Handgun stopping power

[pblanc]

I do not see any reason to give credence to the idea that survival rates from firearm injuries are skewed by hospitals keeping two sets of books on firearm injuries based on whether or not the patient arrives dead or dies onsite.

But I'm open to the possibility that I'm wrong. Is there actually any credible evidence that hospitals actually do keep their statistics in that fashion?If you throw a pole with two flat ends into the air, there are only two options for how it will end up. It can end up lying on its side, or it could land balanced on one of the two ends. It lies flat or stands up--only two options. But one of those options is TREMENDOUSLY more likely than the other. The idea that the odds of an outcome are 50/50 because there are only two options is not at all based on fact.

There is a National Trauma Data Base and the Centers for Disease Control, both of which maintain data on the outcome of victims of all types of trauma, penetrating and blunt, including, of course, gunshot wounds. This data is available to researchers for meta-analysis. This data base extends back many decades, but not hundreds of years. Of course, mortality rates were much higher back in the days before general anesthesia, modern surgical care, antibiotics, aseptic technique, and effective emergency medical treatment and transport. And yes, this data is limited to the US.

Some medical centers with large trauma centers will also publish results of their collective experience over a number of years, and in some larger urban areas these studies might include several hundred cases.

Case fatality rates are given for various types of trauma. Of course, the case fatality rates include those patients who arrive DOA. Gunshot wound victims who have no signs of life at the scene or in transport are not just dropped off in dumpsters on the way to the hospital. Nor do they go directly to morgues or funeral homes. They wind up being declared in the Emergency Department. Even then, they are assigned a patient identification number and bracelet before going to the morgue, and Coroner. Someone who is found stone-cold dead of a gunshot wound out on the streets somewhere nearly always becomes a Coroner's case to establish the mechanism of death, etc, so they are included as well.

There are a number of gunshot wounds that do not appear in the registries because they wind up getting self-treated for various reasons. If these could be accounted for they would tend to skew the case fatality rate for gunshot wounds further downwards.

When looking at studies of the fatality rates for gunshot wounds, one has to take into account that some will include the outcome of all gunshot wounds. The great majority of these will be handgun wounds, but there will usually be a percentage of long gun wounds as well, which skews the case fatality rate higher. Some studies also include the outcome of intentionally self-inflicted gunshot wounds, i.e, suicides and suicide attempts. These self-inflicted gunshot wounds have a much higher fatality rate than those sustained as a result of assault or accident.

The vast majority of handgun gunshot wound victims who arrive at the hospital alive survive. I saw a moderate number of handgun wounds over the course of my career. I only saw one that arrived at the hospital with signs of life die. That was an individual who had a perforating brain injury from a self-inflicted .22 caliber handgun wound. He was later determined to be brain dead and probably was on arrival, but still had cardiopulmonary function on arrival.

 

[44 AMP]

Although the qualifiers are not explicitly stated, it is generally understood that the assertion is not meant to cover the entire half-millennium history of handguns nor to apply to every possible region of the world. Taken in context it applies to modern times and to areas where modern medical facilities are available.

I understand this, and essentially agree, however, when one puts the word "historically" in front of an assertion (and without explicitly stating any/all qualifiers), it opens the door to look at that assertion as it has applied throughout history.

ON the other hand, I suppose it is an irrelevant matter. What use is that statistic, anyway?

 

[briandg]

I'm surprised at how often the subject comes up and the bitter, harping, repetitive dogma that inevitably comes out. People quote the same old things, say the same old things, and generally speaking, if one collects all of the basic points made in a single list, every one of the long threads will say the same darned thing, repeating every single assertion, statistics that support the preferred answer will be paraded and others will rebut them.

People will always bring up the same old things, every time, because it's fun to do, or because they believe that someday, everybody in the world will agree.

 

[osbornk]

There have been several reasons mentioned as to why statistics on gunshot incidents are not accurate but there is one that nobody has mentioned. I think there are a lot of gunshot wounds that are not in statistics because the injured person never went to a hospital or other medical facility and they were never reported to authorities. Since the law requires that any gunshot injury be reported to the police, if the injury is treatable without a doctor, it heals and is never reported anywhere. I am an example. A few years ago, I dropped a 22 revolver that landed on the hammer and it went off. The bullet struck me in the stomach but because of the angle, it went in and out without doing much except causing me to bleed. If it had not been a gunshot wound, I would have gone to the emergency room but I treated it myself because I didn't want the police involved and the publicity it would have drawn. I suspect I am one of many.

 

[pblanc]

There have been several reasons mentioned as to why statistics on gunshot incidents are not accurate but there is one that nobody has mentioned. I think there are a lot of gunshot wounds that are not in statistics because the injured person never went to a hospital or other medical facility and they were never reported to authorities. Since the law requires that any gunshot injury be reported to the police, if the injury is treatable without a doctor, it heals and is never reported anywhere. I am an example. A few years ago, I dropped a 22 revolver that landed on the hammer and it went off. The bullet struck me in the stomach but because of the angle, it went in and out without doing much except causing me to bleed. If it had not been a gunshot wound, I would have gone to the emergency room but I treated it myself because I didn't want the police involved and the publicity it would have drawn. I suspect I am one of many.

