CNN's medical expert on Rep. Giffords' wounds

[wrinkles]

The death rate is almost identical in both the Ft. Hood and Arizona shootings. About 30% for both 9mm and 5.7 calibers.

Unless I've got my numbers wrong.

[DeltaKilo]

It is sad to see what happened, but I also agree with you guys that it also perks a certain scientific curiosity at the same time. The 1986 miami FBI shootout also was a horrific incident, but also had the same effect.

That said, I do not recall 5x7x28 to be that ineffective during the fort hood shooting -- everyone that was hit in COM places died, and some that did not get hit in vital areas did also. I would guess that 9mm FMJ has a bad rap for a reason... My other military friends do not take it with any serious nature at all. Now many WWII guns were 9mm luger and did seem very successful, so why is this? It seems 9mm FMJ has been around and successful at the same time. How can two people with headshots survive, a person shot 4 times in the chest, and yet the little girl who was hit once in the chest died? I thought the shot placement of the fort hood shooting was much worse overall, but I am wondering how these two instances compare given the available data. I know Doc really seems to hate on 5.7x28 for good reason, and I just want to see how this data stacks up. It seems that 5.7x28 was effective in the fort hood shooting. Hell, one of the guys in the 1986 FBI shooting was hit by a 38s +P/9mm 12 times (twelve!). I know the people in the 1997 BOA robbery had armor, but as far as I know both had more than 10 penetrations with one of those two taking 29 hits total. What are your guys thoughts?

Are there any more modern (post 1975) shootouts with .45 acp/357 mag/44 mag? I have done some searching but it seems that bad guys seem to pack AK clones and cheap 9mm handguns if any at all.

If I have any of my information wrong please correct me. I do not own any guns in either of these calibers. The whole reason we study things like the 1986 miami shootout and the 1997 BOA robbery is to evaluate these platforms and tactics so that we further our knowledge.

As a previous poster pointed out, the actual effectiveness of the 5.7mm caliber was only about 30%. In fact, the Ft. hood shooter got off quite a few rounds into an unarmed and largely immobile group of people, and I believe the actual number of people HIT by him was much higher than the number of hits managed by loughner against his group in Tucson. And overall, he had an abysmal effective rate with several wounded not even realizing they'd been hit. Given an indoor, captive group of targets, with a large group of targets immobile and unarmed, the fact that the shooter did as poorly as 30% effective is telling of a lot of things.

The 5.7mm cartridge has been shown time and time again in police shootings and other incidents to be highly INeffective.

9mm Ball rounds, also, are quite ineffective as with the profile of the bullet and their velocity, they will tend to penetrate through tissue doing relatively small amounts of damage.

This is a big reason that the NYPD and other agencies that issued 9mm handguns with ball ammunition jumped onto the hollowpoint bandwagon to increase the amount of damage done to tissue while simultaneously reducing the chances of the bullet overpenetrating without damaging any significant structures.

If anything, this topic of effectiveness has been well and truly resolved and Doc's data as well as many other sources of OIS incidents that involve these calibers has truly proven that neither one are effective.

Doc et al, please feel free to correct me if I'm wrong.

[200RNL]

9mm Ball rounds, also, are quite ineffective as with the profile of the bullet and their velocity, they will tend to penetrate through tissue doing relatively small amounts of damage.

This is a big reason that the NYPD and other agencies that issued 9mm handguns with ball ammunition jumped onto the hollowpoint bandwagon to increase the amount of damage done to tissue while simultaneously reducing the chances of the bullet overpenetrating without damaging any significant structures.

Depends on your definition of 'effective'.

I don't think the politicians running NYPD wanted to increase tissue damage. That's a politically incorrect goal in that city. When 9mm semiautos were first issued, the then commissioner of police wanted magazine capacity limited to 10 rounds. So, you can see the way they think in NYC.

Over penetration was their main concern and expanding bullets were the only way to limit penetration.

[DeltaKilo]

Depends on your definition of 'effective'.

I don't think the politicians running NYPD wanted to increase tissue damage. That's a politically incorrect goal in that city. When 9mm semiautos were first issued, the then commissioner of police wanted magazine capacity limited to 10 rounds. So, you can see the way they think in NYC.

Over penetration was their main concern and expanding bullets were the only way to limit penetration.

Are they effective at poking holes? Yes. Are they necessarily effective at doing a great amount of damage on the way through, increasing the odds that you will quickly incapacitate the threat? Not really, no.

[Odd Job]

Intracranial GSWs have been discussed in chapter 15 of the book "Ballistic Trauma: a practical guide"

MAHONEY, P. F., RYAN, M. J., BROOKS, A. J. AND SCHWAB, C. W. (ed.) (2005). Ballistic Trauma: A Practical Guide, London: Springer-Verlag.

