I continue to watch the Las Vegas case unfold with fascination. There are so many pieces that just don't seem to fit, and so many rumors! You can really see the stress this case is causing the leadership of the Vegas PD.

Stories of the survivors are also more and more fascinating. This one about a victim that was shot in the head has especially caught the attention of the media.

Wounds from firearms can have incredibly varying effects. A solid hit to the skull should probably lead to death in all cases, but for some reason, some survive and others don't. Firearm hits to the body can be just as unpredictable.

So in this Training Newsletter, let's talk a little bit about how firearm injuries affect victims. This is just a tiny glimpse of what will be discussed in the Terror Trauma Medical Training Seminar.

The Projectile

A firearm injury is, in essence, a puncture wound. As the bullet hits, it transfers the kinetic energy of the bullet's speed into the tissues of the body.

Different types of projectiles cause different types of damage. Shotgun shot typically shreds tissue, where handgun rounds cut out a hole like a paper punch, and rifle rounds pass through the body with tremendous speed, open huge wound channels, and with the change in pressure, can even suck the internal organs out of the target!

The Injury

The injuries inflicted by projectiles can vary, from simply tearing muscle to ripping blood vessels and organs or breaking bones. The survival of the target will largely depend on two factors: Where did the damage occur? And how quickly was direct treatment applied?

People often incorrectly assume that you get shot and you bleed to death because you run out of blood. But death from firearms generally comes from asphyxiation, when the low blood flow means you don't get enough oxygen to your brain. 

To outline this in more detail, here's how direct asphyxiation might work:

1. Target is shot in a major muscle, hitting an artery
2. Initially there is no blood loss, as tissues will contract sharply (This can last seconds to minutes depending upon the blood vessel and the condition of the damage.)
3. Suddenly there is major blood flow through wound
   -The body will also try to swell up at the area of the wound to help stop the bleeding, but this swelling will not last long
4. As blood is lost, two issues arise: 
   - Loss of pressure in circulatory system, making heart work harder for less effect
   - Loss of blood to the brain, causing cognition and sympathetic systems begin to
   shut down
5. Within minutes (or less), loss of circulation to the brain will make victim pass out
   - Passed out victims cannot help themselves, and become dead weight in trying to move them or help them
6. As the heart continues to try and pump and there's less and less blood, the body will try to pull moisture from surrounding tissues to add pressure to the circulatory system, and person will massively dehydrate
7. Finally, as the blood pressure reaches a critical low stage, the heart will go into
   cardiac arrest
8. Death from asphyxiation (no oxygen to the brain) occurs within minutes

The Treatment

Since the beginning of the Global War on Terrorism, the US Military has learned that quick and effective bleeding control is essential to the survival of soldiers suffering from gunshot wounds. Tourniquets became a standard issue item of troops deployed in combat zones. Their effectiveness at saving lives has become unquestionably proven.

In the 2009 Annals of Surgery, JF Kragh cited some 232 cases where soldiers lived from battlefield injuries because of the application of a tourniquet. Whereas in the past that soldier would have most likely died before life-saving surgery could have been applied, the tourniquet saved their life.

From the abstract of the study:

"Tourniquet use when shock was absent was strongly associated with survival (90% vs. 10%)....The 5 casualties indicated for tourniquets but had none used had a survival rate of 0% versus 87% for those casualties with tourniquets used." (Kragh 2009)

90% vs. 10%, that is a huge difference.

What Can You Do?

Considering the last three paragraphs, if you want a better chance of surviving a violent encounter - or helping another victim survive - I recommend you get a quality tourniquet and learn how to use it. In a traumatic event where there is massive blood loss, your ability to get that tourniquet on correctly and rapidly (in less than a minute) could mean the difference between survival and death.

If this small sliver of information has you interested, register for the Terror Trauma Medical Class on October 28th. Space is limited, and we won't be running another session until sometime in 2018. Imagine testing your ability to apply a tourniquet to yourself or another under the stress of full scenario - and that's just one part of this unique experience. Don't miss out, register today!