The Impact of Gunshots From a Pathologist’s Perspective

It’s all in a day’s work. When an adult or child dies by gunfire, a medical specialist performs the last exam this person will ever receive. In a painstaking autopsy, the forensic pathologist documents every shattered bone, exploded blood vessel and destroyed organ.

Medical examiners use ballistics — the physics of a projectile’s motion — to analyze the trajectory and impact of one or multiple bullets entering the body. In some cases, they testify on their findings as expert witnesses in criminal court.

Below, U.S. forensic experts from the East Coast, West Coast and Midwest discuss their work with gun victims, and speak out on the urgency of preventing further gun fatalities.

Homicides and Suicides

In New York City, statistics on gun-related deaths remain relatively stable, with some decline over the past four years. Gunshot fatalities have dropped yearly from 308 cases in 2015, to 211 cases as of Dec. 4, 2018.

These figures include gun suicides as well as homicides, explains New York City Chief Medical Examiner Dr. Barbara Sampson. Accidental discharges infrequently account for New York City casualties, she says, such as when someone is cleaning a gun.

[See: 10 Things Pediatricians Advise That Parents Ignore and Really Shouldn’t.]

It’s difficult to rank the relative impact of gunshot wounds in comparison to other types of devastating injuries, Sampson says. “It all depends on how much damage there is in the vital structures of the body,” she says. “How much damage is there to the brain, for example, or to the heart?”

A bullet’s kinetic energy is the major factor in its impact. This energy encompasses both a bullet’s mass and the speed at which it travels.

Someone who is shot with a small-caliber gun with less-powerful ammunition may suffer only minor injuries, Sampson says. However, she adds, “If it’s a larger bullet that’s traveling at higher velocity — which some other parts of the country are seeing much more than we see here — the resulting injuries are absolutely devastating, sometimes like someone fell off a building.”

Having access to guns is dangerous in itself, Sampson says: “The ease of having a gun around can contribute to suicide and, of course, contribute to homicidal violence.” Compared to other modes of injury, she adds, “It’s pretty easy to pull the trigger of a gun.”

The specter of mass shootings is never far from public health experts’ minds. “We’ve been lucky here in New York City,” Sampson says. “I’m knocking on wood because it’s always our greatest fear.” When such shootings appear in other parts of the U.S., she says, particularly when children are victims, it’s heartbreaking.

“We’ve been very fortunate to actually have decreasing (gun violence) to date,” Sampson concludes. “But we want to keep it that way.”

Damage a Bullet Can Do

When a bullet enters your body, it really comes down to having a piece of metal flying through it at an extremely high rate of speed, says forensic pathologist Dr. Darin Wolfe, owner of Indiana Forensic & Surgical Pathology. “Our bodies are not prepared to engage with a force like that,” he says.

“I live out in Indiana, which people think is kind of a backwoods, calm environment where nothing happens,” Wolfe says. “But I personally have done over 200 homicides (involving) gunshot wounds since 2015,” he says, with more than 50 cases this year throughout the state.

Bullets usually move through the air at a rate of at least 1,000 feet per second after they’re discharged, Wolfe says. “It only takes about 200 feet per second to pierce the skin,” he explains. “So you can imagine that at 1,000, 2,000 or 3,000 feet per second, the higher the velocity, the more damage there is to the body.”

[See: 9 Things to Do or Say When a Loved One Talks About Taking Their Life.]

Wolfe frequently describes “disruption” when writing autopsy reports. “That’s just a fancy way of saying that the tissue was destroyed, whether it’s the liver, the heart, the lungs or the brain,” he says. Bleeding can be extensive. “You have hemorrhage from laceration of blood vessels as the bullets pass through. So there’s lots of hemorrhage within the tissues or within the body cavities.”

High-powered AR-15 rifles or even hunting rifles produce higher velocity than handguns, with bullets creating greater energy on impact. “You’ll see severe tissue damage, destruction of organs; massive fractures of bones,” Wolfe says. Skull fractures may occur with gunshot wounds to the head.

Wolfe has investigated shooting episodes from multiple homicides to accidents. “I’ve seen responsible gun owners accidentally kill themselves and other people because they thought the safety was on, or they thought the gun was pointed in a different direction or they thought that the gun wasn’t loaded,” he says.

However disturbing the circumstances, Wolfe focuses on the job at hand. “As soon as it’s time to do the autopsy, I put my emotions to the side and investigate the case on an anatomical basis,” he says. “So I’m looking at things: How did this happen? How far was the gun from the body when it was discharged? I collect that kind of data when I do my autopsy.”

Nevertheless, Wolfe is troubled by these preventable deaths. “Ultimately, what you see is a life that in no way should have ended that early,” he says. “It feels like a missed opportunity. Every time you see a child or a young person who’s been killed with a firearm, it’s just gut-wrenching. Because you know that this is absolutely not something that should be happening.”

Gun Experts

Pathologists are steeped in the aftermath of gun injuries, says Dr. Judy Melinek, a forensic pathologist from the San Francisco Bay Area and co-author of the memoir, “Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner,” published in 2014.

“We have a very intimate knowledge of the decedent, in the sense that we’re the ones who undress them and see the tattoos on their bodies; where they have the names of their loved ones tattooed on their own skin,” Melinek says. “We see the photographs in their bloody wallet of their kids and their pets and their families. It’s part of our job to recover the evidence and document it.”

Melinek is also the author of a viral Twitter response to an early-November NRA tweet advising doctors to “Stay in your lane” instead of speaking out on gun safety. “Do you have any idea how many bullets I pull out of corpses weekly? This isn’t just my lane. It’s my (expletive) highway,” Melinek tweeted back in outrage.

Physicians and other health care providers continue to express their perspectives throughout social media with #thisisourlane and related hashtags. NRA messaging that medical professionals lack sufficient expertise to speak up on gun safety is inaccurate, Melinek says.

“Whether it’s emergency room physicians, surgeons or forensic pathologists — we’re the ones who get called upon to testify in court on terminal ballistics and on what guns do to the body,” Melinek says. “We’re the ones who are brought in by prosecutors as experts on guns. Not just the damage that they do, but also how they work and how they could incapacitate somebody.”

[See: 11 Ways Rural Life Is Hazardous to Your Health.]

Suicide Connection

Suicide cases aren’t getting the attention they deserve in discussions around gun control and injury prevention, Melinek says. Access to lethal means can increase suicide risk.

In 2015 and 2016, a total of 27,394 firearm homicides occurred among U.S. residents in major metropolitan areas, according to the Nov. 8, 2018, Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention. In that same period, a total of 44,955 gun suicides occurred. Firearm suicide rates continue to increase, the CDC report noted.

The public needs to learn more about gun safety and prevention, Melinek says. Many medical and advocacy groups are calling for federal and private funding to conduct statistical gun research.

The public also needs to know about legal measures like extreme risk protection orders, Melinek emphasizes. Also called “red flag laws,” these ERPOs, enacted in a handful of states including California, Maryland and Massachusetts, allow family or household members to petition a court to keep guns away from a dangerous person in crisis who poses a risk of committing violence to themselves or others.

“It’s not about the Second Amendment,” Melinek says. “Nobody’s trying to take away guns from mentally sound individuals or law-abiding individuals. What we want are laws that take them away from people who are not mentally sound and (are) potentially dangerous. I think that’s reasonable and most gun owners would agree with that.”

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