Sorry, PUTzzzz, the medical community emphatically disagrees with you. So yeah, I'm going to go with this rather than what you and others have pulled out of your asses on this subject.
ZERO mass shooting have occurred with assault weapons' firing other than the ammo that is designed for them.
What Gunshots Do to Bodies: Docs Speak Out
Robert Glatter, MD; Heather Sher, MD; Amy J. Goldberg, MD; Joseph V. Sakran, MD, MPA, MPH
https://www.medscape.com/viewarticle/895007
DISCLOSURES April 17, 2018
Robert Glatter, MD: The sheer devastation and loss of life that occurred in the wake of the school shootings at Marjory Stoneman Douglas High School in Parkland, Florida, have been weighing on the minds of everyone in the United States, but especially among healthcare providers.
The number of mass shootings in the United States has significantly increased since the Federal Assault Weapons ban expired in 2004. According to data from the Centers for Disease Control and Prevention (CDC), more than 36,000 people died of gunshot wounds in 2015.[1]
The public has been largely shielded from seeing the destruction that high-velocity bullets cause, how they rip organs apart and injure precious nerves, blood vessels, and tissue.
The firearm we will discuss today is the AR-15. This weapon was the recent topic of a very powerful essay in The Atlantic by Dr Heather Sher,[2] a radiologist who was on call the day of the Parkland shootings.
In her article, she vividly describes the horrific and destructive CT findings caused by the bullets from the AR-15 and contrasts these with the wounds of bullets from a 9-mm semiautomatic handgun.
Here to discuss the ballistics as well as the care of patients after such gunshot wounds are Dr Heather Sher, a board-certified diagnostic radiologist; Dr Amy Goldberg, chair and professor in the department of surgery, and surgeon-in-chief, at Temple University Health System in Philadelphia, Pennsylvania; and Dr Joseph Sakran, director of emergency general surgery and assistant professor of surgery at Johns Hopkins Medical Institutions in Baltimore, Maryland. Welcome, doctors, and thank you for joining me.
Low- Versus High-Velocity Gunshot Wounds
Glatter: It is quite an honor to have everyone together to discuss this. Dr Sher, I want to begin by asking you to describe the differences seen on imaging studies between low- and high-velocity gunshot wounds and how the velocity of these bullets fired from the AR-15 compares with, for example, a standard 9-mm handgun.
Heather Sher, MD: I am a diagnostic radiologist. I have spent my 14-year career in level-1 trauma centers. I have seen many, many handgun injuries over the years. As a radiologist, I have a unique perspective in that most of these patients, if they are stable enough that they do not require emergent surgery, are scanned from head to toe. I have kind of a bird's-eye view of what these injuries look like.
I have seen two recent mass shootings, which is a unique position to be in. One occurred at the Fort Lauderdale International Airport, in which the gunman used a 9-mm semiautomatic handgun with a low-velocity bullet. The second mass murder involved the care of patients from Parkland, in which the shooter used an AR-15. These were very different injuries and led to very different outcomes for the patients.
Handgun injuries are the type we are used to seeing in day-to-day practice. The bullet leaves a linear track through the body and we can see that track on imaging.[3,4,5,6] If the bullet travels through the liver, for example, we can generally see the linear track of the bullet from entry wound to exit wound, and there will be some bleeding. The injury is the permanent cavity that the bullet leaves and it is traceable through the liver.
That is in stark contrast to the injuries we see with the AR-15. This is something that I had read about, but in 14 years of practice I had seen it only once before, in a SWAT injury, and only recalled it after seeing the injuries from the Parkland shooting. These are high-velocity bullets.
Glatter: This obviously took you by surprise. All of a sudden you have an image, a scan, of some devastating wound here, which certainly sparked a memory.
Sher: In the airport shooting, I did not even realize that anything like a mass shooting had occurred until I read the scans from the third case, because simple gunshot wounds are what I see in day-to-day practice. The AR-15 causes a huge swath of tissue damage from something that is called temporary cavitation.
Glatter: Can you explain what cavitation means?
Sher: It is similar to a radial stretch injury. You have the permanent cavity where the linear track of the bullet passes, but there is a wave of energy that, as kinetic energy is imparted to the patient, causes the elastic tissue to move away from the bullet and then return. That whole swath of tissue is damaged.
It results in a 4- to 6-inch area that is damaged. It is completely different. Injury from a low-velocity gunshot wound depends on what the bullet hits.
If you hit an artery directly, that is lethal. If you hit the heart directly, it is still lethal. But with an AR-15, you only have to be in proximity to something like a vessel to have a catastrophic event.
