What an AR-15 Does to a Child's Body: Why Surgeons Can't Look Away
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Glatter: Let's talk about the mechanics of the AR-15 (ArmaLite AR-15) and how this compares with a typical 9-mm handgun (or even a standard rifle or shotgun, for that matter). Joe, can you talk about the injuries and what you see in the ED as opposed to the operating room?
Sakran: When you look at the mass shootings that happen and the use of the AR-15, a weapon of war and a military-style assault weapon, it is very clear that these weapons allow gunmen not only to fire numerous rounds quickly but also to create significant damage because they travel at more than 3000 feet per second. When that happens, a couple of different things take place. The first is you have what's called the permanent cavity that's dependent upon the size of the bullet. Then you have this temporary cavity that's created, which essentially is dependent on the velocity, or how fast this bullet is traveling.
If you think about a boat that's traveling, it has this wake that results behind it. That's the temporary cavity that is created. The faster the boat travels, the larger that wake is. The same thing is happening in the human body, where you get this energy that is dissipated across a path that then results in destruction. The destruction is very dependent upon whether you hit a main vessel, a bone, or a vital organ. It is very different than what we see with a handgun.
Glatter: You're essentially talking about the ability to survive a wound from an AR-15 vs a 9-mm handgun, for example. That really is what this comes down to. If you were shot with one of the two weapons, your chances of surviving would be quite different.
Dr Campbell, I want to hear about your experience with what you have seen from wounds from these assault weapons in San Francisco.
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Campbell: A little bit about bullets and what they do. When I first started surgeries way back when, we had "Saturday night specials," which were 22-caliber bullets, where people got shot, and depending on where you're shot, it could cause catastrophe. Then it became 40-mm, and AR-15, and AK-47, and Uzi submachine guns, and high-capacity rifles. The faster a bullet hits, the more destruction it has. It's traveling at 2000 miles an hour. It's really fast; the bullets bounce and explode.
Just for the regular folks who may not be medically inclined, it causes an explosion in the human body where it hits bone, blood vessels, nerves, and skin. It's a devastating injury when that happens. We've all seen simulations of what these bullets can do. Certainly, you can get shot with a 40-caliber pistol and have devastating injuries.
It's all about where you're shot, what happens after you get shot, whether it's a glancing blow or it's a full-on devastating explosion that happens in the human body — whether it's the thorax, the head, or extremities. If it's the extremities, you may have a shot at trying to save the patient, which is why we've promoted many things that we'll talk about later on. But it's just devastating, unbelievable destruction.
It's minutes before the patients bleed out, so you have to act fast. That's why at trauma centers — we work at level 1 trauma centers — we get the patients there early, we try to get them in the operating room, and our job is to find a way to stop bleeding. We've gotten pretty good at that. Now, we can save many people, but we can't save everybody.
We're out here every day trying to save people and get them back to their families because that's what we do as trauma surgeons. We come in, we save people's lives, and we work in concert with pre-hospital staff, our emergency physicians, and the trauma center to make things happen. I'll just start with that utter devastation, exploding, and the terrible things that happen to people when they are the target of these weapons of mass destruction.
Glatter: That's a very graphic and accurate description. Dr Dultz, if you do survive one of these types of injuries, there is the risk of complications, such as fistulas, wound infections, prolonged hospital stays, and the need for long-term care. You are an expert, working in the surgical ICU at your facility. These are the wounds of war that are in the ICU. These patients have prolonged stays. Can you comment about what you're seeing regarding healing, complications, and so forth?
Linda A. Dultz, MD, MPH: For us working in the trauma bay and in the ICU, we see these devastating injuries. Obviously, the more bullets, the type of bullet, the level of destruction, the more devastating of an injury that patient will have that will lead to their prolonged complication and ICU courses. I think the bigger picture is what we don't see, such as the long, drawn-out PTSD and the mental rehabilitation that comes from that.
It's not just a physical issue. It's emotional, and one that leads to a lower quality of life and long-term disability for these patients. That's where some of our research is focusing on as well — it's not just the physical aspect, because that's going to happen and we will get our patients through that and we will get them home, hopefully, and back to their families. That long-term effect, though, for most people, will never go away. We're focusing on that right now and a large amount of research is being put into that.
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I just want to highlight that the husband of one of the victims recently died because he was so overwhelmed. We're going to talk about the physics and the energy and dissipation of bullets, but these are people. The families are ruined. They're destroyed. And they will never be the same. I think that we should just sit there and ruminate on that first, on what is going on. We need to have a national reckoning, and we'll get into that later.
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Glatter: I was just going to bring that up. It's a crisis among healthcare providers right now that we can't ignore after COVID-19. Healthcare providers are really showing the effects of everything at this point that we're seeing, from trauma incidents to just showing up to work. Taking care of ourselves and programs that are designed to do that are critical.
I wanted to ask you about each of your institutions.
Campbell: Dr Sakran took care of one of his colleagues who was shot just recently. I want him to highlight the power of the statements he made after that right now.
Sakran: As we're hearing both from Dr Campbell and Dr Dultz, it's hard to do what we do. Take that difficult job that we do on an everyday basis and imagine then that it's your colleague, someone that you work with, someone who also happens to be a trauma surgeon and taking care of injured patients.
That's what happened a couple of months ago when I came on call one morning and I got the message that one of my partners was being brought in after they were shot. I don't want to get into this person's story because that's for them to tell.
What I will say is this: As I sat there in disbelief as to what I had just heard, I asked myself whether or not I was going to be able to separate the emotion from the moment, to be able to make one methodical decision after the other. It was a tough moment because I didn't know at the time what type of injuries he had. Many things went through my mind. Of course, even afterwards, thinking about the fact that, thankfully, he physically survived, things could have been different.
It goes on, and it doesn't get any less grim.
This is another big fucking problem, and sorry not sorry, but it can be largely laid at the feet of coin-operated Republicans who have spent decades pimping "2nd amendment" with the Russian mob money being laundered through the NRA.
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