Odd Job's Gunshot Thread

[CobrayCommando]

Odd Job, thanks x1000.

Do you have the book "Bullet Penetration, Modeling the Dynamics and the Incapacitation Resulting from Wound Trauma", by Duncan MacPherson? If not you should definately check it out. If you'd like I would be able to scan a couple dozen pages and email them to you.

 

[Odd Job]

@ CobrayCommando

What a coincidence, my sister has ordered that book for me! She is in Colorado and will mail it to me in London when she gets it.

 

[JohnKSa]

I haven't seen any single-surface spalling (but that doesn't mean it can't happen).

That would mean that secondary projectiles (bone fragments/splinters) would be FAR more likely to originate from a fracture, as opposed to a deflection.

I hadn't really thought about the fact that bones are "sort of" hollow (at least they're not what we think of as bone through and through), but what you say makes perfect sense.

 

[CobrayCommando]

@ CobrayCommando

What a coincidence, my sister has ordered that book for me! She is in Colorado and will mail it to me in London when she gets it.

Fantastic, you'll love it.

 

[Odd Job]

@ JohnKSa

That would mean that secondary projectiles (bone fragments/splinters) would be FAR more likely to originate from a fracture, as opposed to a deflection.

Yes, that fits in with what I have seen so far. Of course if you discuss secondary projectiles that are pieces of bone with an orthopaedic surgeon, he will point out that any loose bone like that can only be as a result of a fracture. What I am saying is, I know what you are getting at in terms of one surface being intact and the other surface giving up bone, but the medics will regard all those loose pieces of bone as fracture fragments regardless of the integrity of the parent bone from which they originated.
I am going to post some fractures caused by gunshots soon.

 

[Odd Job]

Gents (and any ladies that might be reading too), we have reached the point in this thread where I cannot continue without introducing some medical terminology. It is unavoidable if I am to keep things from becoming bloated and verbose. When dealing with trajectories and anatomy there are certain standard terms we use to describe what part of the anatomy is involved. I don't want to turn this into a medical text, but I need to get the basics out of the way. If you bear with me here then you will appreciate the subsequent bone fracture cases even more.

Firstly, when discussing human surface anatomy, we have a thing called the Anatomical Position. You can think of this as a kind of 'default' position that the person adopts while being surveyed. The anatomical position is as follows:

If you stand up and have your arms straight with your palms facing forwards that is the anatomical position. It is quite important because that is the reference position from which all terminology relating to planes and areas of the body are derived.
The next thing to be aware of, is that all radiographs (X-ray films or images) are viewed as if the patient was standing in front of the viewer in the anatomical position. This means that the patient's left-sided anatomy will be seen on your right and the patient's right-sided anatomy will be seen on your left.
Below I have a representation that illustrates this:

Regardless of whether it is a trauma chart or a radiograph, that is how it is viewed. The patient's left is on your right and vice versa. There are more than 200 bones in the human body, but for the purposes of this thread I will make things as simple as possible. For example I may refer to the patella but I will also put in brackets the layman's term for it (in this case the knee cap).
Okay now this is where things get interesting, because in the hospital you don't want to have to spend a long time describing to a doctor on the phone where this guy has been shot, or where you think this bullet has gone. You don't want to have to write reams of notes just to describe where the injuries are. We need a kind of 'port' and 'starboard' terminology for humans, if you follow what I mean. And that's exactly what we do have. It has to be quite precise otherwise mistakes can be made. Furthermore it has to take into account the fact that a human is not a nice angular geometric shape. You will therefore find that anatomical locations are described with reference either to the body itself, or to a specific limb, or even a specific bone or organ. Here is a simple example, using those legs from before:

