When guns are involved in fiction, someone will probably end up injured (or worse). The severity of gunshot wounds depends on a variety of factors – read on for a brief overview that will help you portray them more accurately in your story.
Types of Wounds
This is the place where the bullet enters the body. An entrance wound should have an abrasion collar – scrapes caused by the friction and heat of the bullet – and inside that a grease collar – a black ring composed of lubricant, soot, barrel debris, and bullet lead. Both are thin and may not be observable with the naked eye. The grease collar may not be present if a jacketed bullet is used.
Entrance wounds may be categorized by distance of the shot – this is determined by amount of powder residue and the nature of the injury. Use of a silencer filters out a lot of the gun powder, making it seem as if the victim was shot from a greater distance.
- Contact Shot – Gun was pressed against the body, possibly leaving an imprint of the muzzle or a bruise from the pressure. Gas, powder, smoke, flame, and particles of metal ejected by the gun follow the bullet’s path and exacerbate the damage. The shape varies but often has a caved-in appearance. Hair/clothing surrounding the entry point may be singed or melted, but the skin itself is unlikely to be burnt. “Back spatter” may occur if blood, tissue, or clothing is sucked into the gun muzzle.
- Close Shot – Not a contact shot, but the victim was within range of the muzzle flame (up to about 3 inches). The entrance wound is usually circular with inverted edges – surrounding skin is often burnt and hair singed. At a (slightly) greater distance from the wound, skin may be bruised, blackened, or “tattooed” (abraded by unburnt power and debris).
Internal damage is about the same as a contact shot. Both close and contact shots are considered to be point blank range.
- Near Shot – The victim was out of range of flame, but within range of powder debris (maximum of about 40 inches). The entrance wound is usually a round hole, slightly smaller than the bullet due to skin elasticity. Edges are typically bruised and inverted with some blackening and tattooing – the latter two will lessen with a longer shot and be dispersed over a larger area.
- Distant Shot – The victim was out of range of powder debris (more than 40 inches). The entrance wound is usually circular and smaller than the bullet with inverted edges. Burning, blackening, and tattooing are not visible. If the bullet is semi-jacketed, it will separate as it travels through the body and create a “lead snowstorm” on X-rays of the area as the core disperses and expands.
This is where the bullet leaves the body (which it doesn’t always do without medical assistance). The shape, size, and location of an exit wound varies based on type of bullet and entry, the direction from which the shot was fired, posture of the victim, and the number of bullets involved.
- The skin on the palms and soles is different and will result in distorted wounds, often without an abrasion collar to help distinguish entrance/exit.
- “Pseudo-tattooing” occurs when the bullet passes through another object (such as a window) first and that debris causes additional lacerations.
- If the bullet strikes at an angle, it can be difficult (if not impossible) to determine the caliber.
- An abrasion collar may not appear when the bullet strikes a soft area such as the abdomen or buttocks.
- Angle of entry affects the shape of the abrasion collar relative to the shape of the wound (if the bullet did not enter at a right angle, the wound may be circular but the abrasion collar would be elliptical).
Hard Tissue -When a bullet strikes hard tissue, the energy transfers along the bone and causes splits and/or breaks off fragments. The trajectory of the bullet will also be altered in unpredictable ways.
Soft Tissue – When a bullet strikes soft tissue it will carve out a path, sending a fluid shock wave through the surrounding tissue and causing massive bleeding. Depending on the force of the fluid shock wave and the surrounding area’s ability to absorb the energy, other soft tissue around the primary injury (up to 19 inches away depending on the bullet type) may be torn apart.
Solid Organs – Gunshot wounds to solid organs are similar to soft tissue injuries; the real problem is the fluid shock wave. Even if the organ itself is not hit, the transferred energy can be enough to damage an organ and even stop it from functioning.
Hollow Organs – Fortunately, hollow organs are designed to be flexible so the shock wave does not do much damage to them. Unfortunately, they usually hold things like stomach acid or air which will then leak out into the rest of the body through the bullet hole.
