FIREARM AND EXPLOSIVE INJURIES

Regrettably, the use of firearms in criminal activities appears to be increasing, even where
strict legal controls on guns has traditionally kept such injuries to a minimum. In other
countries, such as the USA, firearms are the most common mode of death in homicide.
The rise of international terrorism has also made some knowledge of explosive injuries
desirable, whereas formerly they had an almost exclusive military relevance.

TYPES OF FIREARM
Shot-gun
The smooth-bore weapon consist of a metal barrel which has either parallel sides or slight
taper. The open end of the barrel is the “muzzle”. These are sporting guns known as ‘shot-
gun’, as they usually fire a large number of small spherical lead shot, though some
ammunition contains only a few (or even a single) large projectile.
Shot-guns have long barrels, though these may be illegally shortened, as in the ‘sawn-off
shot-gun’ favoured by armed robbers. Shot-gun often have two barrels, either side-by-side or
‘over and under’. The taper of one barrel is usually greater, known as ‘choke’, which narrow
the cone of discharge when fired. A shot-gun is designed for use up to about 30-50 meters,
and is unlikely to kill a man at is extreme range. There are two common size of shot-gun, in
relation to ‘bore’ of diameter of barrel. The larger is a ’12-bore’, known as ’12-gauge’ in the
USA, with muzzle diameter of about 19 mm. the other is the ‘410’, as is diameter 0,140
inches or about 11 mm.
The cartridges for shot-guns consist of a metal base containing a central detonating cap,
supporting a cardboard or plastic tube. Inside this tube is the propellant charge, capped by
‘wads’ which act as a piston for the overlying mass of lead shot. The wads used to be made of
felt, cork or cardboard, but are now usually plastic, some of which are shaped into cup-form
which opens out into a star-shape in flight. There may also be cork fillers under the shot and
the open end of the cartridge is closed by a thin over-shot disc.
Some special modifications of shot guns allow a single projectile to be fired; occasionally,
cartridge are tampered with, to fuse the loose shot into a single bolus.
In some areas, especially developing countries or amongst rebels, home-made guns,
sometimes called ‘country guns’, may be made from metal tubing and crude firing
mechanisms. These may fire collections of metal debris, such as nuts, bolts, wood-screws and
even stones, so that the resulting wounds do not comply with the usual descriptions.

Rifled weapons
These comprise revolvers, ‘automatic’ pistols, rifles, and many types of military weapons. All
differ from the shot-gun in that they fire one projectile at a time through a barrel that has
spiral grooves cut into the metal, the intervening projections being called ‘lands’. These grip
the bullet and impart the gyroscopic spin which assists in maintaining in accurate trajectory.
Most rifles weapons have a mechanism for bringing a new ‘round’ into the breech for
repeat firing. In the revolver, the silinder rotates under trigger pressure to line up a new
cartridge. In older rifles, there is a bolt which has to be worked to bring a new round up from
a magazine, whilts in self-loading and automatic weapons, gas pressure provide the energy.
The ammunition for rifled weapons come in very many sizes, but essentially is a closed
metal cylinder carrying the firing cap and propellant charge, into the distal end of which is
clamped a single projectile. These may be lead or a lead core covered with a cupro-nickel,
steel or other hard metal jacket. There may be a soft-tip or an air-space in the tip, design to
the distort the bullet on impact. Some modern bullets may have a small explosive charge in
the tip, also design to distort and thus decelerate the missile on impact.
The propellant charge in modern firearms is no longer the old ‘black powder’ which used
to cause extensive soiling around wounds, though in some parts of the world, old stock or
home-made weapons may still be encountered. Modern propellant consist of nitro-cellulose
or other synthetic compounds, often chopped into small flakes, some of which are highly
coloured and may be found in the vicinity of wound. When detonated by the firing pin
striking the cap, the propellant burns rapidly, producing huge volumes of gas which are
further expanded by the very high temperature of ignition. The pressure of the gas propels the
shot or bullet from the barrel, the muzzle velocity varying from a few hundred meters per
second in a shot-gun to a thousand or more in a high velocity military weapon. It is the
transfer of this high kinetic energy to the body tissues that causes firearm wounds. The
energy is calculated by half the mass times the square of the velocity, so higher muzzle
speeds are more effective than a larger bullet – a fact utilized in modern military weapons.

