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Objectives: To improve firearm injury encounter classification (new vs follow-up) using machine learning (ML) and compare our ML model to other common approaches., Materials and Methods: This retrospective study used data from the St Louis region-wide hospital-based violence intervention program data repository (2010-2020). We randomly selected 500 patients with a firearm injury diagnosis for inclusion, with 808 total firearm injury encounters split (70/30) for training and testing. We trained a least absolute shrinkage and selection operator (LASSO) regression model with the following predictors: admission type, time between firearm injury visits, number of prior firearm injury emergency department (ED) visits, encounter type (ED or other), and diagnostic codes. Our gold standard for new firearm injury encounter classification was manual chart review. We then used our test data to compare the performance of our ML model to other commonly used approaches (proxy measures of ED visits and time between firearm injury encounters, and diagnostic code encounter type designation [initial vs subsequent or sequela]). Performance metrics included area under the curve (AUC), sensitivity, and specificity with 95% confidence intervals (CIs)., Results: The ML model had excellent discrimination (0.92, 0.88-0.96) with high sensitivity (0.95, 0.90-0.98) and specificity (0.89, 0.81-0.95). AUC was significantly higher than time-based outcomes, sensitivity was slightly (but not significantly) lower than other approaches, and specificity was higher than all other methods., Discussion: ML successfully delineated new firearm injury encounters, outperforming other approaches in ruling out encounters for follow-up., Conclusion: ML can be used to identify new firearm injury encounters and may be particularly useful in studies assessing re-injuries., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: As a part of its firearm injury prevention action plan, the American College of Surgeons (ACS) surveyed the entire US ACS membership regarding individual members' knowledge, experience, attitudes, degree of support for ACS Committee on Trauma (COT) firearm programs, and degree of support for a range of firearm injury prevention policies. This survey included questions regarding members' prevalence of firearm ownership, type of firearm(s) owned, type of firearm(s) in the home, personal reasons for firearm ownership, and methods of firearm/ammunition storage., Study Design: An email invitation to participate in an anonymous, 23-item survey on firearms was sent to all US ACS members (n = 54,761) by a contracted survey research firm. Cross tabulation of questionnaire items by demographic characteristics and chi-square analyses were performed with statistical significance p < 0.05., Results: The overall response rate was 20.4% (11,147/54,761). Forty-two percent of respondents keep firearms in their home (82% long guns, 82% handguns; 32% high-capacity magazine fed, semi-automatic rifles); 75% keep guns for self-defense/protection, 73% for target shooting; 39% store firearms unlocked, and 32% store guns unlocked and loaded. Results vary by practice/training location, practice type, military experience, sex, age, presence of children in the home, level of training, and race/ethnicity., Conclusions: A significant percentage of ACS members keep firearms in their home, and nearly one-third store firearms in an unlocked and loaded fashion. Safe storage is a basic tenet of responsible firearm ownership. These data present opportunities for engaging surgeons in efforts to improve safe firearm storage., (Copyright © 2021 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

The majority of homicides in the world are caused by firearms and a good understanding of gunshot wounds is important for the forensic pathologist. We have analyzed all 315 homicides by gunshots in Denmark during 1992-2016 with focus on information relevant to forensic pathologists. Of the 1417 homicides in Denmark in 1992-2016, 315 (22.2%) had gunshot trauma as the primary homicide method. During 1992-2016, there has been a significant decrease in the number of gunshot homicides overall, of homicides committed with hunting weapons, and of domestic gunshot homicides. Most victims (70.5%) and offenders (93.7% of homicides with known offenders) were males. Male victims were significantly younger than female victims. Most victims were killed with handguns (43.8%) or shotguns (41.0%). Compared to all other weapons, the victims killed with shotguns had fewer entry wounds, a higher New Injury Severity Score (NISS), and a higher proportion of contact/close-range entry wounds. The head (58.1%) and thorax (46.7%) were often injured, with injuries to the head being more common in contact/close-range entry wounds. The results show that gunshot injuries in homicides are different from suicides and accidents and clearly are affected by the homicide type, the sex of the victim, and the weapon used and that these entities are intertwined. Our findings provide an evidence-based foundation for use in death investigations and for policy development in the area of interpersonal violence.

From the first half of the twentieth century to the present day, injuries and fatalities from captive-bolt livestock stunners are a major topic in forensic medicine. The vast majority of cases account for suicides with the frontal, temporal, parietal, and occipital regions being the most common sites of entrance (in descending order of frequency). Due to the limited length of the bolt, the corresponding wound channel within the braincase is only several centimeters long. It has been a controversial subject for a long time, whether the skin-bone complex punched out by the conically grooved end of the steel rod may act as a "secondary projectile" being propelled beyond the actual path of the bolt. To answer this question, experimental shots from various types of captive bolt-guns were fired to simulants. Video-documentation employing a high-speed motion camera showed that the punched-out pieces of skin and bone did not move further than the bolt. Thus, a secondary extension of the total wound channel could not be observed. However, the suction effect caused by the bolt's rearward movement may induce a slight retrograde displacement of the skin-bone complex.

