Effects of a fragmenting handgun bullet: Considerations for trauma care providers. Issue 5 (May 2019)

• Record Type: Journal Article
• Authors: Hakki, Lynn; Smith, Alison; Babin, Jonathan; Hunt, John; Duchesne, Juan; Greiffenstein, Patrick
• Is Part Of: Injury. Volume 50:Issue 5(2019)
• Page Start: 1143
• Page End: 1146
• Publication Date: 2019-05
• Subjects: Fragmenting bullets -- Deforming bullets -- Radically invasive projectile; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.01.033
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: A newly-designed fragmenting bullet, Radically Invasive Projectile (RIP) bullet causes devestating injuries to victims. Fragmenting bullets are banned from international warfare, but their use by civilians/ law enforcement is legal in the US. This case report is one of the first in the literature to describe the injuries caused by this fragmenting bullet. Abstract: Introduction: Expanding or fragmenting bullets have been known to cause extensive injuries since they became available in the late 19th century. Although these bullets are now banned from international warfare, their use by civilians and law enforcement is still legal in the US. In this case report, we describe the complex injuries and subsequent complicated hospital course of a civilian trauma patient who was shot with a newly-designed fragmenting bullet, known as a Radically Invasive Projectile (RIP) bullet. Case report: A 22-year-old man presented as a trauma activation after a gunshot wound to his left chest. He subsequently underwent chest tube placement, an emergent thoracotomy, and an exploratory laparotomy. In the operating room, the patient had multiple ballistic fragments lodged within his left thoracic cavity and left upper abdomen. These fragments caused multiple penetrating injuries resulting in an 18 day hospital stay with numerous complications. He underwent 4 emergency operations, 2 separate admissions to the intensive care unit (ICU), and the placement of 4 chest tubes. He was ultimately discharged home in stable condition. Conclusion: Expanding or fragmenting bullets are designed to inflict significantly more tissue damage than non-deformable bullets. This type of ammunition is prohibited in international warfare on the basis that it does not serve a military advantage but can result in excessive wounding and unnecessary suffering. There is no such ban for handgun ammunition for domestic use in most countries including the United States. Ammunition manufacturers have recently released a fragmenting bullet that is designed to inflict a maximum amount of tissue damage. In this case report, we described the devestating effects of this bullet on a civilian trauma patient.