Wounds from smooth-bore guns

Hot gas, flame, smoke, unburn propellant, wads and shot all contribute to appearance of shot
gun wounds. The mass of small pellets leaves the muzzle in a compact mass within the
plastic cup-wad, bt as the letter falls back, the bolus of shot begins to diverge, so that the shot
pattern is a long, shallow cone. The further along this cone the victim is situated, the larger
will be the wound pattern.
A contact wound with the muzzle touching the skin may cause a circular abrasion due to
the gas forced into the tissues pressing the skin up against the metal. This is not a ‘recoil’
mark, as often wrongly stated by many textbooks, as the recoil move the muzzle away from
the skin.
The entrance wound will be circular and about the size of the muzzle, with some smoke
soiling unless the gun was pressed so tight the a good seal was made. The tissues will be
blackened inside and the surrounding area may be pink from carbon monoxide from the
discharge gases. The wound edge will be regular, with no pellets marks; the wad pr plastic
piston will be inside the wound. If the discharge was over an area supported by bone, such as
the scalp or the sternum, then the entering gases cannot disperse as they would in soft areas
such as the abdomen. They rebound from the underlying bone, raise a dome of skin which
then splits, so that the entry wound is ragged and irregular.
A near discharge, within a few centimetres of surface, will be similar, though there can be
no muzzle mark. More smoke soiling can occur, depending on the cleanliness of the
particular propellant, as there is now room for gas escape. Burning of skin and singeing and
clubbing of melted hairs will be seen at this range and the wads will be in the wound. There
may be powdered tattooing, which is due to burning flakes or propellant causing tiny burns
on the surrounding skin. This cannot be washed off, as can smpoke soiling (though this
should never be done, if the wound area is to be sent for forensic examination).
At intermediate ranges, between 20 cm and 1 metre, there will be diminishing smoke
soiling, but powdered tattooing will persist. Burning will persist for a variable distance, up to
about a metre. The spread of shot will begin, first causing an irregular rim to the wound. This
is call ‘rat-hole’ in the USA, from the nibbled edges.
At longer ranges, the shot will spread progressively. At 2-3 metres, satellite pellet holes
will be seen around the central wound, which diminishes in size as the range increases.
Though cylinder and choke barrels vary greatly, as does ammunition, a very rough guide is
that the spread of shot in centimetres equals two to three times the range in metres, i.e. if the
wound pattern is 20 cm across, the discharge was roughly 7-10 metres distant, so could be a
suicide.
At long ranges, such as 20-30 metres, there is a uniform peppering of shot and this is
rarely fatal. The wads or plastic cups fall away at a very variable distance, from 2 to 7 metres.
Shot-guns rarely produce an exit wound when fired into the chest or abdomen, though they
often traverse the body when fired into the head, neck or mouth. The entrance wound from a
shot-gun is easy to recognize, being large from a 12-bore though a .410 can sometimes be
confused with that from a rifled weapon. The exit wound in these cases may be a huge raged
aperture, especially in the head, where the skull may be virtually explode with the gas
pressure from a contact wound, ejecting part or even all of the brain from the cranial cavity.

Wounds from rifled weapons

Due to the higher velocities and the greater mass of the bullet, many rifled wounds till
traverse the body, causing both an entrance and exit wound. Exceptions will be where bone is
struck, obstructing the bullet or fragmenting it. Small-calibre bullets such as .22, unless feom
a high-velocity weapon, may often fail to exit from the body. It is naturally important to
distinguish between the exit and entrance wound in order to tell from which direction the shot
came; this may not always be as easy as some textbooks claim.

