TL;DR: The location of an entrance wound (bullet placement) and the projectile path are the most important factors in causing significant injury or death following a shooting.
Abstract: The location of an entrance wound (bullet placement) and the projectile path are the most important factors in causing significant injury or death following a shooting. The head followed by the torso are the most vulnerable areas, with incapacitation resulting from central nervous system (brain or cord) disruption, or massive organ destruction with hemorrhage. Tissue and organ trauma result from the permanent wound cavity caused by direct destruction by the bullet, and also from radial stretching of surrounding tissues causing a temporary wound cavity. The extent of tissue damage is influenced by the type of bullet, its velocity and mass, as well as the physical characteristics of the tissues. The latter includes resistance to strain, physical dimensions of an organ, and the presence or absence of surrounding anatomical constraints. Bullet shape and construction will also affect tissue damage and bullets which display greater yaw will be associated with increased temporary cavitation. Military bullet designs do not include bullets that will expand or flatten as these cause greater wound trauma and are regulated by convention.
TL;DR: Wound assessment and the type and extent of treatment required should be based on an understanding of the various mechanisms contributing to tissue damage, mainly by temporary cavitation which is a manifestation of effective high-energy transfer to tissue.
TL;DR: Much ballistics research has been conducted including using cadavers, animal models and simulants such as ballistics ordnance gelatine but these models need to accurately represent the human body and its heterogeneous nature which involves understanding the biomechanical properties of the different tissues and organs.
TL;DR: It is important for the trauma surgeon to understand the basic principles of terminal gunshot ballistics and the study of the projectile's effect on striking soft tissue.
Abstract: • It is important for the trauma surgeon to understand the basic principles of terminal gunshot ballistics and the study of the projectile's effect on striking soft tissue. The amount of kinetic energy dissipated to the tissue is directly related to the mass and velocity of the projectile as follows: K = MV 2 /2. Doubling the velocity quadruples the energy, while doubling the mass only doubles the energy. A temporary tissue cavity is produced as the striking projectile compresses the surrounding tissue; the higher the energy release, the more extensive the inapparent compressive damage. The permanent cavity that remains is the result of extrusion of tissue from the pathway of the projectile. The higher the velocity, the higher the likelihood of extensive damage. If the missle expands or fragments within the tissues, more damage will occur. ( Arch Otolaryngol 1983;109:313-318)
TL;DR: To determine the true extent of the tissue injury resulting from gunshot wounds to the brain, microscopic investigations for reactive changes (emigration of leukocytes and macrophages, axonal expression of beta-amyloid precursor protein (beta-APP) in 10 cases of gunshot wound to the narrow channel of the brain with survival times >2h were carried out.