A SURGEONS OVERVIEW OF FIREARMS

James Tatum, MD
Trauma and Critical Care
Cedars-Sinai Medical Center
Premise

A basic level of understanding of firearms

is important for nurses, physicians and
public health personnel that treat, triage or
study victims of gunshot wounds
Incidence of Gunshot Wounds

31,076 Americans die every year from

gunshot wounds
85 deaths per day
3 deaths per hour
62% of these deaths are suicides

73,505 Americans present with non-

fatal gunshot wounds
Incidence

At this rate more civilian gun fatalities

occur every two years than American
fatalities during the entire Vietnam War

Every seven weeks civilian gun deaths

equal all American fatalities that
occurred in the first 7 years of the War
In Iraq
Incidence

600 people die every year from

unintentional shootings

50% of all suicides are accomplished

with a firearm
80% by white males who constitute
less than 40% of the population
Prevalence of Firearms

A report by the Congressional Office of

Research in 2009 found the following:

The estimated number of firearms

available to civilians in the United
States is approximately 310 million: 114
million handguns,110 million rifles, and
86 million shotguns
Prevalence

Population of the United States is 316

million
Goals of Presentation
To provide a useful overview of

Ammunition

Firearms

Gunshot wounds
Terms

Ammunition
Case
Powder
Primer
Bullet
Caliber
Ballistics
Ammunition
Case
Powder
Two types

Black powder
Potassium Nitrate + Sulfur + Charcoal
Explosion
Smokeless powder
Nitrocellulose
Fast combustion = lots of gas
Primer
Bullets
Full Metal Jacket, Hollow point
Military Ammunition
Hague Convention of 1899

The contracting parties agree to abstain from the use of

bullets which expand or flatten easily in the human
body, such as bullets with a hard envelope which does
not entirely cover the core, or is pierced with incisions.
Caliber

Internal measurement of a gun barrel

European bullets are measured in

millimeters (i.e. 9mm, 5.62mm)

American bullets are measured in

inches (i.e. 0.45, 0.308, 0.223)
Gauge
Shotguns are measured by gauges (i.e.
28, 20, 12, 10)

Inverse of the weight of a lead ball that

will fit down the barrel

Soa lead ball weighing 1/12 of a

pound will fit down the bore of a 12-
guage shotgun
Ballistics

Kinetic Energy (Mass x Velocity2)

Pistol large caliber, low velocity

Rifle small caliber, high velocity

Shot Gun large caliber, many small shots or

a single slug, very low velocity, rapid
spread, non-rifled barrel
Shell/Cartridge/Round
Firearms
Terms

Firearms
Parts of a firearm
Pistol
Action type
Rifle
Shotgun
How They Work
How They Work
How They Work
Pistols
Pistols

Big and slow

Single Action Revolver
Double Action Revolver
Semi-Automatic
Semi-Automatic
Pistol Ammunition
Pistol Bullet
 Basic Ballistics Table

Cartridge Bullet (grains) Velocity (ft/second) Energy at 100 yrds (ft/lbs)

.22 Caliber Pistol 36 1180 65
9mm Pistol 95 1250 264
.45 Pistol 195 970 386
7.62mm (0.30) 123 2250 1495
5.56mm (0.223) 55 3169 1115
Hunting Rifle (0.270) 130 2986 2574
9mm
 Basic Ballistics Table

Cartridge Bullet (grains) Velocity (ft/second) Energy at 100 yrds (ft/lbs)

.22 Caliber Pistol 36 1180 65
9mm Pistol 95 1250 264
.45 Pistol 195 970 386
7.62mm (0.30) 123 2250 1495
5.56mm (0.223) 55 3169 1115
Hunting Rifle (0.270) 130 2986 2574

Handgun Ballistics Tables. Guns and Ammo. http://www.handgunsmag.com/ballistics/ballistic-tables/

.45 ACP
Shotguns
Shotguns

Instead of one large bullet there are

many small ones
Shotguns
Shotgun Shells
Shotgun Shells
Types of Shot
Sawed-Off Shot Gun
Buck Shot
Bird Shot
Bird Shot
Bird Shot
Slugs
Rifles
Rifles

Small, heavy and fast

Parts of a Firearm
 Basic Ballistics Table

Cartridge Bullet (grains) Velocity (ft/second) Energy at 100 yrds (ft/lbs)

.22 Caliber Pistol 36 1180 65
9mm Pistol 95 1250 264
.45 Pistol 195 970 386
7.62mm (0.30) 123 2250 1495
5.56mm (0.223) 55 3169 1115
Hunting Rifle (0.270) 130 2986 2574
Semi-Automatic
 Basic Ballistics Table

Cartridge Bullet (grains) Velocity (ft/second) Energy at 100 yrds (ft/lbs)

.22 Caliber Pistol 36 1180 65
9mm Pistol 95 1250 264
.45 Pistol 195 970 386
7.62mm (0.30) 123 2250 1495
5.56mm (0.223) 55 3169 1115
Hunting Rifle (0.270) 130 2986 2574
Rifle Ammunition
 .22 Caliber Rifle/Pistol

Wound Ballistics. Firearms Tactical Institute. http://www.firearmstactical.com/wound.htm

M16 [5.56mm]
7.62mm [Full Metal Jacket vs. Soft Tip]
Gun Shot Wounds

Four factors in wound formation

Penetration
Permanent Cavity
Temporary Cavity
Fragmentation
The Bullet Wound
Improvised Explosive Devices
Improvised Explosive Devices

Muzzle Velocity Kinetic Energy

6000 40
5000 35
4000 30
25
3000 20
2000 15
1000 10
5
0 0
Hand M-16 IED Hand M-16 IED
Gun Gun
Conclusions
Pistols
big, slow, tumbling

Rifles
small, fast, deep penetrating

Shot guns
slow, poor penetration, multiple injuries
Conclusions

Hopefully you have an increased

understanding of what it means when
the police or patient describe to you
what happened, or in the case of seeing
a bullet on an x-ray
Acknowledgments

Daniel Grabo, MD
United States Navy
Naval Trauma Training Center
LAC+USC General Hospital
Bibliography
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Ronald F. Bellamy, M.D., and John A. Malinowski, B.S., JTrauma, 28(1) Suppl: S21-S29,
1988.

3. Handgun Ballistics Tables. Guns and Ammo. http://www.handgunsmag.com/ballistics/ballistic-

tables/

4. The CT Appearance of Shotgun Wadding. Abbie C. Kemper, Anthony J. Wilson and M. L.

Chip Routt, Jr. AJR 2000; 174:400 American Roentgen Ray Society

5. Gunshot Wound Review. Fackler M.L. Annals of Emergency Medicine. Vol 28. Issue 2
August 2006.
6. Penetration Trauma. Foresyth M. Washington State Department of Health.
www.doh.wa.gov/hsqa/emstrauma/OTEP/penettrauma.ppt

7. Wound Ballistics. Firearms Tactical Institute. http://www.firearmstactical.com/wound.htm