product of intent: Both the firepower of guns and the weaponry employed by paramedics, doctors and nurses are improving.
Twenty years ago, the Milwaukee Fire Department had five ambulances; today there are 12, staffed by paramedics who have treated hundreds of gunshot wounds.
Trauma care teams such as those on duty 24 hours a day at Froedtert Hospital and Children's Hospital of Wisconsin have evolved into highly organized units led by board-certified trauma surgeons.
"We may have gotten better at resuscitation . . . ," said John Weigelt, Froedtert's chief trauma surgeon. "We may have better antibiotics . . . We do have easier-to-use devices.
"But when you are bleeding from a wound or have a hole in one of your organs, what works best is a dedicated trauma team that knows what to do, when to do it with the minimal amount of human error possible."
How a bullet does its damage
The damage is determined largely by the type of tissue it hits and the kind of bullet, whether it is a piercing full-metal jacket or a hollow point, which widens on impact.
The path of a bullet creates a permanent cavity in tissue and organs. That cavity is at least as wide as the bullet - and wider if the bullet turns sideways as it travels through the body. Hollow-point bullets create a wider permanent cavity than a full-metal jacket.
"Basically, the bullet crushes the tissue it hits," said Marty Fackler, a ballistics researcher and former military surgeon who works as a consultant in Florida.
Bullets also create a much wider temporary cavity, a rapidly expanding and collapsing tunnel caused by a sonic pressure wave.
Stephen Hargarten, a professor of emergency medicine at the Medical College of Wisconsin, likened it to a person diving into a pool.
"As that diver passes through the water, it expands radically, and when the diver leaves, the water comes back together," he said.
If the bullet slashes through flexible tissue, such as muscle or the lungs, the tissue can bounce back more easily.
However, if the bullet hits an organ such as the liver, with extremely dense tissue, the bullet can do severe damage.
"There are no elastic components (in the liver)," Hargarten said. "There is a lot of bleeding."
The brain is especially vulnerable because it is enclosed in bone, which doesn't allow the energy from the bullet and the resulting pressure wave to dissipate as easily.
Bullet size is especially important in a head shot, Hargarten said.
A patient hit in the head by a smaller, .22-caliber bullet might live 36 hours, while a similar wound from a 9mm might be fatal in an hour.
Large-caliber bullets with a hollow-point design inflict the most damage.
The .44-caliber hollow point, Fackler said, "is sort of in a class by itself."
More dying in the field
Beginning in the mid-1990s, medical studies reported an ominous trend toward the use of larger caliber firearms. But a 2004 study published in the journal American Surgeon found that despite that trend, in-hospital death rates from gunshot wounds had not changed.
The study attributed this seeming paradox to improvements in treatment, including resuscitation and surgical techniques.
But to survive a serious gunshot wound, a victim must first make it to the hospital.
Researchers at the University of Louisville concluded that large-caliber gunshot wounds meant more victims were dying in the field and being transported to the morgue rather than the trauma center.
From 2003 through 2005, doctors at the University of Louisville Hospital saw no patients with gunshots to the heart even though, in years past, as many as one such case a month was admitted, said David Richardson, a professor of surgery at the university.
During that same period, the coroner's office reported 15 to 20 fatalities a year involving gunshot wounds to the heart, meaning that all the victims died before getting to the hospital.
Big-caliber, high-velocity guns "just blow the thing apart," Richardson said.
Some doctors use the term "morselized" in referring to the damage to the heart caused by large-caliber bullets.
"If you get shot with a .22 in the heart, you've got a chance to survive," said Richardson, director of emergency surgical services at the hospital. "If you get shot with a Glock 9mm, you're not going to make it."
Richardson said his data most likely represents what is happening in cities around the country, including Milwaukee.
Police here say that in the early 1990s, inexpensive handguns, such as the .25-caliber Raven, were the most common weapons used in shootings.
Since then, the caliber has increased with more use of 9mm, .40-caliber and .45-caliber guns with high-capacity magazines, as well as assault-style rifles, Deputy Police Chief Brian O'Keefe said.
"Rifles can cause a lot of damage," he said. "They can go through houses."
Medicine strikes back
Trying to keep up with the growing lethality of guns, trauma workers hope to soon test a new weapon of their own, an IV solution known as hypertonic saline with Dextran.
Researchers are awaiting approval from the U.S. Food and Drug Administration for a clinical trial that would involve Milwaukee and several other cities.
The solution would be administered to trauma patients, including gunshot victims, who are in shock. As many as 350 patients in the Milwaukee area would be treated.
The solution, a super-concentrated mixture of sodium and sugar, would be administered by paramedics in the field.
Karen Brasel, a trauma surgeon at Froedtert who would lead the study in Milwaukee, said researchers believe the new IV solution may help raise blood pressure quicker and prevent or delay infections and inflammation.
"It may completely change the way we resuscitate trauma patients all across the country," she said.
But there are limits to what medical technology can do.
The "ominous rise of semiautomatic weapon use in assaults in the last 20 years" may mean an end to further gains in preventing gun assaults from becoming homicides, according to a 2002 study at the University of Massachusetts Amherst.
"At some point," the study warns, "weaponry may yet trump medicine."
From the Nov. 13, 2006 editions of the Milwaukee Journal Sentinel
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"Each worker carried his sword strapped to his side." Nehemiah 4:18
Guns Save Lives. Paramedics Save Lives. But...
Paramedics With Guns Scare People!
November 17th, 2006 07:32 AM
While it's interesting, it would be good if they had a follow up article talking to a self-defense expert on why a hollow point is used.
I think most of us are painfully aware about the amount of damage can be done by a bullet, but why didn't they cover the amount of damage done by a knife, a rock, or even the harmless car?
(I hope I'm not coming across like a jerk, but news coverage bugs me because there is no context or understand about how man tries to kill each other. )
"[T]he people are not to be disarmed of their weapons.
They are left in full possession of them."
Zacharia Johnson (speech in the Virginia Ratifying Convention,25 June 1778)"The best we can hope for concerning the people at large is that they be properly armed."
November 17th, 2006 12:35 PM
Narrow focus + predetermined conclusions = news. Or in this case a special report. We know that gunshot wounds are not good for the body but we need to understand , and have the media report that most gunshot wounds are driectly related to criminal activity.
One should never confuse good fortune with good training.
Illegitimus Non Carborundum.
In God we trust.
November 17th, 2006 12:49 PM
"Rifles can cause a lot of damage," he said. "They can go through houses."
If someone is shooting rifles through my house that is serious. My guns only fire bullets. Where does he buy this so called "rifle shooter"?
Also, remember boys and girls a .22 isn't as bad as a Glock 9mm. It has to be a Glock 9mm because any other brand of 9mm simply won't hurt you.
The news is stupid.
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