On page 344 C.J. Neal et al say:

As previously discussed, a CT scan is the diagnostic modality of choice. Three prognostic indicators can be determined from the patient's initial scan: projectile track, evidence of increased ICP, and the presence of hemorrhage or mass lesion. Projectile trajectories associated with increased mortality include bihemispheric lesions, and those that involve the ventricular system. One exception may be a bifrontal injury.
Basilar cistern effacement on CT, indicative of elevated ICP, is associated with increased mortality. A stronger correlation, however, exists between increased mortality and the presence of intraventricular hemorrhage.

(ICP means raised intracranial pressure).

I've seen a few GSWs involving heads and the CT scans of these cases and their reports. There seems to be quite some variation in the amount of damage seen and the extent of haemorrhage and fragment distribution (both bone and projectile). Obviously I exclude contact wounds here because the release of gases into a confined space such as the skull vault is very destructive. There are ample images of such injuries provided by Di Maio and Dodd repectively:

DI MAIO, V. J. M. (1999). Gunshot wounds : practical aspects of firearms, ballistics, and forensic techniques, Boca Raton, CRC Press.

DODD, M. J. & BYRNE, K. (2006). Terminal ballistics : a text and atlas of gunshot wounds, Boca Raton, FL, CRC Taylor & Francis.

I think it is not a simple matter to view these gunshot heads with the same attitude as we do with soft tissue injuries in unconfined spaces. I read somewhere (I am trying to remember which book it was) that even a perforating .22 LR injury to the head can result in raised ICP to the point where the fragile orbital bone plates can be fractured.

There is a lot that goes on in the head when it is injured by a projectile. There are many variables and many outcomes.
A broader view of these injuries is needed than is currently being exhibited by some posters in this thread.

[FL2011]

I certainly agree with the above in that we do need to think of the brain a little differently in regards to injury patterns. Just by the nature of the brain and various locations of neural pathways, slightly different trajectories can have varying degrees of morbidity and mortality. Like we saw in this case, there can be a perforating injury (through and through) in which the patient seemingly does "well" depending on the bills track. And on the flip side you could have a penetrating injury (retained fragments) from a certain angle that has a much shorter injury track, but injures a much more critical area if brain such as the brainstem with potential for causing a quick death from respiratory arrest.

For those wanting some more reading here's an emedicine article on penetrating head trauma:
http://emedicine.medscape.com/article/247664-diagnosis

I found this paragraph interesting regarding outcome results of a study of perforating vs penetrating missile-related injuries during Iran-iraq war.

As stated previously, a wound in which the projectile breaches the cranium but does not exit is described technically as penetrating, and an injury in which the projectile passes entirely though the head, leaving both entrance and exit wounds, is described as perforating. This distinction has some prognostic implications. In a series of missile-related head injuries during the Iran-Iraq war, a poor postsurgical outcome occurred in 50% of patients treated for perforating wounds, as compared with only 20% of those with penetrating wounds.[3 ]

[Zhukov]

I was hoping that OddJob would eventually find his way here.

Is Dr. Williams still around, BTW? I can't recall him posting in a long time. His input would also be very valued. Seems like Dr. Roberts has chosen to stay on the sideline for now...

Has anyone heard about the type of bullet used in the shootings? A quick look back through the thread mentioned a 100 round value pack, which could be JHP or FMJ. If Loughner used FMJs, then the resulting injury might be quite a bit more survivable than a JHP. It's also possible that a JHP would be clogged by bone fragments - I presume the value pack JHPs aren't the best performing.

Until they release a full medical report - which I doubt they will - all we can do is guess about what happened.

[DocGKR]

There is not much to say--if you work at a busy Level I trauma center for any length of time, you will discover it is not that unusual an occurrence for people to show up in the ER with handgun wounds to the head and survive (especially with FMJ's)...

[DeltaKilo]

There is not much to say--if you work at a busy Level I trauma center for any length of time, you will discover it is not that unusual an occurrence for people to show up in the ER with handgun wounds to the head and survive (especially with FMJ's)...

I would imagine so, if the case I read about where a man walked in under his own power, slightly disoriented, with the presenting symptom of having a kitchen knife stuck hilt-deep in his head...

[tpd223]

There is not much to say--if you work at a busy Level I trauma center for any length of time, you will discover it is not that unusual an occurrence for people to show up in the ER with handgun wounds to the head and survive (especially with FMJ's)...

Agree. We see this on the street as well.


I once worked a case where a guy planned to end it all, drove way out into the boonies with a Charter 2" .38 and one round of standard velocity RNL. He shoots himself in the head and contact range, quickly realizes that he is not dead, and that he is out of ammo. He then drives all the way back into town, pulls into the ambulance bay at the local VA hospital, then collapses, I was told most likely from swelling/bleeding in his brain.

Dude was wide awake and driving, for some of the time in city traffic, for probably 20-30 minutes.