If we want to say that the guy got shot in the 'outside surface' of his leg, we use the term lateral. If we want to talk about the 'inside surface' then we use the term medial. All it means is that we divide the limb down the middle and what is outside is lateral and what is inside is medial. This is true whether you are looking at the guy from the front or from behind. Now you can make this quite specific, because you can refer to the medial or lateral aspect of a particular bone if you want to (and I'm going to be doing that quite a lot when I post all those gunshot fractures later). In addition to medial and lateral we also like to specify which end of the bone we are talking about. For example your tibia (or shin bone) starts at the knee joint and goes down to the ankle joint. Generally when talking about limbs, the part that is closer to the body is called proximal and the part that is furthest away is called distal. In the image above I have indicated the lateral aspect (or side) of the left lower limb and I have also indicated the proximal portion (or nearest half) of the right tibia.
But what about front and back? Here is an image of the right leg, viewed from the medial aspect:

Again, the limb is divided down the middle. Everything to the front is called anterior and everything to the back is called posterior. But if we want to be more specific, we can specify a location that is relative to a particular anatomical feature. For example in that image, I have divided the patella (knee cap) into a front and back half (anterior and posterior portion) with a black line. Everything forward of that line (in the direction of the black arrows) is anatomy that we say is anterior to the patella. Everything behind that line is anatomy that is posterior to the patella, even though when we were talking about the whole limb, some of that anatomy was considered to be anterior.

Continued...

 

[Odd Job]

If we look at a hypothetical gunshot trajectory we can start to describe where the bullet has gone:

In this case the bullet has entered laterally on the left, exited medially on the left and re-entered medially on the right. We could further specify that this trajectory is superior to inferior (from high to low). Or you could say it entered the left thigh distally, exited distal to the level of the entrance wound, and then re-entered the right lower leg distally. And somewhere in the trajectory there was a deflection. The observation would be that the projectile is lodged in the medial aspect of the lower leg, distally. To find out whether it is anterior or posterior would require another X-ray from the side. If you imagine a cross-section of the limb, you can appreciate the various terms used to describe the possible locations of retained projectiles within that limb:

Now you can see that we have terms for a location that is not quite posterior but not quite lateral for example. The proper term for that is postero-lateral. And there you can see the two planes of division that are used to determine whether anatomy is posterior or anterior (coronal plane) or whether the anatomy is medial or lateral (sagittal plane). The actual plane presented on your screen is the axial plane, and that is the 'extra plane' that you see on CTs for example.

Here is another hypothetical trajectory:

In this case, if you look at the surface, you will see that the bullet entered the knee laterally on the left, passed through the distal femur (suffering fragmentation) and then a portion of the original projectile exited medially and superiorly. We don't know where that portion of the projectile is. It didn't hit the other leg, so I have a question mark there. However we do have a retained fragment. We would describe that as having travelled superiorly and centrally (neither lateral nor medial) and we would need further X-rays to determine whether it was within the femur or not. If bone fragments came off the fractured femur, they would more than likely be projected medially, in the direction of projectile travel. But that doesn't mean they would not be able to move anteriorly or posteriorly in relation to the projectile's trajectory.

This may seem complicated to you if you don't have a medical background, but if you at least know what medial is and what lateral is, that is a good start. It can get a lot more complicated, particularly when discussing hands and fingers. The anatomical position dictates that the thumbs are lateral to the little fingers (see the first image again), but you have lateral and medial aspects of each finger to consider, when discussing gunshot wounds of the hand and digits.

You have not been charged for this lesson

 

[Dr. Courtney]

I have read Jussila's thesis and generally I have to say that while his intent is honourable, he is not in touch with the variables associated with shooting incidents and the medical effects/handling of these. That's my opinion as a radiographer. He wants a magic bullet, that is the bottom line.

I don't get that impression at all from the Jussila thesis. Like all works of this size and complexity, the thesis has strengths and weaknesses. However, it seems odd to make a judgment on the author's motive based on a scientific work. There is no hint of a desire for a "magic bullet" in the outline of objectives on page 48.

Basically what he wants here is a round that loses all its energy so that it can't exit, or if it does exit it has reduced energy so that it can't hurt anybody else.

This is a cultural/political view regarding the use of force by law enforcement. Its presence in the thesis helps justify the work in academic and government circles, but such a view does not impact the scientific validity of the work. It simply acknowledges that there is some demand for law enforcement bullets to work this way in Finland, not a scientific assertion that all bullets should work this way.

