FIREARM INJURY

Firearm injuries occur when someone is shot

by a bullet or other sort of projectile from a firearm. They vary hugely depending on anatomical location and ballistic factors.

Mechanism of injury Terminal ballistics (the study of the dynamics of bullets in gunshot injury) is a complex and difficult area. Bullets are composed of a casing enclosing an explosive powder charge, which, on striking, forces the end projectile element out at speeds of up to 1500 metres/second, dependent on the ammunition and type of gun. They inflict injury in a number of ways. Firstly, the projectile crushes structures along its track, similar to other forms of penetrating injury. Temporary cavitation causes shearing and compression, sometimes tearing structures (as with solid abdominal viscera) or stretching inelastic tissue (the brain is particularly susceptible), analogous to blunt trauma. As tissues recoil and hot gases dissipate, soft tissue collapses inwards with the permanent cavity being the resultant defect. Secondly, kinetic energy transfer occurs during retardation of the bullet and this may cause damage outside the tract. Factors influencing the efficiency of kinetic energy transfer include: -The kinetic energy of a bullet is proportional to mass and velocity (mv); -Projectile's deformation and fragmentation; -Entrance profile and path travelled through the body; -Biological characteristics of the transit tissues ; Projectiles tend to be classified as low velocity (<300 m/second) or high velocity (>300 m/second).

FIREARM Every firearm has a chamber in which the cartridge is normally lodged. The chamber leads into a hollow steel tube called the barrel. The projectile released from the cartridge in the chamber is forcefully pushed through the barrel by the expanding gases produced by the explosion of gun powder. The proximal end of the chamber has a minute hole, through which a pin moves forward to strike the base of the cartridge. This striking action produces heat which ignites the primer. This pin, known as firing pin is activated by a spring connected to a trigger mechanism. The spring is released on pulling the trigger.

Types of weapons and ammunition

Classification of firearms 1. Rifled firearm a.High velocity: shoulder arms - e.g., rifle automatic weapons - e.g., machine gun b.Low velocity: hand arms - e.g., revolver, pis tol 2. Smooth bore firearm (Shot gun) e.g.single barrelled, double barrelled 3. Air or gas operated firearm 4. Country made firearm

grooves

lands

caliber

Cross-section of a barrel of rifled firearms Caliber of rifled firearms : distance measured by opposite lands or the inner diameter of the barrel. Caliber of shotgun-the number of balls (pellets) of lead which can be made out of 1 pound(450 gms) of the lead

Anatomy of the Gun

Muzzle

Action Chamber

Barrel

Hammer Bore Caliber Rifling

Magazine (Clip)

CARTRIDGE A cartridge consists of an outer case in which the explosive is stored together with the chemicals required to ignite it, and the projectile. The explosive is called gun powder, while the igniting chemical is called primer. The projectile is either a bullet or pellets (shot). Cartridge = Case + Primer + Gun powder + Projectile (Bullet or shot*pellet*)

1. CASE function: expands and seals chamber against rearward escape of gases. 2. PRIMER function: explodes on compression igniting the powder 3. GUN POWDER function: burns to produce large volumes of gases under pressure. 4. BULLET OR PELLETS (SHOT) function: the part of the cartridge which exits the muzzle.

The appearances of the most common cartridges are shown here. In general, it is difficult to tell from the wound exactly what cartridge was used.

Anatomy of the Cartridge

bullet

Shot

Wad

Powder
Flash Hole Primer Primer Powder

Handgun

Rifle

Shotgun

WOUND BALLISTICS Definitions: Ballistics is the science of the motion of projectiles. Interior ballistics is the study of projectiles in weapons. External ballistics is the study of projectiles in the air. Terminal ballistics is the study of projectile penetration of solids. Wound ballistics is the study of projectile penetration of tissues. A moving projectile has kinetic energy proportional to its weight and velocity. KE=WV/2. The wounding effect of a projectile is produced by transfer of kinetic energy from the projectile to the tissues. Kinetic energy increases in proportion to increases in the velocity squared; hence the wounding potential depends on the velocity of projectiles If a projectile does not exit the body, then all its kinetic energy has been transferred to the tissues. If the projectile exits the body, then only some of its kinetic energy has been transferred to the tissues. The wound produced by a projectile (bullet or shot) as it enters the body is called the entry wound and that by which the projectile leaves the body is the exit wound. The path traversed by the projectile between the entry and exit wounds is called the track.