ENTRANCE WOUNDS
Contact wounds from a rifled weapon are circular, unless over a bony area such as the head,
where gas-rebound splitting may occur. There may be a muzzle mark if pressed hard against
the skin and a pattern may be imprinted from a fore-sight or self-loading mechanism. There
may be slight escape of smoke, some local burning of skin and hair and redness of monoxide
staining, as well as surrounding bruising.
At close range, within 20 cm (but very variable according to gun and ammunition), there
will be a circular hole, unless the discharge was at an angle to the surface, when an oval hole,
perhaps with visible undercutting, may be seen. Some smoke soiling, powder burns and skin
and hair burning may be seen. A bullet hole in the skin is inverted and may be slightly
smaller than the diameter of the missile, as the elastic epidermis is stretched during the
passsge of the bullet and contracts after-wards. There is an ‘abrasion collar’ around the hole,
due to the friction, heating and dirt effect of the missile when it intends the skin during
penetration. There may also be surrounding bruising.
 At longer ranges (which may be up to several kilometres with a high-powered rifle), the
entrance hole will have the same features of an abrasion collar, but beyond a metre or so,
there can be no smoke soiling, burning or powder tattooing. At extreme ranges, the
gyroscopic track is lost and the missile begins to wobble and even turn end-over-end. This
causes a larger, more irregular wound and the bullet may even strike sideways, leaving linear
wound.

EXIT WOUNDS
The exit wound of a bullet is usually everted, with split flaps causing stellate appearance.
There is no burning, smoke or powder soiling. If the bullet has been flattened or distorted or
if it has a struck bone internally, then the exit wound may be more irregular, multiple and
sometimes very large in size. A high-velocity military missile striking a large bone such as
the spine or base of skull, may virtually explode and tear a large defect on exist.
When skin is firmly supported, as by a belt, brassiere band or even leaning against a
partition wall, the exit wound may be as small as the entrance and may fail to show the
typical eversion.
Internally, low-velocity missiles, such as shot-gun pellets and some revolver bullets, cause
simple mechanical disruption of the tissues by pushing them aside, plus damage from
expanding gas in close-range discharge. High-velocity missile, especially from a military
weapons, cause far more damage by transferring energy laterally along their track, especially
in dense organs such as liver and brain. A cavity forms momentarily which may be many
times wider than the missile, the walls of which pulsate with decreasing amplitude,
destroying the involved tissues.

Rubber and plastic bullets; stud guns and human killers

In riot control, police may use special weapons, such as rubber or plastic rounds fired from
shot-guns, whose purpose is to disable and discourage rioters, but not to kill or seriously
injury them. Rubber bullets have been largely replaced by ‘plastic rounds’, which are PVC
cylinders about 10 cm long, weighing 135 g.
They should not be fired at ranges less than 20 metres and should be fired at the lower part
of the body. However, some deaths and many serious injuries have occurred during their
improper use, including fractures of skull, ribs and limbs, eye damage and visceral injuries.
Injuries and deaths from stud guns are well recorder; these are devices used in the building
industry to fire steel pins into masonry or timber by means of a small explosive charge. They
have been used for suicide and even homicide, but injuries are usually accidental, sometime
from the pin being fired right through the structure and hitting someone on the other side.
Humane killers are weapons used in abbatoirs and by veterinary surgeons to kill animals.
They may either fire a small-calibre bullet or a ‘captive bolt’, where a sliding steel pin is fired
out for about 5 cm by an explosive charge.
These have been used for suicide, but accidental discharge may also cause serious injury
or death.
ACCIDENT, SUICIDE OR MURDER
In firearm wounds, this is a major issue for the pathologist to decide. Suicides must show
wound whose range is within the arm’s rich of the deceased, unless some device is present to
reach the trigger. The weapon must be present, though it may be at a distance from the body,
if immediate death need not have been inevitable.
Suicides shoot themselves in ‘sites of election’, which comprise the mouth, the front of the
neck, the forehead or temples, or the front of the chest. Discharges into the temples are
usually on the side of the dominant hand, but this is not absolute. People almost never shoot
themselves in the eye or abdomen – and naturally not in inaccessible site such as the back. In
the Britain and many other countries, women rarely commit suicide with guns and are rarely
involved in firearms accident, so there is a useful rule that ‘a shot woman is a murdered
woman until proved otherwise’.
Multiple firearm wounds suggest homicide, but this is by means inevitable. Many suicides
have fired repeatedly into themselves, even when each wound is potentially immediately
fatal. It is unwise to state that a gunshot wound must have been immediately fatal, unless
destruction of the brainstem or heart or transection of the aorta, etc. has occurred. There are
many instances of gross brain damage, especially in the cerebrum, being followed by
prolonged and purposeful activity. Where suicide can be ruled out, by range or absence of a
weapon, then accident or homicide could have occurred and distinguishing them is a matter
for police investigation, rather than medical evidence.