:
The Swiss delegation to the Expert Meeting of the International Committee of the Red Cross presented a Draft Protocol on Small Calibre Weapon Systems (1994). Recognising that not only bullet expansion but also other factors cause tissue injury, it proposes a limit for the amount of kinetic energy that is released. It suggests prohibiting the use of ‘arms and ammunition with a calibre of less than 12.7 millimetres which from a firing distance of at least 25 meters release more than 20 joules of energy per centimetre during the first 15 centimetres of their trajectory within the human body’.

And how can that figure be reconciled with a terminal trajectory that traverses tissues that are not homogeneous?

When quoting something as long as a thesis (over 100 pages), it would be nice if you included page numbers. Nearly half the thesis (47 pages) is a review of the ballistics literature, and you end up quibbling with Jussila over statements that are not original to him, but that he is relating from the literature. You might quibble with the original authors about the content of the statements, but you could really only quibble with Jussila about whether the statements accurately reflect the original work.

The rule of four C’s is ordinarily used for identifying the devitalised tissue:
- lack of Contractility
- altered Consistency
- altered Colour
- lack of Capillary bleeding

Okay so these are his parameters for determining what devitalised tissue is. Unfortunately his research mixes handgun and rifle projectiles, and the volume of devitalised tissue is determined by a measurement of the debrided tissue, as determined by the subjective impression of the surgeon handling the case. This method lacks precision and throws in confounding variables. As far as I am concerned it sinks the thesis right there.

Once again, you are attributing to Jussila assertions that he is relating from the literature in the review portion of his thesis (p 41). Jussila's review is balanced and acknowledges that there are alternate views in the literature as well. The "Review of the literature" portion of a thesis can usually only sink a thesis if important viewpoints are omitted, if major mistakes are made in attribution, or if the reviewer ascribes assertions to the original authors that are not present in the works cited.

Although the size of the exit wound is included in the Red Cross wound classification [Coupland 1993 and 2000] and a large exit wound should be considered a warning sign of extensive internal tissue destruction [Janzon 1997] its effects are not totally negative. First of all the existence of an exit wound allows access to the wound channel from both ends and signifies that at least most of the projectile has exited from the wound.

He is placing undue emphasis on the size of the exit wound. In handgun injuries it means nothing.

Jussila is discussing the Red Cross wound classification system, not making his own assertions here. Once again, you are attributing to Jussila assertions that he is not making.

Quote:

The rule of four C’s is not unanimously accepted and more conservative approach of excising only the obviously detached tissue has been presented [Fackler 1989, Santucci and Chang 2004]. As stated previously, this view may lead to severe anaerobic infection and possible gas gangrene [Janzon personal communication 2004].

If this was the case (the theory that less aggressive debridement carries the risk of increased necrosis) then we would have ample data for this and hospital procedures would have changed accordingly.

The use of better antibiotics allows for less debridement. In the absence of antibiotic availability, the negative impact of less debridement would be much more obvious.

Penetration ability of the standard issue projectile must be controlled with minimum and maximum tissue simulant penetration in defined tests with a defined maximum for acceptable residual kinetic energy after penetration of 250mm of simulated tissue.

That's a magic bullet. It does not exist. All that can be guaranteed is minimum penetration in gel.

A maximum penetration in gel can also be guaranteed, as well as a specified energy after penetrating 250mm of gel. Also keep in mind that he is discussing requirements for a "standard issue projectile" for a specific cultural and political situation (Finland). He is not making a global recommendation.

In addition, Wolberg showed that penetration in humans is well correlated to gelatin. There is a wider variation in humans, of course. But one could probably say with some degree of confidence that most bullets are unlileky to penetrate humans more than 150% of their maximum penetration in gelatin.

I am not an engineer but it seems to me that the heavy nose and controlled expansion are mutually exclusive. It rules out a hollow point straight away. Perhaps an engineer can comment here.

What about a design something like the Corbon Pow'r Ball with a tungsten or depleted uranium ball up front?