Glatter: These AR-15 bullets are smaller, nimble bullets and they travel faster. Their muzzle velocity is much greater, correct?
Sher: The injury is a function of the velocity. Low-velocity injuries with a handgun occur at 1200 feet per second, more or less. These assault rifle bullets cause injuries at 3200 feet per second. These really fast, small bullets result in a totally different pattern of injury. The physics is different in terms of the cavitation phenomenon, and in the patient, it is completely different.
In a solid organ, you see a large area of tissue destruction. If the bullet tracks anywhere near the porta hepatis or the vascular pedicle of the spleen, that patient would never make it to us.
In a long bone injury, the bone is absent; it is like sawdust— a whole 6-inch segment of bone is just gone when you shoot it with an AR-15. There are images from military surgeons that are posted in the New York Times that illustrate that point perfectly.[7]
Treating Entry and Exit Wounds
Glatter: Dr Goldberg, you are on the front lines, in the operating room and the ICU; you resuscitate these patients. Can you tell me what you are seeing physically with these wounds, exit and entry, and how you are managing them from a damage-control standpoint?
Amy J. Goldberg, MD: I have been a trauma surgeon in north Philadelphia Temple Hospital for about 25 years now. I cannot say that I am a ballistics expert, but unfortunately, I am an expert on what bullets can do to bodies.[8] You can take what Heather has said and apply that to what it looks like when you make that incision and you are now peering at a liver that has been morselized by the high energy of these assault rifles.
The wounds are so large. They are large cavitary wounds, whether it is the liver or the spleen, the aorta or the vena cava. You are doing your best, first of all, to stop the bleeding, whether by packing or clamping. You are feverishly trying to stop the patient from exsanguinating and dying immediately on the operating room table.
Glatter: In terms of damage control techniques and what came out of the battlefield, these wounds are problematic, and just to resuscitate the patients to get them to the ICU is a challenge because patients often will die. With a standard handgun injury, you at least have some time, but with the sheer internal destruction from these high-velocity bullets, I imagine that you simply do not have that time.
Goldberg: If you are lucky enough to get the patient to the operating room, then at least you have a chance to stop that patient from bleeding. Many of the patients we have seen in these mass-casualty incidents have died at the scene and have not made it to the hospital.
If you are lucky enough to get the patient to the hospital, you know that your first job is to try to stop the bleeding and, at the same time, resuscitate the patient with blood and blood products—and doing whatever you can, packing and clamping.
ZERO mass shooting have occurred with assault weapons' firing other than the ammo that is designed for them.
What Gunshots Do to Bodies: Docs Speak Out
Robert Glatter, MD; Heather Sher, MD; Amy J. Goldberg, MD; Joseph V. Sakran, MD, MPA, MPH
https://www.medscape.com/viewarticle/895007
DISCLOSURES April 17, 2018
Robert Glatter, MD: The sheer devastation and loss of life that occurred in the wake of the school shootings at Marjory Stoneman Douglas High School in Parkland, Florida, have been weighing on the minds of everyone in the United States, but especially among healthcare providers.
The number of mass shootings in the United States has significantly increased since the Federal Assault Weapons ban expired in 2004. According to data from the Centers for Disease Control and Prevention (CDC), more than 36,000 people died of gunshot wounds in 2015.[1]
The public has been largely shielded from seeing the destruction that high-velocity bullets cause, how they rip organs apart and injure precious nerves, blood vessels, and tissue.
The firearm we will discuss today is the AR-15. This weapon was the recent topic of a very powerful essay in The Atlantic by Dr Heather Sher,[2] a radiologist who was on call the day of the Parkland shootings.
In her article, she vividly describes the horrific and destructive CT findings caused by the bullets from the AR-15 and contrasts these with the wounds of bullets from a 9-mm semiautomatic handgun.
Here to discuss the ballistics as well as the care of patients after such gunshot wounds are Dr Heather Sher, a board-certified diagnostic radiologist; Dr Amy Goldberg, chair and professor in the department of surgery, and surgeon-in-chief, at Temple University Health System in Philadelphia, Pennsylvania; and Dr Joseph Sakran, director of emergency general surgery and assistant professor of surgery at Johns Hopkins Medical Institutions in Baltimore, Maryland. Welcome, doctors, and thank you for joining me.
Low- Versus High-Velocity Gunshot Wounds
Glatter: It is quite an honor to have everyone together to discuss this. Dr Sher, I want to begin by asking you to describe the differences seen on imaging studies between low- and high-velocity gunshot wounds and how the velocity of these bullets fired from the AR-15 compares with, for example, a standard 9-mm handgun.
