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A Civilian Perspective on Ballistic Trauma and Gunshot Injuries

May 7, 2018

Background: Gun violence is on the rise in some European countries, however, most of the literature on gunshot injuries pertains to military weaponry and is difficult to apply to civilians, due to dissimilarities in wound contamination and wounding potential of firearms and ammunition. Gunshot injuries in civilians have more focal injury patterns and should be considered distinct entities.Methods: A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed.Results: Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of nonspace consuming hematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however, for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity. With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference.Conclusion: The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively.

The Shootings in Oslo and Utøya Island July 22, 2011: Lessons for the International EMS Community

January 26, 2012

SJTREM has published an account by Sollid and colleagues of the pre-hospital medical response to the major incidents, which occurred in Oslo and Utøya island on July 22, 2011. Although very similar incidents have occurred in Europe and elsewhere, this terrible day saw the greatest loss of life recorded in this type of incident in recent times. Internationally EMS providers looked on with the certain knowledge that this type of incident is sadly one that we all have to prepare for. It is unrelated to national foreign policy, religious extremism or the existence of known terrorist activity. In short this type of incident is unpredictable and has the potential to happen in any community at any time.