THE DOCTOR’S DUTY IN FIREARM INJURIES AND DEATHS

In the living, all effort are naturally directed to saving live, but the doctor should make good
notes of the original appearances before any surgical cleaning or operative procedure were
completed. Any missiles, foreign body such as and any skin removed from the margin of a
repaired firearm wound should be carefully preserved for the police.
The same applies to post-mortem examination, lead shoot, bullets, etc., being preserved
without damage. The skin around the entrance wound should be removed and kept (without
formalin, but refrigerated if necessary) for forensic test for powder residues. Photograph or
drawings with accurate measurements of wound size should be obtained.
In many countries, firearm wounds must be reported to the police even if not fatal;
naturally all deaths would come into the category of medicolegal investigations and must be
reported. In the mainland of Britain, non-fatal woundings need not be reported by doctors,
though the circumstances usually mean that the authorities will know about any criminal
events. In Northern Ireland, the state of emergency due to the terrorism makes it compulsory
for doctors to inform on any shooting or explosive injuries – and this situation applies in
many other parts of the worlds.

EXPLOSIVES
Terrorism and warfare lead to many deaths from explosive devices. In military bomb, shell
and missile explosions, the release of energy may be so high that death and disruption from
blast effects may occur over a wide area, though the energy falls off rapidly (by the inverse
square law) as the distance from the epicentre increases.
 In contrast, terrorist devices, unless containing very large amounts of explosive, rarely
compare with military effectiveness and thus the pure blast effect are far more limited. Often
only the people within a metre or two are killed by the primary energy effects – and may be
only the bomb-layer himself, in the frequent event of a premature explosion.
When an explosion occurs, the generation of huge volumes of gas, expanded by chemical
interaction and great heat, causes compression wave to sweep outwards. At the origin, this is
many times the speed of sound, but rapidly slows down. The pure blast effects cause either
physical fragmentation, disruption and laceration of the victim, from high pressure and hot
gas striking the body. A minimum pressure of about 700 kilopascals (100 lb/sq inch) is
needed for tissues damage in humans.
There may be pressure effects upon the viscera, which are far more damaging where an
air-fluid interface exist, such as in the air-passages, lung and alimentary canal. Ruptures and
haemorrhage of these zones is the classical blast lesion.
Far more casualties, fatal and otherwise, are caused by secondary effects of explosive
devices, especially in the lower-powered terrorist bombs. These include:
1. Burns, both from the near effects of the explosions and secondary burns from
conflagrations started by the bomb.
2. Missile injuries from part of the bomb casing and from adjacent objects and fragments
projected by the explosion.
3. Peppering by small fragments, debris and dust propelled by the explosion. These can cause
multiple abrasions, lacerations ad bruises and discolour the skin from impacted dirt.
4. All types of injury due to collapse of buildings, roofs, ceilings, etc., due to structural
damage from the explosion.
5. Injuries and death from vehicular damage or destruction, such as decompression, fire and
ground impact of bombed aircraft and crash damage to cars, trucks, buses, etc.

Where the above type of damage is inflicted, either to living or dead, the medical
examination is similar to that in any form of trauma, in that the catalogue of abrasions,
bruises, lacerations and burns is required.
If a near or massive explosion disrupt one or more bodies, than identification of the
fragments is essential, not least to determine how many victims were killed – a task which
can be extremely difficult. The task resembles that after a mass disaster such as an air crash,
where many bodies may be both disrupted into hundreds of fragments and burned as well.