Projectiles disrupt tissues by two principal mechanisms: 1.Direct laceration of the tissues as occurs with any penetrating object ("drilling effect"). This is the main mechanism in low velocity gunshot wounds e.g. from a pistol, and in such cases the permanent cavity seen at autopsy accurately reflects the tissue damage produced by the path of the bullet. 2. In high velocity rifle wounds, there is an additional effect of temporary cavity formation. Produced by the large amount of kinetic energy transferred to the tissue, this cavity may be up to 30 times the diameter of the projectile, has a lifetime of 5 to 10 milli-seconds, produces pressures of 100 to 200 atmospheres. The diameter of the resultant permanent cavity is variable but usually larger than the diameter of the bullet. At autopsy, the evidence of temporary cavity formation may be a wide zone of haemorrhage around a small permanent cavity. If the pressure of temporary cavity formation exceeds the elastic limit of the tissue, then the organ may be disrupted ("bursts"). Organs which are dense (and thus cause greater loss of projectile KE) and relatively inelastic are most susceptible to this bursting effect e.g. liver. Organs with low density and high elasticity are relatively protected e.g. lung. High velocity gunshot wounds of the head produce bursting injuries of the skull due to temporary cavity formation.

Cavitation
temporary cavity

direction of motion permanent cavity

bullet

direct injury

Injuries of cavitation.

Other wounding mechanisms include: 1.Secondary projectiles such as shattered bone fragments e.g. gunshot wounds to the head. 2.Discharge gases exiting the muzzle of the weapon pass into the wound track in hard contact wounds and produce tissue disruption e.g. contact shotgun wounds to the head. 3. Additional components of the shot flame, smoke, gun powder particles (unburnt or burnt)

Gunsmoke ejected from the muzzle of a revolver at the time of discharge. The volume of gas created is equal to the weight of gunpowder burn. The light streaks are glowing particles of gunpowder. The bullet in seen on the left side of the photograph.

SKIN SURFACE CHARACTERISTICS OF GUNSHOT (BULLET) WOUNDS

Term Skin defect Abraded margin Synonyms Permanent cavity Abrasion collar, Marginal abrasion, Contusion ring, Abrasion ring Cause Passing of the projectile through the skin (a). Forward motion of bullet indenting the skin and abrading the margin of entry wound (b).

Micro-tears Grey ring Smudging (c) Tattooing (c) Contact ring, Bullet wipe Fouling, Blackening Stippling, Peppering

High velocity centre fire rifle bullets tend to produce these rather than an abrasion ring. Lubricant and debris on bullet surface wiped off onto the wound edge. Deposition of soot from partially burnt gases. Unburned, partially burned and burning gun powder abrading and embedding in skin (sine qua non of intermediate/ close/near range). Hot gases from muzzle at close range Skin impact against muzzle produced by discharge gases or temporary cavity formation in contact and near contact wounds

Singeing (c) Muzzle impression

Branding/Burning Muzzle contusion, Muzzle imprint

(a) Exit wound is typically larger and more irregular than entry due to bullet tumbling and deformation.

(b) May be absent in the palm or sole, and re-entry wounds of axilla and scrotum Typically absent from exit wounds, allowing their distinction from entry wounds. May be seen in "shored" exit wounds. (c) The term "powder burns" is variably used to include one or more of these features.

BULLET WOUNDS

RANGE OF FIRE OF BULLET WOUNDS-The distance between the muzzle end of firearm and the target is called the range. This may be:
Range Muzzle-target distance Entry wound characteristics

1. Contact

-Muzzle in contact with body

Contact wound is generally large and cruciate ( stellate, or star shaped), due to explosive effects of the gases liberated. The imprint of the muzzle of the weapon may be found stamped on the skin. Burning, fouling by smoke, and tattooing are slight or absent in the adjacent skin, since all the components of the explosion are driven into the wound. The tissues are often saturated with carbon monoxide and therefore cherry red in colour.