Then he wants data recorded by physicians attending to gunshot victims so that it can be correlated with data from tissue simulant firings and computer models. These are the data he wants:

Weapon type (if known)
Calibre (if known)
Ammunition type (if known)
Shooting distance (if known)
Impact type (direct/ricochet/through barrier)
Barrier type
Ballistic protection worn
Projectile type (if known)
Projectile retained weight
Projectile degree of deformation
Wound channel length and proximity to vital organs
Entry and exit wound locations
Maximum diameters of entry and exit wounds
Mass of excised tissue
Bone injury classification

In the medical environment, in cases not involving LEOs, it is going to be almost impossible to get these variables: weapon, ammunition, distance, impact type, projectile type, and wound channel length and proximity to vital organs.
. . .

This guy hasn't seen a lot of gunshot wounds, and it is obvious by reading his recommendations.

Actually, the text is clear that Jusilla does not expect all of the desirable information to be available in every case. However, there is nothing worng with the approach of collecting all of the available data and restricting a given analysis technique to the subset for which the needed information is available.

I would say my impression is this: he has a study that links kinetic energy with devitalised tissue. I have issues with how that tissue was measured, but I don't have issues with the concept in principle (that increased kinetic energy leads to more devitalised tissue, when such devitalisation is specified to manifest itself in the manner that he outlines). However, it does not automatically follow that devitalised tissue leads to necrosis. If that was the case then every gunshot victim we sent home without a debridement would eventually end up with gangrene.

Devitilized tissue that is not debrided presents the risk of gangrene and other infections. Better anitobiotics significantly reduce this risk. But what shall we do when the infectious agents become more resistant even to the better antibiotics? With appropriate use of prohpylatic antibiotics, splitting hairs over how much devitalized tissue becomes necrotic is not that important.

However, nor can you assert that the absence of infection is proof that none of the devitilized tissue becomes necrotic.

I am afraid my initial thoughts on this matter are unchanged. I don't think devitalised tissue from the indirect effects of the handgun projectile are very significant in terms of incapacitation. There is variation (according to tissue type) on the prognosis of the gunshot victim.

Jussila is very clear in his distinction between wound ballistics and incapacitation ballistics. His work on devitilization of tissue is relevant to trauma treatment, particularly in cases where effective antibiotics are unavailable. I do not believe that Jussila asserts any importance of his link between energy and devitilized tissuue to the subject of incapacitation.

Michael Courtney

 

[Odd Job]

When quoting something as long as a thesis (over 100 pages), it would be nice if you included page numbers. Nearly half the thesis (47 pages) is a review of the ballistics literature, and you end up quibbling with Jussila over statements that are not original to him, but that he is relating from the literature. You might quibble with the original authors about the content of the statements, but you could really only quibble with Jussila about whether the statements accurately reflect the original work.

My comment in this thread, on Jussila's thesis, is not an article in a peer-reviewed journal. It was made on the not unreasonable assumption that the gentleman who asked me about it had read the whole thesis. If the lack of page numbers was an inconvenience to you, that is most unfortunate. I will provide them specifically for you this time.
As for quibbling with Jussila, he is not immune from critique when he subscribes to cited material in the review part of his thesis. This is evident here:

The most critical opponent of the “kinetic energy deposit” proportionality to tissue devitalisation is Martin Fackler [Fackler 1987]. The core of Fackler’s reasoning is that too much tissue is excised by the surgeons. This line of thinking does not seem to have gained undivided acceptance and is countered by saying that unless devitalised tissue is removed a severe anaerobic infection will result with heightened probability of perfringens (gas gangrene) jeopardising the life of the patient [Janzon personal communication 2004].

Jussila has his objectives and it is clear when reading the whole thesis that this is the line he is taking. If I am critical of that (and the references he uses to support that), then that is my valid opinion. You are welcome to yours.

Quote:
I have read Jussila's thesis and generally I have to say that while his intent is honourable, he is not in touch with the variables associated with shooting incidents and the medical effects/handling of these. That's my opinion as a radiographer. He wants a magic bullet, that is the bottom line.

I don't get that impression at all from the Jussila thesis. Like all works of this size and complexity, the thesis has strengths and weaknesses. However, it seems odd to make a judgment on the author's motive based on a scientific work. There is no hint of a desire for a "magic bullet" in the outline of objectives on page 48.