Purpose: Although household firearm ownership has been consistently associated with increased suicide rates in the U.S., scant data speak to the type of gun used in U.S. suicides. We address this research gap using data from the National Violent Death Reporting System Restricted Access Data Set, 2005-2015, by describing the types of guns used in firearm suicides over time, by urban versus rural residence, for the population as a whole, and separately among adolescents, and by sex, race, and age., Methods: The types of firearm used by 44,540 firearm suicide decedents in 13 states from 2005 to 2015 are based on individual-level data from the National Violent Death Reporting System and urban-rural classification schemes from the National Center for Health Statistics. Rates are calculated using population data from the National Center for Health Statistics' CDC WONDER online database., Results: Between 2005 and 2015, suicide rates by handguns, but not long guns, increased markedly in both urban and rural counties. Among adolescents, handgun suicide rates doubled over the study period in both rural and urban areas; long gun suicide rates increased modestly. Although handguns were used in nearly three fourths of firearm suicides for the population as a whole, long gun use was relatively higher in rural counties and among adolescents. In rural counties, long guns were used in 51% of adolescent male suicides., Conclusions: Suicide prevention efforts that advise gun-owning families to reduce access to household firearms should focus not only on handguns but also on long guns, especially in rural areas and among households with adolescents., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Firearm related injuries continue to increase throughout the world and they become the first or second cause of mortality in worldwide. The present study aimed to determine the factors that affect mortality in firearm injuries., Methods: The patients which were admitted to emergency service between January 2011 and December 2015 due to firearm injuries, were reviewed from hospital records. The patients were evaluated in terms of their age, sex, event time, admission time, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), the reason of event, type of weapon, the region of the body that injured, department in which they were hospitalized, hospitalization duration and the relation between these parameters and mortality., Results: A total of 174 patients (86.8% male, 13.2% female) were identified. The mean age of patients was 35.2 years and 30 patients (17.2%) died. Among the cases, 137 were attempted homicide (78.7%), 23 were accidents and the remaining 14 were suicides. The suicidal cases had significantly higher mortality rate than other causes (P=0.003). The most frequently used weapon was pistols (73.6%) and the events took place between 18.00 and 24.00 (36.2%) hours mainly. The injuries were mostly on extremities, however many of deaths were seen after head- neck injuries and the mortality rate of head and neck injuries was significantly higher than other regions (P<0.001). The mean of hospitalization duration was 9.1 days and it was 10.2 ± 11.7 days for survivors, 4 ± 7.3 days for died subjects. The hospitalization duration of died patients was significantly shorter than survivors (P=0.042). The GCS of died patients (4.4 ± 1.7) was significantly lower than those of survivors (13.3 ± 2.8) (P<0.001). The ISS score of died patients (49.7 ± 24.1) was significantly higher than those of survivors (13.6 ± 10.6) (P<0.001)., Conclusion: It was determined that GCS, ISS, length of hospitalization, injuries due to suicide attempt, the department of hospitalization, injuries to head-neck regions affected mortality significantly., (© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Thoracic and abdominal injuries caused air weapons are rarer compared with gunshot wounds. Nevertheless, pneumatic weapons are able to inflict potentially fatal lesions despite small mass and dimension of projectile. Three clinical cases of patients with various internal injuries are presented in the article. Differentiated diagnostic and surgical approach is suggested.

Information on homicide firearms can be used to help state and local communities understand the problems of violence and decrease injuries and deaths. However, it is difficult to collect these data. To our knowledge, in the public health arena, the National Violent Death Reporting System (NVDRS) is the only system that collects detailed firearm information. The Rhode Island State Crime Laboratory (RISCL) can provide detailed information about the firearms and cartridge cases\bullets involved in firearm deaths. With help from the RISCL, the firearm information related to homicides in Rhode Island has improved dramatically. In 2015, information on caliber/gauge increased by 80%, the firearm type by 50%, the make by 50%, and the model by 20%. By documenting the process of using information from the RISCL, it is hoped that this process can be used as a model by other states when reporting on violent deaths.