2a Close range 2b Near range

-if the range is within the distance travelled by flame

- if the range is within the distance travelled by unburnt or burnt gun powder burns

Close shot: Flame travels approximately up to 7 cm in the case of revolver or pistol, and 15 cm in the case of rifle. The wound appears as a circular hole surrounded by singeing, and smudging. These may be absent if firing has occurred through clothing. Abrasion collar, Grey ring, and tattooing may be present. Near shot: The entry wound is circular or oval in shape. Unburnt powder burns and small metallic particles travel approximately up to 60cms in the case of revolver and pistol, and 70 cm in the case of rifle. In practical situations, tattooing is seen up to a maximum distance of about 90 sm. Singeing of hair

Differences between Entry and Exit wounds

Contact entrance wound

A firm contact discharge against tissue overlying bone (such as the skull) caused gas to rebound from the rigid base. This raises dome under the skin can split to give a ragged entrance wound.

Contact entrance wound.

Diagram showing of a shot fired with the muzzle in tight contact with the skin The pocket between the skin and the bone is filled with soot and gunpowder.

Soot is frequently deposited on the underlying a contact bullet wound. The presence of the soot can usually only be demonstrated after careful removal of the area`s soft tissues. Particular care must be taken in stripping the periosteum in the immediate vicinity of the bullet hole. Gunsmoke is often deposited on the bone after the periosteum has been elevated by the gas pressure.

Suicidal bullet wound of the forehead. This shot was fired with the muzzle pressed against the skin. The abraded ring around the wound is due to impact of the muzzle on the skin by the recoil of the weapon.

This is an contact gunshot entrance wound. Since the barrel contacts the skin, the gases released by the fired round go into the subcutaneous tissue and cause the starshaped laceration. Note also the grey-black discoloration from the soot, as well as the faint abrasion ring.

An abrasion ring (arrow), formed when the force of the gases entering below the skin blow the skin surface back against the muzzle of the gun, is seen here in this contact range gunshot wound to the right temple.

The abrasion ring, and a very clear muzzle imprint, are seen in this contact range gunshot wound.

Contact gunshot wound on the chest. An abrasion ring (arrows) around the wound.

The gunsmoke (arrows) is deposited around on the wound between the sternum and the ribs.

Gunshot wound on the heart.

Un this intraoral shotgun wound, note the tissue tears extending from the side of the mouth. These tears result from the large amount of the gases exiting the end of the barrel at high pressure (see next slide).

2 1
Similar case: (1) entrance wound; (2) exit wound.

1
1.A man shot himself in the chest with a 20-gauge shotgun. Note the oval entrance wound with oval marginal abrasion and the eccentric rim of soot on this contact wound.

2
2. Another example, this is self-inflicted contact shotgun wound of the chest shows singeing of the skin from the flame that exited the end of the barrel.

Formation of entrance wound (close range) and exit gunshot wounds (see next slide).

Diagram of close-range shot with a handgun. At distance of 2 to 5 cm from the target, gunpowder burns are around the bullet hole, while wave of soot disperse over a much area.

Two homicidal shots of the right side of the face. The upper shot show plentiful soot and very little gunpowder burns around the wound. This shot was fired at near contact with skin. The lower shot is surrounded by a small amount of soot, while gunpowder burns are scattered over a diameter of about 5 cm. This shot fired from a distance of a 15 cm.

As the muzzle-to-target-distance increases, the dispersion of gunpowder burns on the target increases in diameter, while density of gunpowder burns scattering decreases.

Homicide. Close-range shot of the left temple. Densely scattered gunpowder burns but no soot indicate a shot fired a distance of about 30 cm.

Powder tattooing is seen in this near range gunshot wound. The actual entrance site is irregular, because the bullet can tumble in flight.

This is a near range gunshot entrance wound in which there is powder "tattooing" around the entrance site. Distances of 60 cm or less.

1 2
An near range gunshot wound was on the left temple of a female homicide victim (1). The man who shot the woman had an near range gunshot wound to the right temple (2). The wounds in both the woman and the man were inflicted with the same firearm and ammunition. Note the presence of black soot and residue and increased concentration of stippling immediately around the gunshot wound in the female as compared with minimal soot residue and a wider, less concentrated stippling pattern around the gunshot wound in the male. The range of fire was slightly greater in the male.