Well, we got different impressions then. I didn't arrive at mine from the objectives, I arrived at it from his proposals in Paper 1 on page 60, under the heading "To avoid superfluous injury and unnecessary suffering to the offender" and from the general tone and drift of his paper.

The use of better antibiotics allows for less debridement. In the absence of antibiotic availability, the negative impact of less debridement would be much more obvious.

That's speculation on your part. The jury is out on low velocity gunshot wounds and antibiotics (the question of whether to use antibiotics at all in simple cases). There is adequate support for the use of antibiotics routinely in the treatment of high velocity gunshot wounds.

Here is the most recent article I can find on this subject:

http://www.jaaos.org/cgi/content/full/14/10/S98

Devitilized tissue that is not debrided presents the risk of gangrene and other infections.

How do you arrive at that conclusion?

Actually, the text is clear that Jusilla does not expect all of the desirable information to be available in every case. However, there is nothing worng with the approach of collecting all of the available data and restricting a given analysis technique to the subset for which the needed information is available.

There is nothing wrong with the approach, but I have stated my reasons why the majority of those variables cannot be found. It is a matter of experience, and seeing what happens in real shootings. I recommend both you and Jusilla spend some quality time at a level 1 trauma center and get back to me on how many of those variables you can find when dealing with gunshot victims.

Quote:
I am not an engineer but it seems to me that the heavy nose and controlled expansion are mutually exclusive. It rules out a hollow point straight away. Perhaps an engineer can comment here.

What about a design something like the Corbon Pow'r Ball with a tungsten or depleted uranium ball up front?

I can see the headlines now: "Outrage as Finnish police shoot man with depleted uranium."
Setting aside the legal and ethical issues, I doubt that a small tungsten sphere or DU sphere would be enough to shift the center of gravity of any police projectile to the nose. My guess is that the amount of DU or tungsten needed to shift the center of gravity forward is not compatible with an expanding projectile.
Once again, we need an engineer's comment on that one.

 

[Dr. Courtney]

Well, we got different impressions then. I didn't arrive at mine from the objectives, I arrived at it from his proposals in Paper 1 on page 60, under the heading "To avoid superfluous injury and unnecessary suffering to the offender" and from the general tone and drift of his paper.

This goal comes from the political realities of the author's country. Goals that arise from political and cultural considerations should not be considered to detract from the scientific validity of a work.

I have personally seen hundreds of gunshot wounds and I am well aware of a wide range of variables make analysis challenging.

I can see the headlines now: "Outrage as Finnish police shoot man with depleted uranium."
Setting aside the legal and ethical issues, I doubt that a small tungsten sphere or DU sphere would be enough to shift the center of gravity of any police projectile to the nose. My guess is that the amount of DU or tungsten needed to shift the center of gravity forward is not compatible with an expanding projectile.
Once again, we need an engineer's comment on that one.

You don't need to shift the center of gravity "to the nose" merely slightly further forward. A DU or tungsten sphere can shift the center of gravity sufficiently forward to significantly improve stability during penetration. This is an engineer's comment on the matter.

Michael Courtney, PhD

 

[Dr. Courtney]

Okay so these are his parameters for determining what devitalised tissue is. Unfortunately his research mixes handgun and rifle projectiles, and the volume of devitalised tissue is determined by a measurement of the debrided tissue, as determined by the subjective impression of the surgeon handling the case. This method lacks precision and throws in confounding variables. As far as I am concerned it sinks the thesis right there.

It's the only method for which data is available to perform any sort of analysis on devitalized tissue vs. energy. Jussila acknowledges the lack of precision.

It should also be noted that the material in Jussila’s thesis has been subject to a significant level of peer review, both from his supervisor and thesis reviewers, as well as that involved with the five peer reviewed papers resulting from the thesis (four scientific papers, one legal paper). His thesis supervisor and two additional thesis reviewers are well-qualified:

Ari Leppaniemi, MD, Thesis supervisor, Department of Surgery, Meilahti Hospital, University of Helsinki, Helsinki, Finland.