Context: Short-range shotgun wounds of the craniomaxillofacial region are life-threatening and are as devastating as military rifle wounds., Aims: This study aimed to evaluate the pattern of presentation of craniomaxillofacial shotgun injuries, types of shotgun injuries, and the outcome of treatments in our environment., Setting and Design: This is a prospective observational study. Materials and Methods: This is a prospective observational study conducted from February 2006 to March 2012. All patients with shotgun wounds to the craniomaxillofacial region were included in the study by convenient sampling method. Glezer's shotgun classification scheme was used to categorize the patients into short-, intermediate-, and long-range shotgun wounds. Data collected were analyzed using SPSS version 16., Statistical Analysis Used: Descriptive statistics were used to calculate the data. Mean and standard deviation (SD) were calculated for all quantitative variables such as age. Frequency and percentages were presented for qualitative variables., Results: A total number of 28 patients were seen. Ages ranged from 19 to 64 years with a mean (±SD) of 32.7 (±11.4) years. The two most commonly used shotguns were locally made pistol (25, 42.9%) and the cut-size gun (10, 35.7%) and the least commonly used was Dane gun (1, 3.6%). Close-range injury to the face was 17 (60.7%) while that of intermediate- and long-range injuries were 6 (21.1%) and 5 (17.9%), respectively., Conclusion: Wounds sustained from close-range shotguns to the face were the most common in this environment. The outcome of treatment was satisfactory when treated with conservative debridement and early reconstruction., Competing Interests: There are no conflicts of interest.

The available literature reports only rare cases of injuries inflicted by the speargun shots. The last publication of this sort of which we are aware dates back to 1960. This article describes an example from the expert practice concerning the accident involving a wound caused by the speargun shot to a member of an amateur fishing party. The authors examined the weapon of injury (a 'Zelinka' speargun), the harpoon, its head, and fragments of the skin with the traces of the punctured wound obtained from the corpse of the victim. The investigative experiment included the underwater shooting from different distances with the use of a pork carcass as the target. The results of the comparative studies gave evidence of the possibility of formation of the wounds caused by exactly that harpoon, its head and cord which served as the weapons of the wound experienced by the victim. Moreover, the distance and the direction of the shot as well as a number of important concomitant circumstances of the accident were determined.

Although bean bag guns are considered a "less-lethal" form of law enforcement, these blunt projectiles have risk. The purpose of this study was to perform a literature review of morbidity and mortality associated with less-lethal munitions and present a case report of a bean bag injury leading to a traumatic globe evisceration and skull base fracture. Patients presenting with bean bag gun associated injuries warrant a high clinical suspicion for injury to deeper structures.

Objectives Firearms have an enduring and visible presence within American culture. However, the public health impact of nonpowder firearms and other "toy" guns has not been fully studied. These guns-including BB guns (ie, ball bearing), paintball guns, and pellet guns-are typically marketed to a younger audience. The objective of this study is to analyze head and neck injuries related to nonpowder firearms. Study Design Cross-sectional analysis of a national database. Setting Academic medical center. Subjects and Methods The National Electronic Injury Surveillance System was queried for head and neck injuries involving nonpowder guns, including air, BB, and pellet guns, and associated ammunition. Analysis of age, sex, incidence, injury location, and diagnosis was performed. Results From 2005 to 2014, there were 1695 cases recorded, or 55,060 estimated emergency room visits, due to injuries related to nonpowder guns and fired ammunition. The majority of patients were male (80.9%). These injuries were most common in children 6 to 12 years of age (37.9%), followed by those 13 to 18 years old (27.1%) and adults (≥19 years old; 17.8%), while preschool children (0-5 years) represented 17.2%. The most common injury diagnosis was penetrating foreign body (34.9%), followed by lacerations (24.3%) and contusions/abrasions (13.7%). Conclusion Nonpowder and other nonlethal firearm-related injuries to the head and neck region are a frequent source of emergency room visits nationally. Safety measures and public education on a mainstream level are required.

This article was designed to report the results of forensic medical, criminalistics, and comprehensive expertise of the subject who suffered from a non-perforating shotgun wound affecting the soft tissues and blood vessels in the femoral region. It was shown that only the scrutinous comprehensive full-scale expert examination of the injured site in the framework of forensic medical expertise makes it possible to exclude the probability of the expert error and formulate the reliable and substantiated conclusion as regards the fact and the conditions of the shotgun injury by a concrete type of the cartridge (e.g. having a caliber equal to 410/76 Stopper-2) with two spherical rubber bullets fired from a known weapon (Saiga-410S hunting carbine).