Yes, as I said earlier, there are a substantial number of gunshot and knife wounds that go unreported either because the injury was obtained in the course of some criminal activity, or the victim is afraid of retribution from the attacker if it is reported, or the injury was acquired as a result of an embarrassing accident.

Obviously, virtually all of these unreported GSWs are non-fatal and if they were reported would slew the case fatality rate for GSWs in general significantly downward.

 

[Nanuk]

I do not see any reason to give credence to the idea that survival rates from firearm injuries are skewed by hospitals keeping two sets of books on firearm injuries based on whether or not the patient arrives dead or dies onsite.

But I'm open to the possibility that I'm wrong. Is there actually any credible evidence that hospitals actually do keep their statistics in that fashion?

If someone is dead at the scene then the hospital will never know, unless they are the medical director of that EMS system and their DR called the vic.

If they did not provide treatment they would have no record of treatment and could not add that one to the stats.

I personally hate stats. I will go out on a limb and say that if you make it to a modern trauma center alive your chances are very good of survival. It is just that our emergency medical providers are so good they can get people to the ER with non survivable injuries.

 

[JohnKSa]

If someone is dead at the scene then the hospital will never know, unless they are the medical director of that EMS system and their DR called the vic.

Correct--that makes perfect sense. I mentioned that possibility in a subsequent post:

"If they aren't transported to the hospital, I could see why that would be true, but if they are transported to the hospital to be declared dead, why would the hospital not keep a record of that fact and the circumstances of the injury that resulted in the death?"

 

[Nanuk]

If they aren't transported to the hospital, I could see why that would be true, but if they are transported to the hospital to be declared dead, why would the hospital not keep a record of that fact and the circumstances of the injury that resulted in the death?"

They are not normally transported just to be called (declared dead). A paramedic in contact with medical direction ( a DR that oversees paramedics per a prior written agreement) can call in cases of obvious death.

 

[stagpanther]

Isn't there somebody called a coroner?

 

[Cosmodragoon]

... so how strong can a Mountain Lion be ?

They are amazingly agile but not much sturdier than a coyote. A relative of mine killed one with a handgun in .40 S&W using whatever usual defensive hollow-points.

 

[44 AMP]

They are not normally transported just to be called (declared dead).

I've been through this, in my state, if the death is "unattended" meaning there was no one with them when they died (and that means not in the same room with them) the sheriff's deputies show up and do an investigation. Then, someone from the Coroner's office (a DR) shows up at the scene, and declares them dead. THEN EMT's can transport the body, or it waits for pickup by a funeral home.

Father in law went to the kitchen for a snack, and then expired, wife in the living room, found him on the floor when he didn't come back in a reasonable time. This is what happened. Call made, cops showed up with ambulance, asked enough questions to rule out foul play, waited till the coroner showed, death legally pronounced, then cops left. EMT's waited until informed funeral home was on its way, then left. I was there and helped load him into the wagon... overall, I've had better nights..

now, I've been thinking about the "survivability of handgun wounds", and while I'm not going to argue the numbers, I think there has got to be a better way to say it.

Something that doesn't leave me (and anyone else??) with the impression that any or every handgun wound is 80-85% survivable.
I get it that in defensive shooting, with small targets, moving, and often in low light, getting good hits is tough and the overwhelming majority of hits are not going to be instantly fatal, or even immediately stopping. SO yes, statistics will count numbers and pronounce the result. But I think the result of just those numbers is misleading.

Sadly, people do die from wounds that with proper and timely treatment are survivable, and a tiny percentage of people actually survive wounds that normally prove fatal. The way I see it, maybe 80-85% of people do survive, but the odds of any one case being in that percentage depend on a hugely complex host of factors interacting, and a blanket statement about survival percentage by the numbers simply doesn't begin to convey the actual reality of being shot.

And so, again I ask, what value is the statistic??

 

[Nanuk]

Isn't there somebody called a coroner?

https://www.crimesceneinvestigatoredu.org/coroner/

 

[pblanc]

They are not normally transported just to be called (declared dead). A paramedic in contact with medical direction ( a DR that oversees paramedics per a prior written agreement) can call in cases of obvious death.

That was not the case in the states in which I practiced medicine, but the law may vary from state to state and things may have changed since I retired from practice. During my practice in multiple states, only MDs or DOs could declare patients dead. Even Registered Nurses could not.

Yes, very obviously dead individuals usually become coroner's cases without a hospital being involved. However, in any instance of a fresh shooting if an individual is without signs of life, first responders will initiate resuscitative attempts and transport to a medical facility. How many times have you heard in the news that a gunshot victim was transported to a hospital where he later died? Well, most of those individuals were already dead before they got to the hospital, they were just declared dead after they arrived at the hospital.

But the number of gunshot wound fatalities that were the result of unwitnessed events and later found obviously dead is really pretty small considering the numbers of gunshot wounds in the whole, and many of those are suicides. So those fatalities really wouldn't have much affect on the overall reported case fatality rates for gunshot wounds that were the result of assault, self-defense, or police action.