Harri Pihlajamaki, MD, Thesis reviewer, Institute of Military Medicine, Helsinki, Finland.

Ulf P. Arborelius, MD, Thesis reviewer, Swedish Defense Research Agency—FOI, Stockholm Sweden.

The work described in the thesis was not only subject to review by the thesis supervisor and reviewers, but also to the standard editorial and peer-review processes associated with these five scholarly journal articles:

Ballistic skin simulant. Forensic Science International, Volume 150, Issue 1, Pages 63-71 J. Jussila, A. Leppäniemi, M. Paronen, E. Kulomäki (2005).

Measurement of kinetic energy dissipation with gelatine fissure formation with special reference to gelatine validation. Forensic Science International, Volume 150, Issue 1, Pages 53-62 J. Jussila (2005)

Preparing ballistic gelatine—review and proposal for a standard method. Forensic Science International, Volume 141, Issue 3, Pages 91-98 J. Jussila (2004)

Ballistic variables and tissue devitalisation in penetrating injury—establishing relationship through meta-analysis of a number of pig tests. Injury, Volume 36, Issue 2, Pages 282-292 J. Jussila, B. Kjellström, A. Leppäniemi (2005)

1: Med Confl Surviv. 2004 Jan-Mar;20(1):55-69. International law and law enforcement firearms. Jussila J, Normia P. (2004)

So whose opinion should we accept about the quality of Jussila’s thesis, an anonymous radiographer, or the qualified supervisor, reviewers, editors, and peer-reviewers?

I doubt that Odd Job’s poorly constructed criticisms above would withstand the editorial and peer-review needed to get published as a comment in one of the same journals as Jussila’s original work. (When one disagrees with published scientific work, the most credible venue to express that disagreement is to publish a comment in the same venue as the original work.)

As I said before, like any work of thesis length, Jussila’s thesis has strengths and weaknesses. We could certainly have a good discussion of the boundaries of applicability of each of his findings. However, on the whole, Jussila’s thesis and the five associated scholarly journal articles represent sound and valuable contributions to the subject of terminal ballistics. I was delighted when a colleague brought the thesis to my attention, and I consider my copy a valuable addition to my collection of scholarly works.

Michael Courtney, PhD

 

[Odd Job]

You don't need to shift the center of gravity "to the nose" merely slightly further forward. A DU or tungsten sphere can shift the center of gravity sufficiently forward to significantly improve stability during penetration. This is an engineer's comment on the matter.

I would be interested to see your draft designs on those (if that doesn't conflict with a possible patent application). How far forward does the insert have to be? How large will it be relative to the core?

The work described in the thesis was not only subject to review by the thesis supervisor and reviewers, but also to the standard editorial and peer-review processes associated with these five scholarly journal articles:

Ballistic skin simulant. Forensic Science International, Volume 150, Issue 1, Pages 63-71 J. Jussila, A. Leppäniemi, M. Paronen, E. Kulomäki (2005).

Measurement of kinetic energy dissipation with gelatine fissure formation with special reference to gelatine validation. Forensic Science International, Volume 150, Issue 1, Pages 53-62 J. Jussila (2005)

Preparing ballistic gelatine—review and proposal for a standard method. Forensic Science International, Volume 141, Issue 3, Pages 91-98 J. Jussila (2004)

Ballistic variables and tissue devitalisation in penetrating injury—establishing relationship through meta-analysis of a number of pig tests. Injury, Volume 36, Issue 2, Pages 282-292 J. Jussila, B. Kjellström, A. Leppäniemi (2005)

1: Med Confl Surviv. 2004 Jan-Mar;20(1):55-69. International law and law enforcement firearms. Jussila J, Normia P. (2004)

Don't get me wrong, I don't say it is all bad. I have no problem with his tests and preparations regarding ballistic gel and skin simulants. I just don't think that his proposals are compatible with actual variables on the ground. Feel free to disagree.

So whose opinion should we accept about the quality of Jussila’s thesis, an anonymous radiographer, or the qualified supervisor, reviewers, editors, and peer-reviewers?