The specific features of soot deposition after a shot fired from the Kalashnikov AK-74 assault rifle are determined by the influence of the multiple factors, with the effect of the muzzle brake (MB) designed to enhance fire density and decrease the fire recoil energy being prevalent over other factors. The special windows, slots and holes in the muzzle brake mechanism are responsible for the appearance of the specific topographic features of soot deposition formed by the combustion gases passing through the assembly. Apart from the characteristic butterfly-shaped soot deposition patterns that appear due to the presence of two windows in the muzzle brake assembly, the additional zones of soot deposition can sometimes be seen on the objects and targets due to the escape of the combustion gases through the MB compensator openings. This phenomenon enables a forensic medical expert to determine orientation and position of the AK-74 rifle with respect to the shooting target. This article reports the results of the forensic medical expertise of a serviceman who died from the injuries to the head inflicted by a burst of shots fired from the Kalashnikov AK-74 assault rifle. The direction of the wound canals and their topographic patterns (including the shape, size, number, and localization) of soot deposition around the inlet wounds made it possible to determine the position of the AK-12 rifle with respect to the affected regions of the head and thereby to prove that the death of the serviceman was a result of suicide.

In Germany, suicides by firearms are not very common in contrast to deaths by hanging and intoxications. The use of historical muzzle-loading firearms in the context of suicides is a rarity. Contact shots from muzzle loaders cause an unusual wound morphology with extensive soot soiling. We report the case of a 59-year-old man, who committed a planned complex suicide by shooting into his mouth with a replica percussion gun in combination with hanging. The gunshot injury showed strong explosive effects in the oral cavity with fractures of the facial bones and the skull associated with cerebral evisceration (so-called Krönlein shot). Due to the special constellation of the case with hanging immediately after the shot, external bleeding from the head injuries was only moderate. Therefore, the head injuries could be assessed and partially reconstructed already at the scene.

Increase of environmental awareness of the population has pressured research activities in the defence area to cover environment and toxicity issues, where have been considered appropriate manners to reduce the environmental and toxicological impacts of ammunition. One of the adopted approaches to achieve such goal involves the replacement of lead and other heavy metals by alternative materials. However, the consequences of using alternative materials in ammunitions manufacturing are uncertain for the other life-cycle phases and trade-offs can occur. The present paper describes the potential benefits from the replacement of lead in the primer and in the projectile of a 9mm calibre ammunition. For that purpose, it is assessed and compared the environmental and toxicological impacts associated with the life-cycle of four ammunitions: combination of two types of projectiles (steel jacket and lead core; copper and nylon composite) with two types of primers (lead primer; non-lead primer). In addition, some potential improvements for the environmental performance of small calibre ammunition are also presented. To assess the impacts two Life-Cycle Impact Assessment methods are applied: CML for six environmental categories and USEtox to three toxicity categories. Results showed that the conclusion drawn for environmental and toxicological impact categories are distinct. In fact, ammunition production phase presents higher impacts for the environmental categories, whilst the operation phase has a higher impact to the toxicity categories. The substitution of lead in the primer and in the projectile provides a suitable alternative from a toxicology perspective; however, the composite projectile still presents some environmental concerns. The conclusions drawn are important for the procurement (and design) of environmental responsible ammunitions, in order to avoid (or decrease) the impacts for their manufacture and the effects on human health (e.g. shooters) and ecosystems near shooting ranges or hunting areas., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Gunshot residues (GSR) result from the discharge of a firearm being a potential piece of evidence in criminal investigations. The macroscopic GSR particles are basically formed by burned and non-burned gunpowder. Motivated by the demand of trace analysis of these samples, in this paper, the use of surface-enhanced Raman scattering (SERS) was evaluated for the analysis of gunpowders and macroscopic GSR particles. Twenty-one different smokeless gunpowders were extracted with ethanol. SERS spectra were obtained from the diluted extracts using gold nanoaggregates and an excitation wavelength of 633 nm. They show mainly bands that could be assigned to the stabilizers diphenylamine and ethylcentralite present in the gunpowders. Then, macroscopic GSR particles obtained after firing two different ammunition cartridges on clothing were also measured using the same procedure. SERS allowed the detection of the particles collected with an aluminum stub from cloth targets without interferences from the adhesive carbon. The results demonstrate the great potential of SERS for the analysis of macroscopic GSR particles. Furthermore, they indicate that the grain-to-grain inhomogeneity of the gunpowders needs to be considered. Graphical Abstract SERS allows the detection of GSR particles collected with adhesive stubs from cloth targets using gold nanoaggregates and an excitation wavelength of 633 nm.

This article reports the results of analysis of the data borrowed from the special literature. They demonstrate the absence of objective forensic medical evidence needed to diagnose injuries to the human body and clothes inflicted by the darts fired from the pneumatic rifles. Meanwhile, the use of the darts differing in the design parameters has the significant influence on the morphological features of the resulting injuries. The knowledge of the dart characteristics creates the prerequisites for the differentiation between the injuries caused by these missile weapons and other metallic objects.

