Mass Shootings and Devastating Gunshot Wound Injuries

• To date, the United States has had a staggering 314 mass shootings, and over 25,000 people have died from gun violence in 2022. 
• Unfortunately these statistics show healthcare workers need to remain vigilant and prepared to treat a variety of gunshot wounds. 
• Numerous factors dictate the severity of a gunshot wound, including a bullet’s mass, velocity, composition, and impact location. A gunshot wound needs proper care as soon as possible.

It is worth repeating. The pervasive, unrelenting gun violence in the United States is abhorrent. As a country, we have reached a point of social unraveling with the continued senseless and tragic killings. To date, the United States has had a staggering 314 mass shootings, and over 25,000 people have died from gun violence in 2022.  

This is an average of 121 deaths per day in the United States, secondary to gun violence. And it could happen anywhere.  

Imagine you are at a local musical festival. Mid-day more than a dozen gunshots ring out. Screams overtake the music. The crowd scatters. Left behind two adults, and a dozen injured children. As with most mass shootings, the nearest pediatric trauma center is over 10 miles away. As a nurse, what injuries might you expect from a high-velocity weapon?  

Gunshot Wound and Injury Patterns

Victims of assault-style weapons (AR-15-style) were rare when compared to handgun wounds and shotgun wounds. Handgun trauma that follows a limited, thin linear track through the organs, is survivable. Even a handgun wound to the heart, absent massive hemorrhage prior to arrival at a hospital, can be non-lethal if the injury occurs within proximity to a trauma center. A 9mm bullet from a handgun with less magazine capacity that travels half or a third of the speed of a high velocity weapon is far less devastating.  

In opposition, high-velocity weapons produce a wide swath of tissue damage and devastation, making injuries difficult, if not impossible, to treat.  

Numerous factors dictate the severity of a gunshot wound, including a bullet’s mass, velocity, composition, and impact location. If the bullet strikes the heart or visceral organs, survival is improbable. In high-velocity injuries, muscles, skin, and fat shear. Entry wounds can be a small, penetration wound, exit wounds appear blown-out secondary to the yaw (vertical rotation) of the bullet and can be twelve inches wide.

High energy bullets discharged from high-velocity weapons create a blast wave around the bullet. Bullets that strike bone cause fragments, slicing tissue within the fragment’s path. As a bullet forces tissue and organs aside, cavitation occurs. Organ’s shatter, blood vessels tear, and victims exsanguinate before arriving at the hospital.

Those who survive transport, repairing the damage caused by the energy transmitted as a bullet passes through the human body, is paramount. Trauma to the torso is often fatal, with entire quadrants of the abdomen eviscerated. Limbs and large sections of bone disintegrate.  

Opinions aside, military style assault weapons kill civilians. Rounds from the muzzle of an M16 or AR-15 have a velocity of over 3,000 feet per second. An AR-15 rifle with an after-market magazine and one hundred rounds fired without reloading into a crowd causes unimaginable damage.

Scene Management

In any disaster, registered nurses have proven to be dependable first responders. At their core, a nurse’s compassionate nature compels action in a mass casualty incident or pandemic. Under life-threatening circumstances, the scene must be secure before any action from lay individuals or medical personnel. 

Unexpected mass shootings have a preparedness gap. The scenes are chaotic. The goal is to get injured patients the right care as soon as possible. Victims of high-velocity gunshot wounds need trauma surgeons for their survival.  

Nurses and healthcare professionals speak a language that can foster communication with healthcare facilities and trauma centers.  

A secondary goal, help healthcare facilities optimize a response team when a mass shooting occurs.  

Effective communication between pre-hospital personnel at the scene and local hospitals is essential. Scene triage, identifying those who need a trauma center and those who require a lower level of care can avoid overwhelming trauma centers.  

Control the Hemorrhage

Scene control of hemorrhage can save lives in a mass shooting. Tourniquets, though requiring training to apply, can save lives. A global initiative from the American College of Surgeons, STOP THE BLEED® program has prepared over a million non-medical individuals on how to stop bleeding and tourniquet application in an injured person.  

Knowing how to stop blood loss can save a life during a mass casualty situation. Stabilization does not require a medical professional, lay people can recognize life-threatening hemorrhage and intervene.  

Why does it matter? Trauma patients’ hemorrhage. In the time that the gunshot victim awaits the first responders to arrive (ten minutes), they have bled to death in the minute’s prior.  

The Bottom Line

If we are ever to prevent mass shootings, our society requires a fundamental change in social attitudes and government policy. Though mass shootings are a small part of gun violence, the damage and causality rates are disproportionate. Until there is a change in thinking regarding assault weapons, how we respond as nurses and bystanders can save lives.  

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