I might very well have levelled that comment at you, considering how you have staunchly defended your 'citation' of the "Strasbourg tests" in your own research. The difference being that I don't expect my opinion to be included in a journal or thesis, yet you were quite happy to accept an anonymous 'study' as the basis for many of your proposals. If you don't think that an anonymous radiographer's opinion is worth anything then why is it that we seem to have long exchanges on a variety of matters on several fora? Why do you even bother?

I doubt that Odd Job’s poorly constructed criticisms above would withstand the editorial and peer-review needed to get published as a comment in one of the same journals as Jussila’s original work. (When one disagrees with published scientific work, the most credible venue to express that disagreement is to publish a comment in the same venue as the original work.)

Whether you think my criticisms are valid or not, is of no concern to me. You have your opinion of the thesis and I have mine. I have already stated what the basis is for my opinion and the fact that it isn't an article in a peer-reviewed journal.
But anyway it looks like we are going to go backwards and forwards on this issue and I am quite happy to let it rest there.

I have personally seen hundreds of gunshot wounds and I am well aware of a wide range of variables make analysis challenging.

I would be interested to know the demographics of that sample. What was the average age of these men? Did you find that there was a trend in the types of clothing they wore? Did you find any indications that the statements they made concerning the shooting were not consistent with the evidence at hand? Which hospital was that in? I am always interested in other studies of this nature.

 

[Dr. Courtney]

Don't get me wrong, I don't say it is all bad. I have no problem with his tests and preparations regarding ballistic gel and skin simulants. I just don't think that his proposals are compatible with actual variables on the ground. Feel free to disagree.

Thanks for clarifying. When you wrote, "It sinks the thesis for me right there" I tended to interpret that as if you were asserting there was little of scientific merit in the thesis.

The thesis is a bit removed from the emergency room and trauma table. But that's not a problem for me. Good science is done at various degrees of separation from "actual variables on the ground." Peters' work is even further removed, for example. Simplifying (even over simplifying) problems is often how scientific progress is made. Every Freshman physics course, for example, begins by ignoring the effect of air resistance on projectiles. Once the description of an oversimplified phenomenon is understood, then the complicating factors can be added back one at a time to gain a more realistic view.

Progress in many areas of science is made in this way. Eventually, the simplified views grow in complexity to be comparable with "actual variables on the ground." Acknowledging that the two have not yet met in terminal ballistics is just recognizing the state of the science.

So whose opinion should we accept about the quality of Jussila’s thesis, an anonymous radiographer, or the qualified supervisor, reviewers, editors, and peer-reviewers?

I might very well have levelled that comment at you, considering how you have staunchly defended your 'citation' of the "Strasbourg tests" in your own research. The difference being that I don't expect my opinion to be included in a journal or thesis, yet you were quite happy to accept an anonymous 'study' as the basis for many of your proposals.

First of all, I would more view the work of Suneson and Wang as the basis for my proposals regarding the ballistic pressure wave, as well as the large volume of work on the fluid percussion model of traumatic brain injury [TLM05] and references therein. Strasbourg is a corrorborating data set. I have appended references below to a number of scholarly articles that support the pressure wave hypothesis in one way or another. In addition, we've also performed research of our own that is in various stages of the publication process. We expect to be able to cite a number of our own references by the end of this year.

If you haven't read Suneson (esp. [SHS90a] and [SHS90b]) and Wang [WWZ04], I highly recommend it. No one is in a good position to criticize the pressure wave hypothesis until they have a good understanding of these papers.

It is also an exaggeration to say that I view anonymity as a disqualifying factor in a scientific discussion. It isn't. But remaining anonymous increases the burden for supporting one's view by referencing data that is experimentally (or observationally) repeatable. In other words, data from an anonymous source has much more merit in a scientific discussion than an opinion that has no data to back it up.

You make many points that are well supported with hard data. I have no disagreement with most of these. Hard data can lead to valuable discussions, and we have had a number of them in the past. However, your comments on the Jussila thesis were opinions for which you offered little data to support.

