Date: Mon, 17 Apr 1995 21:57:51 -0700 (PDT) From: "Edgar A. Suter" To: firearms-alert@shell.portal.com Subject: Journal of Trauma/Managment of "assault weapon" wounds The current issue of the Journal of Trauma includes an article discussing the complications of treatment of a single patient shot with a 7.62x39mm. The article epitomizes the abysmal understanding of wound ballistics and even wound treatment by "specialists" who should be knowledgeable about these matters. ************************************************************************* * Edgar A. Suter, MD Martin L. Fackler MD * * Doctors for Integrity in Research & Public Policy * ************************************************************************* April 11, 1995 John H. Davis, MD Editor, Journal of Trauma Letters to the Editor Department of Surgery D-319 Given Bldg. University of Vermont College of Medicine Burlington, VT 05405 Re: Trask AL, Richards FD, Schwartzbach CC, and Kurtzke RN. "Massive Orthopedic, Vascular, and Soft Tissue Wounds from Military Type Assault Weapons: A Case Report." J. Trauma. 1995; 38(3):428-431. Dear Dr. Davis, In their report of a single case of wounding by a projectile from the 7.62x39mm cartridge, the cartridge of the AK-47 rifle, Trask et al. made discredited and dangerous recommendations for wound management. The authors' opined that "The management of wounds caused by these weapons is considerably different from the wounds caused by low or medium velocity missiles... 1. Even though surface wounds appear minor, the degree of internal tissue necrosis is usually massive. 2. Management of the bone and vascular tissue differs from that of low velocity projectile wounds, requiring more extensive debridement... 3. In contrast to low velocity projectile wounds, a high-velocity wound to the torso is likely to be fatalI." Massive evidence shows all these points to be in error. >From the current edition of Emergency War Surgery - NATO Handbook we learn that "The widespread belief that every wound caused by 'high-velocity' projectiles must be treated with 'radical debridement' is incorrect and results from failure to recognize the role of other variables, such as bullet mass and construction, in the projectile-tissue interaction."[1] Specifically regarding performance of the AK-47 rifle bullet, the NATO Handbook notes that "The long path through tissue before marked yaw begins (about 25cm) explains the clinical significance that many wounds from this weapon resemble much lower velocity handguns."[1] Additionally, depending upon the bullet type, bullets fired from the AK-47 attain velocity of 2,200 to 2,350 ft/sec,[1,2] not the 2,800 ft/sec claimed by the authors. Reports from Vietnam confirmed the often minimal wounds caused by AK-47 bullets: "Uncomplicated perforating soft-tissue wounds were the most common bullet wounds of the extremities; They showed small entry and exit wounds and a clean soft tissue track with little or no devitalization of tissue. They usually healed if left alone."[3] In the proceedings of the Tri-Service War Surgery Conferences, in which those who were treating the war surgery casualties met to report and discuss their findings, all three of Trask et al.'s conclusions were shown to be in error.[4] More recent reports from Afghanistan concur: "Wounds with the greatest tendency to spontaneous healing were the through and through gunshot wounds. Of note were the number of patients in this group with gunshot wounds, the bullet passing through the body, who did not have the massive tissue destruction that one expects, even when bone had been fragmented."[5] The most convincing and undeniable available evidence exposing the exaggerations and misstatements by Trask et al. comes from examining the mortality rates from incidents in which deranged persons shot multiple victims (1984-1994). "Assault rifles" were used in four incidents: 89 persons were shot; 17 died, for a mortality rate of 19%. Shotguns were used in five incidents: 71 persons were shot; 48 died, for a mortality rate of 68%. The much lower velocity projectiles fired by the shotguns produced a mortality rate more than three and one-half times that produced by the "high -velocity" assault rifle bullets.[6] Trask et al.'s assessment of public policy is as mistaken as their review of wound care. Over two dozen studies on the criminal use of military-style weapons undercut the authors' "800% increase" claim. We direct readers to a review of those studies (including a review of lethality, firepower, and constitutional issues).