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Student Education

Trauma surgery: Ballistic trauma

BMJ 2003; 326 doi: (Published 01 June 2003) Cite this as: BMJ 2003;326:0306188
  1. Omar Mukhtar, final year medical student1,
  2. Kirsten Jones, consultant in emergency medicine2
  1. 1University of Bristol
  2. 2Frenchay Hospital, Bristol

In the third article in our series on trauma, Omar Mukhtar and Kirsten Jones explain how to assess and manage ballistic trauma

Ballistic trauma is a sad and tragic part of everyday life in many parts of the world, from South Africa to Palestine, from Afghanistan to the United States. Yet the perceived glamour of the gunshot wound lures many students to undertake an elective in trauma surgery. Here we explore the basics of ballistic trauma.

Classifying firearms

Firearms are weapons that require an additional source of energy, usually provided by the ignition of a propellant to fire a projectile--for example, bullets or pellets. Firearms are classically divided into four groups (see box). When a firearm is discharged, a cloud of vapour (gas) and particulate matter (solid) is deposited nearby, on skin and clothes for example. Explosives--such as bombs and hand grenades--behave in a similar manner.

Box 1: Four types of firearm

  • Rifled firearms

    • Handguns--pistols, revolvers

    • High velocity assault rifles--AK47

  • Smooth bore firearms--shotguns

  • Homemade firearms

  • Modified firearms--release tear gas, rubber bullets

Rifled firearms

Handguns and rifles are rifled firearms. In both, the barrel of the weapon is grooved, causing the bullet to twist when fired; the shooter experiences less recoil and can take a more accurate shot. The range (the distance between the muzzle of the weapon and the victim) can be determined by close examination of the entrance wound.

Smooth bore firearms

Smooth bore firearms--the commonest example of which is a shotgun--are weapons in which the barrel is simply a tube. The cartridge for smooth bore firearms is also quite distinctive--releasing between seven hundred and six hundred pellets depending on the type of shotgun.

Homemade firearms

“Homemade firearms” is a term which covers many weapons. Their variability accounts for a range of unpredictable injuries. However, they have become …

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