Heather Sher, MD: I am a diagnostic radiologist. I have spent my 14-year career in level-1 trauma centers. I have seen many, many handgun injuries over the years. As a radiologist, I have a unique perspective in that most of these patients, if they are stable enough that they do not require emergent surgery, are scanned from head to toe. I have kind of a bird's-eye view of what these injuries look like.
I have seen two recent mass shootings, which is a unique position to be in. One occurred at the Fort Lauderdale International Airport, in which the gunman used a 9-mm semiautomatic handgun with a low-velocity bullet. The second mass murder involved the care of patients from Parkland, in which the shooter used an AR-15. These were very different injuries and led to very different outcomes for the patients.
Handgun injuries are the type we are used to seeing in day-to-day practice. The bullet leaves a linear track through the body and we can see that track on imaging.[3,4,5,6] If the bullet travels through the liver, for example, we can generally see the linear track of the bullet from entry wound to exit wound, and there will be some bleeding. The injury is the permanent cavity that the bullet leaves and it is traceable through the liver.
That is in stark contrast to the injuries we see with the AR-15. This is something that I had read about, but in 14 years of practice I had seen it only once before, in a SWAT injury, and only recalled it after seeing the injuries from the Parkland shooting. These are high-velocity bullets.
Glatter: This obviously took you by surprise. All of a sudden you have an image, a scan, of some devastating wound here, which certainly sparked a memory.
Sher: In the airport shooting, I did not even realize that anything like a mass shooting had occurred until I read the scans from the third case, because simple gunshot wounds are what I see in day-to-day practice. The AR-15 causes a huge swath of tissue damage from something that is called temporary cavitation.
Glatter: Can you explain what cavitation means?
Sher: It is similar to a radial stretch injury. You have the permanent cavity where the linear track of the bullet passes, but there is a wave of energy that, as kinetic energy is imparted to the patient, causes the elastic tissue to move away from the bullet and then return. That whole swath of tissue is damaged.
It results in a 4- to 6-inch area that is damaged. It is completely different. Injury from a low-velocity gunshot wound depends on what the bullet hits.
If you hit an artery directly, that is lethal. If you hit the heart directly, it is still lethal. But with an AR-15, you only have to be in proximity to something like a vessel to have a catastrophic event.
Glatter: These AR-15 bullets are smaller, nimble bullets and they travel faster. Their muzzle velocity is much greater, correct?
Sher: The injury is a function of the velocity. Low-velocity injuries with a handgun occur at 1200 feet per second, more or less. These assault rifle bullets cause injuries at 3200 feet per second. These really fast, small bullets result in a totally different pattern of injury. The physics is different in terms of the cavitation phenomenon, and in the patient, it is completely different.
In a solid organ, you see a large area of tissue destruction. If the bullet tracks anywhere near the porta hepatis or the vascular pedicle of the spleen, that patient would never make it to us.
In a long bone injury, the bone is absent; it is like sawdust— a whole 6-inch segment of bone is just gone when you shoot it with an AR-15. There are images from military surgeons that are posted in the New York Times that illustrate that point perfectly.[7]
Treating Entry and Exit Wounds
Glatter: Dr Goldberg, you are on the front lines, in the operating room and the ICU; you resuscitate these patients. Can you tell me what you are seeing physically with these wounds, exit and entry, and how you are managing them from a damage-control standpoint?
Amy J. Goldberg, MD: I have been a trauma surgeon in north Philadelphia Temple Hospital for about 25 years now. I cannot say that I am a ballistics expert, but unfortunately, I am an expert on what bullets can do to bodies.[8] You can take what Heather has said and apply that to what it looks like when you make that incision and you are now peering at a liver that has been morselized by the high energy of these assault rifles.
The wounds are so large. They are large cavitary wounds, whether it is the liver or the spleen, the aorta or the vena cava. You are doing your best, first of all, to stop the bleeding, whether by packing or clamping. You are feverishly trying to stop the patient from exsanguinating and dying immediately on the operating room table.
Glatter: In terms of damage control techniques and what came out of the battlefield, these wounds are problematic, and just to resuscitate the patients to get them to the ICU is a challenge because patients often will die. With a standard handgun injury, you at least have some time, but with the sheer internal destruction from these high-velocity bullets, I imagine that you simply do not have that time.
Goldberg: If you are lucky enough to get the patient to the operating room, then at least you have a chance to stop that patient from bleeding. Many of the patients we have seen in these mass-casualty incidents have died at the scene and have not made it to the hospital.
If you are lucky enough to get the patient to the hospital, you know that your first job is to try to stop the bleeding and, at the same time, resuscitate the patient with blood and blood products—and doing whatever you can, packing and clamping.