Entrance wounds near range. Generally found at distance of 60 cm or less. Tattooing is pathognomonic. Density of tattooing is dependent on the distance & caliber

Diagram showing difference configuration of the marginal abrasion of an entrance bullet wound, depending on the angle at which the bullet strikes the body: (a)- bullet perpendicular to body; (b)-bullet at an acute angle.

The diagram illustrates the basic differences between the skin appearance of a contact, close (near), and distant range gunshot wound.

Wounding characteristics in the skull-the wound of entrance shows a punched clean hole in the outer table. The inner table is a cone-shaped piece of bone is detached forming a crater that is larger than the hole on the outer table. Exit wound shows a contrary feature. This is a good indicator of the direction of the bullet.

Entrance wound on the outer table of skull.

Exit wound on on the outer table of skull.

SHOTGUN WOUNDS

SHOTGUN WOUNDS: The smoke extends up to 30 cm., flame up to 50 cm., and unburnt powder burns up to 60 to 90 cm. Wadding can produce minor injury, up to a distance of three metres.

The character of a SHOTGUN wound depends on :

1. The distance from weapon is discharged. -contact wound -close range -near range - distant range
2. The nature of the explosive. 3. The gun itself

RANGE OF FIRE OF GUNSHOT wound. This may be:

Range Muzzle-target distance Entry wound characteristics

1. Contact

-Muzzle in contact with body

Contact wound is usually a large, irregular hole, resulting from the explosive blast effect. The edge of the defect is scorched by flame, and the skin surrounding it is blackened by smoke, and tattooed by unburnt powder. An imprint abrasion produced by the muzzle end may be seen. The shot passes into the body as a solid mass. The injured tissue is usually cherry red in colour. Close shot: This produces a circular defect with irregular inverted edges. The edges are scorched due to flame, and smudged by smoke. A wide zone of tattooing may surround the edges of the wound. Tissues often appear cherry red in colour. The pellets enter the track en masse. Near shot: The wound is circular or oval in shape. Smudging may be evident around the wound up to a maximum distance of 30 cm. Tattooing is present over a wide area. The pellets travel in a compact mass up to a distance of about 50 cm, after which they begin to disperse

2a Close range 2b Near range

-if the range is within the distance travelled by flame ( up to one metre)

- if the range is within the distance travelled by unburnt or burnt gun powder burns ( up to four metres)

3. Distant

-if it is beyond the range of flame, smoke and gun powder burns (above four metres)

produced by mechanical action of pellet penetration of skin only; Beyond a range of 2 metres, there will be no burning or blackening. Tattooing is also rare. The dispersion of pellets becomes significant at

Shotgun wounds at varying distances: 1(a)- split wound contact over bone( skull); 1(b)- usual round contact wound; 2- close but not contact range up to about 30 cm (variable); 3- rat-hole wound from 30 cm to about a metre (variable); 4-satellite pellet holes appearing over a metre; 5- spread of shot increases, central hole diminishes; 6uniform spread with no central hole over about 10 metres.

A man used 12-gauge shotgun to inflict a contact shotgun wound on the chest. Note unique circular abrasion adjacent to the entrance wound. This is seen in double-barrel shotgun in which only one of the barrel fires (see next slide).

Similar case.

Contact shotgun wound on the head.

Shotgun discharge at 2 m into the chest. Note the scatter of the shot.

Homicidal assault with a 12-gauge pump action shotgun from a distance of 20 cm to 30 cm.

Homicidal assault with a 12-gauge weapon from a distance about 4 metres.

Pellet injuries from a distant 12-gauge shotgun discharge. The range was about 20 metres and the injuries were shallow. Death was caused by coronary heart disease due to the shock of injury.

Wound inflicted from a distance of 40 metres (see next slide).

X-ray of the shot pattern associated with wound in previous slide.

MEDICOLEGAL ASPECTS OF FIREARM INJURIES The kind of firearm used The range of firing The direction of fire The place from where firing took place The cause of death Whether the firing was an accident, homicide or suicide.