- The nature and severity of the injury is affected by bullet type. Some bullets are designed to penetrate and will likely pass straight through, while others are created to expand and cause maximum damage to the body.
- Infection is a problem with any wound, but the gas, powder, grease, and barrel debris that come with gunshot wounds make them especially dangerous.
- Bullet/Bone fragments may travel throughout the body and create additional problems.
- If the bullet does not pass through, it becomes very hard to find. Depending on where it ends up, it may be safer to leave one in than to remove it.
Treatment varies depending on circumstances, but here are some general guidelines:
First Aid – Apply pressure to the wound, cover with gauze and a bandage, elevate the injury, and keep the victim still. Do not try to take the bullet out. A tourniquet may be used, but improvised versions often fail and commercial tourniquets can be difficult for the inexperienced to apply properly. Pressure points can be used to help control bleeding with arm or leg wounds.
Perform CPR if necessary. Do not give the victim anything to eat or drink. Chest wounds should be sealed with plastic to help prevent the lung from collapsing. If the person is conscious, let them find a position that’s comfortable for them; unconscious victims should be put in the recovery position.
Watch for rapid swelling, which is a sign of internal bleeding.
Professional Treatment – The victim may need surgery to repair damage and remove bullets or shrapnel. Cleaning the wound may result in the loss of large amounts of tissue due to widespread damage from powder, expelled gases, and other debris. Antibiotics, painkillers, and a tetanus shot will likely be administered and at least one IV will be inserted to replace the fluids lost. If the injury is to the chest, a tube may be inserted to remove fluid and prevent the lung from collapsing. X-rays may be ordered to search for bullets/debris, and patients with non-trivial wounds will be placed in intensive care with machines monitoring their vital signs, blood gases, and cardiac/vascular function.
- Elevating the legs is a typical treatment for shock but should not be done when the victim has been shot above the waist (excepting the arms) as it will cause these wounds to bleed more and the patient will have more trouble breathing.
- Both the entrance and exit wound (if one exists) need to be treated, but sometimes it’s safer to keep the victim still rather than search for a second wound.
- If a bone was hit, a splint or similar treatments may be needed.
- Lead poisoning from bullets that have not been removed is very unlikely unless the bullet fragmented or became lodged in a joint where synovial fluid could break down the casing.
- The primary concern for a first responder is their own safety, as they can’t help anyone else if they’re injured themselves. They will move in as soon as the scene is safe unless the victim is delivered to them.
- Medical professionals are expected to report all gun-related injuries, but they can choose to keep the patient’s personal details private if doing so will not endanger others. In cases where identifying details are shared, consent should be obtained whenever possible and the patient should be informed prior to disclosure so long as this does not pose a safety risk. The victim’s belongings and any bullets (etc) removed should be bagged, labelled, and secured as forensic evidence in applicable cases.
This varies, but as a general time frame, someone treated in a modern hospital may be discharged in 1-2 weeks with full recovery in 3-6 months. Additional treatments for broken bones, damaged organs, and other complications can prolong this timeframe significantly. For instance, patients with stomach wounds will not be allowed to consume anything by mouth for an extended time and may need to remain in the hospital on a feeding tube or intravenous fluid diet.
Gunshot victims may also require physical, respiratory, and/or other types of therapy. If they have not fully recovered before leaving the hospital, their wound must be kept bandaged, clean, and dry. They should have regular follow up visits to monitor their progress.
In the event that advanced medical treatment is not available, recovery will be much more difficult if it happens at all. Loss of function in the affected area becomes more likely as well as permanent damage from infection and other complications.
Of course, this is just the physical recovery. For more on the possible psychological effects, check out my previous article on PTSD.
Dee is a moderator and blogger for Story Scribes. In her downtime she tries out various crafts, plays video games, and makes music. Currently, she’s working on a fantasy story that’s been trying to escape for a few years.