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Tue Jun 12 17:39:01 BST 2012

Pret

Sorry that you do  not understand. I said and I repeat: I use my
knowledge of ballistics on the assessment of almost every penetrating
trauma that I manage. Almost all of my treatment plans are *modified* by
what I see and what I estimate the energy exchange to be and what the
patient or the officer tells me is the most likely weapon

Maybe I assess trauma patients differently than do you and perhaps I
make my management judgments differently. Ballistics is very important
to my judgements 

Norman
Professor, Tulane  Univ, Surgery
Trauma Director, Spirit of Charity Trauma Center, ILH
New Orleans, 504-988-5111 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
Sent: Tuesday, June 12, 2012 11:28 AM
To: 'Trauma-List [TRAUMA.ORG]'
Subject: RE: Ballistics

Never met a ballistics fan who could mount any useful rebuttal to Martin
Fackler (his infinitely readable opus, celebrating its 25th anniversary
of publication, is still strong stuff.):

http://www.rkba.org/research/fackler/wrong.html

In my experience, nobody has EVER usefully modified a treatment strategy
based on any clarification of mass or energy.  In the battle of physics
vs. biology, bet on physics, plus the spread, every time, and don't let
the details get in the way.  Guns are designed to kill things, even
.22's.  Hell, we've seen critical (and indeed, fatal) wounds from PELLET
guns.

Besides, when was the last time you really KNEW "what type of bullet you
were treating?"  Even when it's a law-enforcement intervention, the
caliber usually changes once or twice before discharge.  Admit it.

I agree that it's interesting.  And the slo-mo videos on YouTube (the
apples and gel blocks) are kind of awesome.  But clinically?  Honestly?
Meh.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Stuke, Lance E.
Sent: Tuesday, June 12, 2012 11:41 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Ballistics

Good question and I believe the answer is definitely yes, especially for
surgeons in places with high volumes of penetrating trauma. In some
situations understanding, or more importantly - respecting, the
significant energy exchange which can happen in a GSW can guide care or
certainly raise the index of suspicion for other injuries such as
surrounding blast effect. This is particularly true with high energy
weapons such as an AK-47. At a center such as ours here in New Orleans,
where 60% of our trauma activations are for penetrating trauma,
understanding ballistics is critical to the comprehensive care of the
trauma patient. Besides, it's pretty cool stuff!

Stuke

Lance Stuke, MD, MPH
Associate Program Director
LSU Department of Surgery
Spirit of Charity Trauma Center
New Orleans, LA

On Jun 12, 2012, at 10:00 AM, "Bjorn, Pret" <pbjorn at emh.org> wrote:

> Been awhile: has somebody discovered some new way in which any of this
is important to healthcare providers, at any level?
> 
> In previous debates on the List, I think the majority opinion has been
that ballistics is a science far more important to the killer than the
healer.
> 
> Skunk poked.
> 
> Pret Bjorn, RN
> Bangor, ME USA
> 
> 
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
> Sent: Tuesday, June 12, 2012 10:41 AM
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: Ballistics
> 
> Christos
> 
> Energy exchange is affected by 1)the number of tissue particles hit by
the penetrating object, and by 2)the momentum of the projectile. The
more energy exchange therefore the more damage to the patient.
> 
> NUMBER OR PARTICLES HIT during  transit of the projectile *The more
dense the tissue, the more particles that will be hit and the more
energy exchange that will result.  The  body can be divided into 3
tissue densities for convenience of discussion. 
> -Air density such as the lung;
> -water density such as muscle and soft tissue; and  hard density such
as the bone. 
> 
> *the larger the frontal projection of the penetrating object the more 
> tissue particles hit. Three things happen to the projectile that can 
> increase the frontal projection
> - tumble: if the bullet rotates to 90 degrees then it has a much
greater frontal surface than if it simply goes though in a straight
line. 
> -deformation: if the projectile spreads out (mushrooming) such as 
> hollow point bullets or other mechanism used to produce spread at the 
> time of traversing tissue
> - Fragmentation: Fragmentation can occur as the projectile1) leaves 
> the muzzle (shotgun) or 2) when inside the tissue (exploding rounds)
> 
> [By a *hard nose round*, I mean a round that is solid and does not 
> fragment or mushroom. This is usually a round(bullet) that has 
> slightly oblong nose that is covered my solid metal. Many target 
> rounds are so shaped]
>    
> 2
> MOMENTUM is related to Kinematic energy. KE = mass/2 x V (Velocity
> squared)
> For discussion momentum can be divided into: 
> *low energy - knives and cutting instruments *medium energy - hand 
> guns with ~1000 f/s muzzle velocity *high energy - long guns with
> ~2000 f/s muzzle velocity
> 
> This is very brief description. More detail is in the "Kinematics"
> chapter of the PHTLS text book
> 
> 
> 
> Norman
> Professor, Tulane  Univ, Surgery
> Trauma Director, Spirit of Charity Trauma Center, ILH New Orleans,
> 504-988-5111
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Christos Giannou
> Sent: Tuesday, June 12, 2012 2:05 AM
> To: trauma-list at trauma.org
> Subject: Ballistics
> 
> Dear Norman,
> 
> What do you call a "hard nose round"?
> 
> There are many (hundreds?) of handgun bullets that have been developed
by private industry, most are concerned with what is euphemistically
called "stopping power".
> 
> As you well know, tissue damage after ballistic injury is the result
of effective transfer of kinetic energy. Velocity of the bullet at point
of impact, and whether it stays in the body or exits, is only one
factor.
> That is why "high-velocity bullet" means very little in terms of wound
ballistics.
> 
> A bullet that deforms or fragments transfers more kinetic energy than
one of similar mass and velocity that does not. That is the definition
of a "dum-dum" bullet, that the British army invented to better fight
the Afridi Afghans in 1897.
> 
> If you mean a bullet with a steel or tungsten core, I believe that
this only increases the penetrating power of the bullet (therefore can
be used against armour), but does not increase its kinetic energy.
> 
> Just wondering about Louisiana ballistic practice.
> 
> regards
> christos giannou
> 
> --
> christos giannou
> Monemvasia Lakonia
> 23070 Greece
> tel & fax: (++30) 27320-61772
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