Based on its intrinsic mass and velocity, a bullet has an upper limit of wounding potential. Actual wound severity is a function of the bullet construction and trajectory, as well as the properties of the tissues traversed. Interpreting physicians must evaluate the bullet trajectory and describe patterns of injury resulting from the effect of energy transfer from the projectile into living tissue. A basic understanding of firearms, projectiles, and wound ballistics can help the interpreting physicians in conceptualizing these injuries and interpreting these cases., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

France has adopted a new firearms regulation. Firearms are now classified into four categories (A, B, C, and D). The administrative procedure for acquisition and possession of firearms of categories B and C requires medical advice. The medical certificate must be dated less than a month, and detail a state of health compatible with the acquisition and possession of a firearm. There are no guidelines mentioning the conditions that can lead to incompatibility. Compatibility does not apply to the handling and use of the firearm. If the applicant is undergoing or has undergone treatment in a psychiatric institution, he must also produce a medical certificate issued by a psychiatrist. The hunting license application requires a medical certificate mentioning a state of physical and mental health compatible with the possession of a firearm. Its validity is acquired for life. The practice of shooting sports or skeet requires an annual medical certificate of non-cons in reference to the rules of sports federations., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Airsoft is a recreational combat sport that originated in Japan in the 1970s and is currently increasing in popularity in the UK. Participants use air or electrically powered weapons to fire small plastic pellets at a controlled pressure. UK law strictly regulates the maximum muzzle velocity and the type of ammunition used in these weapons. A search of published papers found several reports of penetrating ocular injuries caused by Airsoft pellets, but no reports of penetrating injuries to other areas of the body. We report the case of a 25-year-old man who sustained a penetrating injury to the cheek after being shot with an Airsoft weapon., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Gunshot injuries to the craniomaxillofacial region are a challenge to the trauma and reconstructive surgeon. Although management of these injuries has been standardized and early rather than late intervention is advocated, the patient characteristics before, during, and after have been poorly elucidated., Methods: A prospectively maintained Level I trauma center database was queried as to gunshot wounds of the craniomaxillofacial skeleton. Over a five-year period (2007-2011), 168 patients were identified with these injuries. Charts were reviewed as to demographics, presentations, and outcomes and these were tested for significant relationships with hospital length of stay, numbers and types of procedures, morbidity, and mortality., Results: Gunshot wounds to the craniofacial skeleton resulted in 71 deaths in this patient population. Those that died were significantly older, presented with a lower GCS, had a shorter LOS, and a higher INR than those that lived. Subgroup analysis of mechanism demonstrated mortality was more likely to occur as a result of self-inflicted injury in whites and due to assault in the African-American population., Conclusions: Data gathered from this study disputes some commonly held beliefs regarding the epidemiology of gunshot injuries and should allow for better characterization of which outcomes are consistent with which presentations., (Published by Elsevier Ltd.)

Analogous to use of bullet scratches in forensic science, the authenticity of a digital image can be verified through the noise characteristics of an imaging sensor. In particular, photo-response non-uniformity noise (PRNU) has been used in source camera identification (SCI). However, this technique can be used maliciously to track or inculpate innocent people. To impede such tracking, PRNU noise should be suppressed significantly. Based on this motivation, we propose a counter forensic method to deceive SCI. Experimental results show that it is possible to impede PRNU-based camera identification for various imaging sensors while preserving the image quality.

Suicidal gunshot wounds are a common appearance in forensic casework. The main task of the coroner lies in the detection of typical pathomorphological correlates, thus differentiating between homicide, suicide and accident. Apart from characteristic bloodstain patterns on the gun and shooting hand, the localisation of the entrance wound and the position of the weapon, additional details such as family background or medical history are important aspects of forensic investigation. An uncommon choice of weaponry and its unusual morphological manifestation often complicate the examination and reconstruction of such cases. Furthermore, due to social stigmatisation, the possibility of secondary changes by relatives at the crime scene should be considered. In addition to autopsy findings, a careful crime scene investigation and bloodstain pattern analysis, a ballistic reconstruction can be an essential tool to gain knowledge of the shooting distance and position of the gun.

