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Practice ABC of Major Trauma, 4th Edition

Ballistic Injury

BMJ 2014; 348 doi: (Published 24 March 2014) Cite this as: BMJ 2014;348:bmj.g1143
  1. Rob Russell1,
  2. Jon Clasper1,
  3. Bruce Jenner2,
  4. Timothy J. Hodgetts3,
  5. Peter F. Mahoney1
  1. Royal Centre for Defence Medicine Birmingham, UK
  2. Royal Air Force UK
  3. University of Birmingham Birmingham, UK

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  • Ballistic weapons can produce very complex injuries.

  • Managing a ballistic incident includes managing threats to rescuers as well as managing casualties.

  • Weapon design is influenced by international regulations and conventions.

  • Surgery for ballistic injury follows principles developed in wartime.

‘Ballistics’ is the study of thrown objects. Ballistic injury (from thrown or projected material) may be caused by a number of weapon systems including firearms and explosives.

The damage to tissues caused by projectiles depends on a number of factors.

  • The kinetic energy of the projectile (influences the amount of energy that the object has available to deliver to tissue). This is given by the equation KE = ½ × mass × velocity × velocity.

  • The size and shape of the projectile influence how the object behaves in contact with tissue and in turn how much kinetic energy is given up. For example, the energy given up by a bullet will vary if it strikes nose first, side first, ‘tumbles’ in tissue or breaks into pieces in the tissue.

  • The nature of the tissue (how ‘elastic’ a tissue is influences the amount of energy it can absorb before damage occurs).

  • Intervening structures between the tissue and the projectile (such as ballistic protection—‘body armour’).

Bullets and firearms

Firearms work by applying an explosive force (e.g. gunpowder ignited in a confined space) to a projectile (e.g. a cannon ball), propelling it down a tube towards a target.

During the 19th century, cartridges were developed, packaging the bullet (boulette—‘little ball’), propellant and primer within a case. …

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