Injuries caused by fragmenting rifle ammunition |
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| Institution: | 1. Department of Traumatology, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway;2. Department of Vascular Surgery, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway;3. Department of Paediatric Surgery, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway;1. Department of General Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie (Paris VI), 75651 Paris, France;2. Department of Radiology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie (Paris VI), 75651 Paris, France;3. Department of Anesthesiology, Critical Care, Emergency Medicine and Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie (Paris VI), 75651 Paris, France;1. Department of Surgery, Jamaica Hospital Medical Center, Jamaica, New York, United States;2. Department of Radiology, Jamaica Hospital Medical Center, Jamaica, New York, United States;3. Division of Otolaryngology, Jamaica Hospital Medical Center, Jamaica, New York, United States;7. Burn Centre Beverwijk, Beverwijk, The Netherlands;8. Burn Centre Rotterdam, Rotterdam, The Netherlands;9. Burn Centre Groningen, Groninge, The Netherlands;10. Association of Dutch Burn Centres, Groningen, The Netherlands;1. Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands;2. Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands;3. Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands;4. Association of Dutch Burn Centres, Martini Hospital, Groningen, The Netherlands;5. Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands;6. Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands;1. Department of Anaesthesiology CHUV, 1011 Lausanne, Switzerland;2. Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK;3. Royal London Hospital, Barts and the London NHS Trust, London, UK;4. Royal London Hospital, Barts and the London NHS Trust, London, UK;5. Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK;1. Department of Neurosurgery, Sir Charles Gairdner Hospital, Western Australia, Australia;2. Department of Neurosurgery, Royal Perth Hospital, Western Australia, Australia;3. Department of Intensive Care Medicine and School of Population Health, University of Western Australia, Australia |
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| Abstract: | IntroductionAlthough penetrating injuries are encountered on a regular basis in high volume trauma centres, most civilian trauma teams will be unfamiliar with the treatment of patients with injuries caused by fragmenting ammunition. The terrorist attacks in Norway on July 22, 2011 included a shooting spree causing 69 deaths and 60 injured. One of the weapons used was a semi-automatic rifle, calibre 5.56 mm, with soft tip, short stop ammunition. The aim of the present study was to describe the characteristic injury patterns and lessons learned from the treatment of multiple patients admitted at the regional trauma centre with injuries from this type of ammunition.MethodsWe undertook an observational study of patients admitted at Oslo University Hospital, Ulleval after the shooting spree at Utoya on July 22, 2011. Data on demographics, injuries, injury severity, surgical procedures and outcome were collected prospectively.ResultsOf the 21 patients admitted after the shooting incident, 18 were identified with injuries caused by fragmenting ammunition and included in the study. Median age was 17 years (IQR 16, 19), median ISS 21 (IQR 12, 30) and 12 patients were female. They had been hit by a total of 38 projectiles, of which 32 were fragmenting bullets. Of the seven patients who sustained injuries to the head, neck and face, one patient required a craniotomy and one patient had a non-survivable head injury. Of the 11 patients with torso injuries, six of the eight patients with chest injuries had intra-thoracic injuries that could be treated with chest tubes only. One patient had cardiac tamponade, requiring thoracotomy. Six patients underwent laparotomy, four of them more than one. Of the 10 patients with extremity injuries, two had nerve injuries and six patients had fractures. Five amputations were performed within the first nine days.A total of 101 operations were required within the first four weeks. The majority of these were repeated soft tissue debridements due to progressive necrosis.ConclusionKnowledge about the specific challenges created by the progressive soft tissue necrosis caused by fragmenting ammunition should lead to planned, repeated debridements to reduce total tissue loss and complications. |
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| Keywords: | Fragmenting ammunition Mass casualty Terrorist attacks Gunshot injury Penetrating injuries |
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