Objective: To evaluate with CT the efficacy of various combinations of firearms and ammunitions to penetrate and disrupt the brain tissue of cadaveric heads of feedlot steers., Sample: 42 fresh cadaveric heads of 12- to 18-month-old Bos taurus steers., Procedures: For each of 7 combinations of firearms and ammunitions (.22-caliber rifle firing a long rifle 30-grain plated lead solid- or hollow-point round, .223-caliber carbine firing a 50-grain ballistic-tip round, 9-mm pistol firing a 124-grain total metal jacket round, .45-caliber automatic Colt pistol [ACP] firing a 230-grain full metal jacket round, and 12-gauge shotgun firing a 2.75-inch 1.25-ounce No. 4 birdshot shell or a 1-ounce rifled slug), 6 cadaveric heads were shot at an identical distance (3 m), angle, and anatomic location. Heads were scanned with third-generation CT, and images were evaluated to determine extent of penetration, projectile fragmentation, cranial fracture, and likelihood of instantaneous death (≥ 30% destruction of brain tissue or a brainstem lesion). RESULTS-41 of 42 skulls were penetrated by the projectile. Instantaneous death was considered a likely consequence for 83% (25/30) of heads shot with a rifle-fired .22-caliber solid-point round, pistol-fired .45-caliber ACP round, carbine-fired .223-caliber round, and shotgun-fired birdshot and slug. Of the 18 heads shot with pistol-fired 9-mm and .45-caliber ACP rounds and rifle-fired .22-caliber hollow-point rounds, only 6 had brainstem lesions. CONCLUSIONS AND CLINICAL RELEVANCE-Results suggested that gunshots delivered by all firearm-ammunition combinations except rifle-fired .22-caliber hollow-point rounds and pistol-fired 9-mm rounds were viable options for euthanasia of feedlot cattle.

In this article we focus on the effects of so called non-lethal ammunition. We studied possible mechanism of firearm injury formation as a consequence of using firearm on the body, to present a more comprehensive material in wound ballistics. We pointed out possible actions of a projectile causes on human, respectively other animal organisms, as well as to a manner in which an injury is caused by rifles or shotguns using non-lethal ammunition with rubber projectiles. In the experiment, we have focused on macroscopic analysis of the tissue penetrated by a rubber projectile fired from a long firearm and pump-action shotgun while focusing on the anatomical-morphological analysis of entry wounds to determine the effectiveness respectively, the wounding potential of the projectile. The results of the experiment based on the macroscopic analysis of entry wounds, cavities and exit wounds, show that when a rubber projectile penetrates the body it causes loss of the tissue (i.e. the minus effect) and mechanical disruption of the tissue similar to lethal projectile. Based on the measures and ballistic computations we concluded that in specific cases, like for example in a close range hit, a penetration of vital organs can cause serious or even lethal injuries.

The author compares the properties (caliber, power, speed) of the firearm projectiles and bullets with the high muzzle energy shot from pneumatic weapons. Results of experimental observations with the use of biological and non-biological objects are presented. The entry and exit wounds in the skin and bones as well as the resulting damage inflicted to the tissues and the character of bullet deformation are described.

Ballistic injury wounds are formed by variable interrelated factors, such as the nature of the tissue, the compositional makeup of the bullet, distance to the target, and the velocity, shape, and mass of the of the projectile. This complex arrangement, with the ultimate outcome dependent on each other, makes the prediction of wounding potential difficult to assess. As the facial features are the component of the body most involved in a patient's personality and interaction with society, preservation of form, cosmesis, and functional outcome should remain the primary goals in the management of ballistic injury. A logical, sequential analysis of the injury patterns to the facial complex is an absolutely necessary component for the treatment of craniomaxillofacial ballistic injuries. Fortunately, these skill sets should be well honed in all craniomaxillofacial surgeons through their exposure to generalized trauma, orthognathic, oncologic, and cosmetic surgery patients. Identification of injured tissues, understanding the functional limitations of these injuries, and preservation of both hard and soft tissues minimizing the need for tissue replacement are paramount.

The data on the history of development and further improvement of pneumatic weapons are presented with special reference to specific features of different types and varieties of these weapons, cartridges for them, and the sphere of their application. Investigations into peculiarities of damages caused by high-capacity pneumatic weapons to the objects of forensic medical expertise affected from different distances are reviewed. Results of forensic medical expertise and clinical studies on the structure of body injuries inflicted by gunshots from pneumatic weapons to the human body are discussed. The author emphasizes the necessity of developing up-to-date terminology and classification of gunshot injuries caused by shooting from pneumatic weapons.

