Gunshot wounds: A review of ballistics, bullets, weapons, and myths.
Venue: The journal of trauma and acute care surgery

I the United States, someone experiences a gunshot wound every 4 minutes 44 seconds, and a person dies as a result each 16 minutes. Annually, this means that approximately 111,000 Americans are shot and 33,800 die as a result of these injuries, which equates to 93 deaths caused by firearms every day. In contrast, the war in Iraq and Afghanistan has resulted in less than 200 deaths per year from gunshot wounds during the height of the conflict (Table 1) Gunshot wound injuries are a preventable epidemic in the United States. This silent epidemic is largely deaf to the American public because we are so accustomed to these injuries that they rarely make the news. Gun violence leading to homicide may get some attention, but an even greater toll is placed on the survivors who must live with the loss of loved ones or are burdened by the costs associated with the temporary or permanent disability caused by these wounds. Gunshot wounds not only hurt the body and mind of the victim but also burden the family of the victim and the society, both mentally and from a financial perspective. It is not unusual to have survivors accumulate hospital costs of more than $1 million per year, and some have total hospital and recovery costs of more than $10 million. Since most do not have the money to afford these enormous costs, the burden then falls on the society and ultimately the taxpayers. Additional societal costs that are harder to quantify are the costs associated with the permanent disabling and unemployment seen not infrequently in the victims of gunshot wounds. Whether these injuries are intentional or unintentional, the patients are in our health care system. These costs have been estimated to range from $100 to $174 billion annually. Furthermore, there has been an alarming escalation in the numbers of mass shootings throughout the United States (which leads theworld in mass shootings) with 265 individuals killed and 269 wounded in the past 16 years (Table 2) Recent terrorist related mass shootings have reignited vigorous and volatile public debate over access to weapons designed for inflicting mass casualties. The predictable reflex response to these mass shootings has been in several forms, of which one is in the call for reviving and funding research on gun violence and inadequate recognition and treatment of mental illness that warrants federal and state tax support. As health care providers for trauma care, we have witnessed the ravages of gunrelated violence and, thus, should become proactive in the ongoing national debate as it is our duty. The numbers of gunshot wounds are increasing in the United States, although the gun related homicide rates remain relatively stable. Guns are ubiquitous in the United States, and it is known that where there are guns, there will be gunshot wounds. In other countries, it has been shown that gun law reformswere associated with a decrease in the numbers of mass shootings and firearm deaths. Canada, with their strict handgun control, has one third fewer gunshot wounds than the United States. Australia and the United Kingdom have less than half of the deaths from gunshot wounds seen in Canada. The United States, which constitutes approximately 5% of the world's population, owns between 35% and 50% of its guns. Legislation regarding firearms differs within the United States, but what is certain is that gunshot wounds are a daily part of our society and will remain a part of it for a very long time. While any topic relating to firearms remains volatile in our country, the fact is that where there are guns, people will be shot. The real tragedy is that with as many gunshot wounds occurring daily in the United States, even collection of the basic data, scientific inquiry, policy formation and analysis, and rigorous evaluation are limited. Firearm research is difficult because of politically motivated constraints. A blue ribbon commission appointed by the National Academy of Sciences concluded that very little is currently known about effective ways to reduce gun violence and injury within the United States because it is rarely studied. While mortality rates from every major cause of death have declined dramatically during the past half century, the homicide and gunshot wound rates in America are the same as those in 1950. Without challenging the Second Amendment of the Constitution, we can still work toward some semblance of regulation and control. The costs of inaction are more gunshot wounds to both intended and unintended victims. The cost of total freedom to bear arms is measured not only in terms of the financial burden to the society but also in terms of lives and lives ruined. The cost to life and the society is too enormous to ignore. The costs are generally to the taxpayers because it is costly to the court system, police system, and health care system. By promoting discussions on this topic and synergy of collaboration, we can at least attempt to make effectual progress. Despite gunshot wounds being an epidemic, many health care providers' understanding of ballistics, bullets, and guns REVIEW ARTICLE