Here is a retrospective analysis of case fatality rates for gunshot wounds resulting from firearms assault for the period 2003-2012. The authors maintain that the overall case fatality rate remained constant at 22%. Now, 22% is higher than the 15-20% overall fatality rate for handgun GSWs that I referenced. But this is an analysis of gunshot wound overall and doubtless included some long gun injuries as well.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508146/

As for the value of the statistic, for those who find it of no value or no interest I suggest they just ignore it.

 

[dahermit]

"...223 was developed for killing men in war..." Nope. It was never intended to be a battle rifle cartridge. Strictly an air crew survival rifle cartridge. Until McNamara decided the M-16 was sexy and jammed it down everybody's, the U.S. Army included, throats.

I remember reading (when the M16 first replaced the M14 in Vietnam that two reasons for the change was to allow soldiers to carry more ammunition and that it was found that in Korea, G.I.'s would sometimes get so fatigued by the recoil of their M1's that they would elect to pass-up shooting even in a "target-rich" environment...the mild recoiling .223 was the supposed remedy for that. I do not know how true that was, but that was what I read back then.
Having been one of the last to be issued an M1 in basic training, I can attest to cumulative effect of heavy recoil as being a possible factor in passing up a target.

 

[ManyMag]

Regarding stopping power of slow pistol caliber projectiles;
There is a small but busy community out there dispatching 500 to 1000 hogs (similar structure to humans) on any given week.
If you listen you'll learn the slower heavier projectile is better suited to breaking down and disabling the target.
Stopping and killing are two different things.

 

[Cosmodragoon]

There is a small but busy community out there dispatching 500 to 1000 hogs (similar structure to humans) on any given week.
If you listen you'll learn the slower heavier projectile is better suited to breaking down and disabling the target.
Stopping and killing are two different things.

I hope that we've all agreed that stopping power and killing power are different by this point in the thread.

The question I have is whether hogs and human are really that similar. I'm no pig expert but it seems to me that humans generally have a thinner cross section from many angles. When it comes to humans, how different are "fast and light" versus "slow and heavy" with respect to entering a skull cavity, severing a spine or major artery, fatally disrupting a heart, or just plain breaking bones?

Also, how fast does "fast and light" need to be and how heavy does "slow and heavy" need to be to achieve those things?

 

[JohnKSa]

That was not the case in the states in which I practiced medicine, but the law may vary from state to state and things may have changed since I retired from practice. During my practice in multiple states, only MDs or DOs could declare patients dead. Even Registered Nurses could not.

This is my understanding as well. I was not aware that in some states EMTs were allowed to make the call.

 

[ManyMag]

You missed my point, Cosmodragoon.
The thread subject is handgun stopping power.
Since you're throwing a big slow pill best suited for breaking things aim at a big bone to increase your odds of actually stopping whatever you're trying to stop.

 

[rwilson452]

I believe it was Wyatt Earp that once said, " Fast is good, accuracy is final."

Where I live in rural PA it usually takes a least 20 min to get an ambulance and another 20 min run to get to the hospital. Often it takes much longer to get to you. I suspect should I hit a house invader twice in center mass with my .45ACP. Their chances of living are darn poor. If I hit him in center mass with my 12GA, the odds would get really worse.

I will add: You may or may not get an EMT before you get to the hospital.

 

[Archie]

"Stopping power" is used in various forms. The goal is to prevent the villain - attacker - from continuing his attack. A 'stop' occurs when the villain is unable to continue. This may be death, serious injury, psychological defeat - including fear.

The villain does not have to be on the ground. If his eyes have rolled up in his head and he isn't tracking, he's stopped. No, that's not the easiest call to make.

Having spent some 28 years as a lawman, I have noted several facets. No. It isn't guaranteed. Too many variables for a sure fire prediction, sitting at home. However, it is a possibility and various conditions tend to encourage the phenomenon.

Accuracy is rather important. But accuracy applies to all calibers and weapons. A mediocre hit with a large caliber is better than a mediocre hit with a small caliber. A good, solid hit with a small caliber is better than a miss with a large caliber, but shooting a small caliber doesn't guarantee a hit. A good high center of the torso hit is the best 'ordinary' shot. The best shot is through the center of the brain, disrupting the motor centers of the brain. It is also rather difficult to effect. One must practice with one's defensive pistol and ammunition to encourage a good shot.

Sufficient caliber is important. An eight inch cannon does a much better job of it than a .45 ACP, for instance, but they are hard to holster. A standard .32 ACP is quite easy to carry, but tends to lack 'authority'. My own thought is nothing less than a .38 Special with full weight bullets and a reasonable velocity. I prefer larger, but I'm bucking the trend.

Also, it has been noted but is worth repeating. Death is possible in such matters but not needed. One wishes to end the threat, not kill the villain. It happens, but is not a requirement for the task. Which is not to encourage the idiotic notion of 'shoot to wound'.

Do not confuse animals with humans. Human sized animals tend to be more vital and harder to kill. A deer will not comprehend it has been shot, lay down and die like a human will.