Over the period 1981-1985 the author treated 1486 patients with facial gunshot wounds sustained in combat in Afghanistan. In the last quarter of 20th century, more powerful and destructive weapons such as M-16 rifles, AK-47 and Kalashnikov submachine guns, became available and a new approach to gunshot wound debridement is required. Modern surgeons have little experience in treatment of such wounds because of rare contact with similar pathology. This article is intended to explore modern wound debridement. The management of 502 isolated soft tissue injuries is presented. Existing principles recommend the sparing of damaged tissues. The author's experience was that tissue sparing lead to a high rate of complications (47.6%). Radical primary surgical debridement (RPSD) of wounds was then adopted with radical excision of necrotic non-viable wound margins containing infection to the point of active capillary bleeding and immediate primary wound closure. After radical debridement wound infection and breakdown decreased by a factor of 10. Plastic operations with local and remote soft tissue were made on 14, 7% of the wounded. Only 0.7% patients required discharge from the army due to facial muscle paralysis and/or facial skin impregnation with particles of gunpowder from mine explosions. Gunshot face wound; modern debridement., (Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

In Republic of Macedonia the use of air guns is quite widespread. They are used mainly for target practice. They are regulated by the Law of Arms, where they are defined as pneumatic weapons. There is no legal limit on type or quantity of ammunition that one may possess. Our Institute performs at least 90% of the forensic autopsies in Macedonia. In this report we describe the only fatality by pneumatic weapon to come to our attention over the past 10 years. A 6-year-old girl was accidentally wounded by her brother when he and his father were trying a new air gun, a 4.5mm single shot, break barrel, spring piston air rifle manufactured in China under the brand "Westlake". She died within minutes. Autopsy showed cardiac tamponade due to penetration of the aorta. A 0.5g metal projectile, 4.5mm in diameter, with a pointed, conical shape, was recovered from the pericardial sac., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

A method for the three-dimensional modeling is proposed designed to enhance the objective value of situational expert investigations of the mechanism of gunshot wounds. The method was successfully validated in a number of forensic medical situational studies and allowed their objectiveness, demonstrativeness, and evidentiary force to be significantly improved.

The results of analysis of the data presented in the special literature and normative legal documentation indicate that the forensic medical aspects of the injuries inflicted by gunshots of limited-lethality weapons either need to be clarified or remain virtually unexplored. There is the long overdue necessity to consolidate efforts of forensic medical experts and specialists from other agencies and institutions for the comprehensive solution of the problems related to the injury prevention characteristics of limited-lethality weapons and participation in the interdepartmental activities for the improvement of the legislation regulating weapon trafficking.

The data available from the forensic medical practice do not allow the comprehensive, objective, and reliable assessment of injuries to the human body and damages to the clothes inflicted by the shots from a 9 millimeter (.357) or higher-caliber pneumatic rifle equipped with the pre-charge pneumatic system. The use of bullets of specific structure and configuration for such weapons accounts for their marked influence on the morphological features and the extent of the resulting wounds. These peculiarities provide a basis for the objective differentiation between their injurious effects.

Background: Pellet gunfire injuries inflicted while controlling agitated mobs has been studied., Methods: A total of 198 patients admitted to the Accident and Emergency Department with pellet gun injuries were studied in terms of anatomic site, severity and type of injury, treatment, and outcomes., Results: 72.7% of patients were aged 16-25 years. The most common sites of injury were the extremities (47.9%), abdomen (36.3%) and chest (31.3%). 59.5% of patients were found to have minor injuries. Of the 80 patients admitted to the hospital for their injuries, 43 (53.7%) required an operative procedure. Six deaths (3.03%) were observed., Conclusion: While the pellet wound itself may seem trivial, if not appreciated for the potential for tissue disruption and injuries to the head, chest, and abdomen, there can be catastrophic results. Patients should be evaluated and managed in the same way as those sustaining bullet injuries.:

This paper reports the results of analysis of the data obtained in experimental studies and practical expert assessments of body injuries inflicted by rubber balls for traumatic weapons. The causes accounting for the polymorphism of such injuries and the mechanisms of their development were elucidated by means of damage simulation taking into consideration the physical and dynamic properties of elastic ball-type destructive agents and the morphological structure of different anatomical regions of the human body. The results of the study may be of interest for differential diagnostics of gunshot lesions caused by elastic destructive agents.

This histological study of calvarian bones with the injuries inflicted by a shot from an Osa traumatic non-lethal pistol revealed nephrogenic osteopathy in the preceding period. The pathologically altered bone tissue was damaged by a relatively mild tangential traumatic impact. It is concluded that the possibility of such pathological changes should be taken into consideration in the forensic medical expertise of any trauma including gunshot injuries.

In this paper, the authors review the types of air soft gun replicas depending on the type of drive and ammunition, showing the possibilities of altering the M4A1 rifle replica's technical parameters and the effect of such modifications on initial energy of the projectile. A PJ4 CQB NAVY replica's inner barrel, spring, motor and cylinder kit were replaced. Subsequently, the muzzle velocity was determined and compared to the initial muzzle velocity. This example showed that amateur modifications can greatly increase the initial energy of the pellet. The authors suggest that especially in terms of determining the exposure to direct danger of death or grave detriment to health, the manufacturer's data about pellet energy should not be taken without question, but one should strive for an individual assessment of the ASG replica constituting the evidence.

