Firearm Storage Practices of US Members of the American College of Surgeons.

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.

Gunshot homicides in Denmark 1992-2016.

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.

The punched-out tissue complex (skin-bone "imprimatum") in shots from captive-bolt guns: does it act as a secondary projectile?

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.

[Thoracic and abdominal injuries caused by air weapons]. / Pulevye raneniia grudi i zhivota iz pnevmaticheskogo oruzhiia.

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.

Type of Firearm Used in Suicides: Findings From 13 States in the National Violent Death Reporting System, 2005-2015.

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.

Evaluation of Factors Related to Mortality Caused by Firearm Injury: A Retrospective Analysis from Malatya, Turkey.

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.

To Improve Homicide Firearm Information Reporting - Rhode Island State Crime Laboratory.

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.

[The characteristic of the injuries inflicted by a 'Zelinka' speargun shot]. / Kharakteristika povrezhdenii, prichinennykh vystrelom iz ruzh'ia dlia podvodnoi okhoty 'Zelinka'.

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.

A study on shotgun injuries to the craniomaxillofacial Region in a Nigerian Tertiary Health Center.

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.

[The role of the comprehensive approach for the characteristic of the destructive effect of a non-lethal cartridge with two rubber bullets]. / Znachenie kompleksnogo ékspertnogo podkhoda v ustanovlenii porazhaiushchikh svoistv patrona travmaticheskogo deistviia s dvumia rezinovymi puliami.

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).

[Determination of the barrel inclination of the AK-74 assault rifle from the specific features of soot deposition after a shot around the inlet wounds caused by a burst of shots]. / Ustanovlenie ugla naklona avtomata AK-74 po osobennostiam otlozheniia kopoti vystrela vokrug vkhodnykh ognestrel'nykh ran, prichinennykh ochered'iu vystrelov.

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.

A 10-Year Analysis of Head and Neck Injuries Involving Nonpowder Firearms.

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.

Penetrating Ocular Trauma from a Bean Bag Gun: A Case Report and Review of Less-Lethal Force and Their Consequences.

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.

Reducing impacts from ammunitions: A comparative life-cycle assessment of four types of 9mm ammunitions.

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.

Surface-enhanced Raman spectroscopy for the analysis of smokeless gunpowders and macroscopic gunshot residues.

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.

¿Son efectivos nuestros centros de reconocimiento médico valorando la aptitud psicofísica para permisos de conducción y licencias de armas? / Are our medical centres for fitness to drive and firearms licences effective?

Objetivos. Este artículo se propuso evaluar la efectividad de los centros de reconocimiento médico en la valoración de la aptitud psicofísica para permisos de conducción y licencias de armas, describiendo las diferencias observadas en sendas valoraciones. Método. Mediante un diseño transversal se tomó una muestra representativa de titulares de permisos de conducción y licencia de armas calificados como aptos en la provincia de Málaga durante 2014 (363 informes para permisos de conducción y 626 para licencia de armas), evaluando la concordancia de la aptitud psicofísica informada por los centros con los registros del Servicio Andaluz de Salud. Se estimó la proporción de dichos titulares que no reunirían los requisitos legales de aptitud, analizando el origen de las discordancias en relación con la información de la que dispusieron los centros. Resultados. Se estimó la discordancia en la valoración de la aptitud psicofísica para permisos de conducción en 15,4% (IC 95%: 12,0 a 19,4), proporción 2,7 veces mayor para licencias de armas (41,4%), relacionándose el origen de la discordancia con la información que dispuso el centro más que a la calificación realizada por estos. Conclusiones. Es limitada la efectividad de los centros en la valoración de la aptitud psicofísica para permisos de conducción y, especialmente, para licencias de armas. Podría mejorar con un mayor seguimiento de su actividad, disponiendo de personal sanitario con formación adecuada y acceso a los registros asistenciales de los solicitantes (AU)

Objectives. This article aimed to evaluate the effectiveness of medical centres in the assessment of medical fitness for driving and gun licences, as well as describing the differences between them. Method. Using a crossover design and a representative sample of holders of driving and firearms licences in the province of Malaga during 2014 (363 reports for driving licenses and 626 for firearms licenses), an assessment was made of fitness report issued by the centres by comparing it with the records of the Andalusian public health service. The proportion of those that would not meet the legal eligibility requirements was calculated. An analysis was made of the origin of the disagreements as regards the information made available by the centres. Results. The discordance in the assessment of fitness to drive was estimated as 15.4% (95% CI: 12.0 to 19.4), while for firearms licenses it was 2.7 times higher (41.4%). The origin of the discordance is related to the information provided to the centres, rather than the assessment made by them. Conclusions. The limited effectiveness of the centres in the assessment of fitness for driving and, especially, for firearms licenses, could be improved by increased monitoring of their activity, providing health workers with adequate training and access to healthcare records of applicants (AU)