[7] The authors, like many before them, inappropriately relied upon gun trace data. Gun traces are not representative of the criminal prevalence of gun use any more than the index of a research journal reflects the prevalence of disease. Journal indices and gun traces reflect a level of interest in the topic or the gun. For example, in 1989 in Los Angeles, a hotbed of drug gangs and violent crime, "assault weapons" represented approximately 3% of guns seized, but 19% of gun traces.[8] The Congressional Research Service and the Bureau of Alcohol, Tobacco and Firearms (BATF) have acknowledged that the gun trace system is inappropriate for statistical purposes: The [B]ATF tracing system is an operational system designed to help law enforcement agencies identify the ownership path of individual firearms. It was not designed to collect statistics... Two significant limitations should be considered when tracing data are used for statistical purposes: * First, the firearms selected for tracing do not constitute a random sample and cannot be considered representative of the larger universe of all firearms used by criminals, or of any subset of that universe. As a result, data from the tracing system may not be appropriate for drawing inferences such as which makes or models of firearms are used for illicit purposes; * Second, standardized procedures do not exist to ensure that officers use consistent definitions or terms in the reports of circumstances that lead to each trace request. Some trace requests do not even identify the circumstances that resulted in the request.[9] No crime need be involved to initiate a gun trace. For example, efforts to return stolen guns to rightful owners and guns found incidental to other investigations are included amongst gun traces. The statistically unreliable nature of gun traces should be clear. Additionally, in the period 1986-1992 cited by the authors, increased media attention and changing definitions of "assault weapon" further complicate interpretation of gun trace data. In the worst areas of gang and drug crime, the studies show that military-style, semiautomatic guns account for generally 0% to 3% of crime guns and, nationally, represent less than 1% of crime guns, far less than their proportion amongst American guns. More pointedly, ten times more Americans die annually from attacks using hands and feet than die from military-style rifles.[6] We hope that this information helps put the authors' unusual case report in perspective. Sincerely, Edgar A. Suter, MD National Chair, Doctors for Integrity in Research & Public Policy Member, International Wound Ballistics Association Col. Martin L. Fackler MD, US Army (retired) President, International Wound Ballistics Association Former Director, US Army Wound Ballistics Laboratory Member, Doctors for Integrity in Research & Public Policy [1] Bowen TE. Emergency War Surgery - NATO Handbook. 2nd. US Revision. Washington DC: Government Printing Office. 1988. pp 24,33. [2] Fackler ML, Malinowski JA, Hoxie SW, and Jason A. "Wounding Effects of the AK-47 Rifle Used by Patrick Purdy in the Stockton, California, Schoolyard Shooting of January 17, 1989." Am J Forensic Medicine and Path. 1990; 11(3): 185-90. [3] King KF. "Orthopedic Aspects of War Wounds in South Vietnam." J. Bone and Joint Surg. 1969; 51B:112-117. [4] Commander in Chief Pacific (CINCPAC). War Surgery. in Proceedings of the Commander in Chief Pacific Fifth Conference on War Surgery, 29 March - 2 April 1971, Tokyo, Japan. 1971: 33. (available from CINCPAC, Attn: Surgeon, FPO San Francisco CA 96610). [5] Coupland RM and Howell PR. An Experience of War Surgery and Wounds Presenting After 3 Days on the Border of Afghanistan." Injury. 1988; 19:259-262. [6] Suter EA. Testimony before the Pennsylvania State Senate Select Committee on the Use of Full- and Semi-Automatic Firearms in Crime. Pittsburg, PA. August 16, 1994. [7] Suter EA. "'Assault Weapons' Revisited - An Analysis of the AMA Report." Journal of the Medical Association of Georgia. May1994; 83: 281-89. [8] Kleck G. Point Blank: Guns and Violence in America. New York: Aldine de Gruyter. 1991. [9] Bea K. "CRS Report for Congress - 'Assault Weapons': Military-Style Semiautomatic Firearms Facts and Issues." Washington DC: Congressional Research Service, The Library of Congress; May 13, 1992 (Technical Revisions, June 4, 1992). Appendix B. pp. 65-76.