Ballistics for the EMS Provider

How guns work, what they can do, and how to treat gun shot wounds

Jeff Brosius, B.S., NREMT-P, CCEMT-P

Basic Principles of Ballistics

Physics Firearm mechanics Bullet properties Tissue response to force Treatment

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

Newtons Laws of Energy

Kinetic Energy = Mass x Velocity 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.)

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.

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.)

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

Handguns, by the Numbers

Caliber
.25 .32 .357 .38 .40 .44 .45 9 mm

Velocity
Ft/sec 810 745 1410 855 985 1470 850 935

Muzzle Energy
73 140 540 255 390 1150 370 345

Energy at 45 feet
60 120 475 255 365 875 350 315

Rifles, by the Numbers

Caliber Velocity Muzzle Energy Energy at 300 ft

.22 Hornet .243 M-16 Uzi AK-47

3770 3500 3650 1500 3770

1735 1725 1185 440 1735

1262 1285 805 277 (150 ft) 1262

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.

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

Cavity Formation
Tissue

Temporary Cavity

M-16 Rifle Wound

NATO 7.62 Wound

.22 Long Rifle Wound

AK-74 Rifle Wound

.22 cal Hollow Point Wound

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.

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.

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.

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.

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.

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.

Controversial Issues

Cervical Spine Immobilization. Large volumes of fluid replacement. Traumatic cardiac arrest treatment.

Pictures of injuries from firearms.

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

Web Sites

ww.umds.ac.uk http://medstat.med.utah.edu http://igm.nlm.nih.gov/ http://www.vnh.org/EWSurg/EWSTOC.html http://internet.cybermesa.com/~jbm/ballistics /calculations.html http://www.firearmstactical.com

Web Sites

http://www.iwba.com/ http://www.milnet.com/milnet/weapons.htm http://www.wwa.com/~dvelleux/html http://www.vnh.org/EWSurg/EWSTOC.html

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.

Questions?