A basic understanding of the ballistic behaviour of projectiles or fragments after entering the human body is essential for the head and neck surgeon in the military environment in order to anticipate the diagnostic and therapeutic consequences of this type of injury. Although a large number of factors influence the missile in flight and after penetration of the body, the most important factor is the amount of energy transmitted to the tissue. Long guns (rifles or shotguns) have a much higher muzzle energy compared to handguns, explaining why the remote effects beyond the bullet track play a major role. While most full metal jacket bullets release their energy after 12-20 cm (depending on the calibre), soft point bullets release their energy immediately after entry into the human body. This results in a major difference in extremity wounds, but not so much in injuries with long bullet paths (e.g. diagonal shots). Shrapnel wounds are usually produced with similarly high kinetic energy to those caused by hand- and long guns. However, fragments tend to dissipate the entire amount of energy within the body, which increases the degree of tissue disruption. Of all relevant injuries in the head and neck region, soft tissue injuries make up the largest proportion (60%), while injuries to the face are seen three times more often than injuries to the neck. Concomitant intracranial or spinal injury is seen in 30% of cases. Due to high levels of wound contamination, the infection rate is approximately 15%, often associated with a complicated and/or multiresistant spectrum of germs.

The analysis of the data published in the special literature indicates that forensic-medical aspects of the injuries inflicted by blank shots fired from a variety of small-arms weapons remain poorly known or virtually unexplored. Despite considerable variability of such injuries, their forensic-medical examination should include three basic components, viz. the proof of the absence of the injurious action of the shot, differential diagnostics of the consequences of injuries attributable to each traumatic factor of the shot, and experimental simulation of the damages to the human body and the clothes taking into account concrete models of the weapons and the blank cartridge.

Unlabelled: Recent changes in the law concerning air gun ownership have made air guns a topical subject and many have called for even tighter restrictions. A case of accidental injury during play with an air rifle is described. It highlights the dental and soft tissue damage that can arise from an injury from such a 'toy' and outlines its subsequent management., Clinical Relevance: This case highlights the problems that any dental practitioner may have to deal with when faced with the consequences of air-pellet injuries.

Pediatric anesthesiologists care for children with penetrating trauma from nonpowder (BB and pellet) guns. We present the case of a 9-year-old boy who required urgent median sternotomy for cardiac tamponade after sustaining a close-range BB gun injury to the chest. After summarizing the epidemiology of nonpowder gun injuries in children, we clarify the nomenclature, ballistics, and mechanisms of these guns, discuss the tendency to minimize these kinds of injuries, explain bullet embolization, and review (by body area) current clinical management issues.

While many handguns are used in crime each year in the USA, most are not. We conducted this study to identify factors present at the time of a handgun's most recent retail sale that were associated with its subsequent use in crime under circumstances suggesting that the handgun had been trafficked--purchased with the intent of diverting it to criminal use. Handguns acquired in multiple-gun purchases were of particular interest. Using data for 180,321 handguns purchased from federally licensed retailers in California in 1996, we studied attributes of the handguns, the retailers selling them, the purchasers, and the sales transactions. Our outcome measure was a handgun's recovery by a police agency, followed by a gun ownership trace, conducted by the Bureau of Alcohol, Tobacco, Firearms and Explosives, that determined (a) that the recovery had occurred within 3 years of the handgun's most recent purchase from a licensed retailer and (b) that the person who possessed the gun when it was recovered by police was not its most recent purchaser. Altogether, 722 handguns were recovered and had trace results that met the additional criteria. Handguns acquired in multiple-gun, same-day transactions were more likely to be traced than were single-purchase handguns (odds ratio [OR] 1.33, 95% confidence intervals [CI] 1.08 to 1.63). This was not the case for multiple-purchase handguns defined more broadly as multiple handguns purchased by one individual over any 30-day period as used in "one-gun-a-month" laws. Bivariate regressions indicated increased risk of a handgun being traced when it sold new for $150 or less (OR 4.28, 95% CI 3.59 to 5.11) or had been purchased by a woman (OR 2.02, 95% CI 1.62 to 2.52). Handguns sold by retailers who also had a relatively high proportion (>or=2%) of purchases denied because the prospective purchasers were prohibited from owning firearms were more likely to be traced than were those sold by other retailers (OR 4.09, 95% CI 3.39 to 4.94). These findings persisted in multivariate analyses. Our findings suggest specific strategies for intervention to prevent gun violence.