Wound ballistics: exploring the reality of penetrating projectile injury

Within the civilian pre-hospital environment, penetrating projectile injury may be caused by an extremely broad range of firearms and explosive propellants. Despite a great variance in the potential for injury however, a basic knowledge of how penetrating projectiles behave and interact with living tissues is likely to assist emergency healthcare professionals with making informed decisions, and establishing priorities for treatment and transportation.
Important considerations include the transference of kinetic energy from a projectile to the tissues; which is itself influenced by factors such as the area of presentation, deformation, fragmentation, mass and velocity. Projectile retardation (with correlating levels of energy transference) will also be influenced by the density of the affected tissues, and the permanent disruption caused by the stretching and shearing forces of temporary cavitation will be largely dictated by the elastic tolerance of the tissues and their capacity to expand. The location of entrance and exit wounds (if present) may offer some clue to the nature of the projectile/tissue interaction, but caution needs to be taken when interpreting such signs.
Focussing upon the civilian pre-hospital environment, this article will thus seek to highlight some of the key features of wound ballistics. It will also explore some of the misconceptions that may exist surrounding the emphasis placed upon projectile velocity, and the dangers of drawing potentially erroneous clinical conclusions based solely upon the nature of the firearm involved, or visible signs of injury.