Assault rifle injuries in civilians: ballistics of wound patterns, assessment and initial management

Wounds from assault rifles and their commercial offspring have been encountered with increasing frequency in civilian practice. Our aim is to summarize wound ballistics related to the main injury patterns that can also affect management strategies.

An online search of the PubMed was conducted for research and review articles published after 2000 in English, using the MeSH terms “gunshot wounds”, “mass casualty incidents”, “war-related injuries”, “soft tissue injuries”, “vascular system injuries”, “colon injuries”, “wound infection”, “antibiotic prophylaxis”, “debridement”, “hemorrhage”, “penetrating head injuries”, “pneumothorax” and additional free-text terms. Other academic databases were also searched for relevant articles and book chapters.

Consensus regarding recognition of high energy wounds from assault rifle projectiles is largely based on war experience. Studies of such wounds inflicted by expanding projectiles suggest that their wounding effects significantly increase tissue damage and adverse outcomes following injury, as a result of the temporary cavity and bullet fragmentation. The use of assault rifles in mass shootings has prompted utilization of tourniquet for control of life-threatening hemorrhage, also derived from military experience, while limited evidence indicates that tension pneumothorax rather than extremity wounds is the leading cause of potentially preventable death in these incidents.

Wound ballistics provides a system for evaluation of injuries from assault rifles and risk analysis of shooting incidents. Lessons learned from armed conflicts can improve the management of victims, with due consideration given to characteristics of civilian injuries. Further research is required to define the impact on survival by key life-saving procedures in the prehospital setting, in order to prioritize these interventions.