Michael Courtney

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[Odd Job]

In other words, data from an anonymous source has much more merit in a scientific discussion than an opinion that has no data to back it up.
You make many points that are well supported with hard data. I have no disagreement with most of these. Hard data can lead to valuable discussions, and we have had a number of them in the past. However, your comments on the Jussila thesis were opinions for which you offered little data to support.

It is unreasonable to ask me to supply data in support of my rejection of Jusilla's proposals, when not even he has data to support the viability of them. My original comment outlined why I reject his proposals and what the reasons are:

I said in the beginning: In the medical environment, in cases not involving LEOs, it is going to be almost impossible to get these variables: weapon, ammunition, distance, impact type, projectile type, and wound channel length and proximity to vital organs.
These other variables can only be found if the projectile is recovered from the victim during a medical procedure: projectile retained weight and projectile degree of deformation (although the latter may be found if the axis of the retained projectile is such that it can be X-rayed in two planes and an approximate deformation can be assumed, even if the projectile is not going to be removed). The bone injury, entrance and exit locations and clothing and in some cases the barrier can be found. Those are the easiest to get.
Even if you take into account LEO shootings only (where the LEO is the shooter) you still have a problem with projectiles in situ that cannot be retrieved, or even projectiles at the scene that cannot be found or are not complete, when assessing deformation and final weight. Don't forget that you can get projectile fragments deposited in the wound even if it is a perforating injury. This guy hasn't seen a lot of gunshot wounds, and it is obvious by reading his recommendations.

The thesis is a bit removed from the emergency room and trauma table. But that's not a problem for me. Good science is done at various degrees of separation from "actual variables on the ground."

I don't mind if the thesis is removed from the trauma table, if the proposals are equally removed. They are not. The thesis has proposals that are aimed directly at real life shootings of human subjects, and the collection of data associated with them. My opinions stem from the fact that I can't reconcile his proposals with my experience of real life gunshot wounds on human subjects.
A casual onlooker might then ask if my experience is relevant and substantial. Well, sir, that is partly why I asked you for the demographics of the hundreds of gunshot wounds you have seen. My experience comes from being involved in the acute care of around 3000 human gunshot victims, 150 of which are research subjects in a protocol that I devised and executed with specific clearance from the Ethics Committee attached to the University of the Witwatersrand in Johannesburg, South Africa. I don't claim my experience and research to be the pinnacle of excellence in the world of ballistic trauma. What I claim is a better understanding of the variables that pertain to real life shootings of human subjects, with specific regard to many of the proposals Jussila has made.

 

[Dr. Courtney]

It is unreasonable to ask me to supply data in support of my rejection of Jusilla's proposals, when not even he has data to support the viability of them. My original comment outlined why I reject his proposals and what the reasons are:

Your shifting the topic from your original assertion that the difference between debrided and devitilized tissue "sinks the thesis right there" to a separate objection to a proposal for future data collection in future work.

I was challenging you to reference data to support your assertion that there is a substantial difference between debrided and devitalized tissue.

I said in the beginning: In the medical environment, in cases not involving LEOs, it is going to be almost impossible to get these variables: weapon, ammunition, distance, impact type, projectile type, and wound channel length and proximity to vital organs.

A lot of these parameters are determined in standard forensic investigations. Weapon and ammunition type can often be determined from a shell casing if the original projectile is not recovered or too deformed to identify. Distance can be determined from several methods. Projectiles that pass through are often recovered. Examination and weighing of the recovered projectile can often rule out the possibility of fragments remaining in the body.

This guy hasn't seen a lot of gunshot wounds, and it is obvious by reading his recommendations.

The author never suggests that all the information will be available in each case, he merely asserts that as much information as possible should be collected.

I don't mind if the thesis is removed from the trauma table, if the proposals are equally removed. They are not. The thesis has proposals that are aimed directly at real life shootings of human subjects, and the collection of data associated with them. My opinions stem from the fact that I can't reconcile his proposals with my experience of real life gunshot wounds on human subjects.

There are many cases where the suggested information can be collected. Your objection stems from a strawman fallacy where you put into the author's mind the thought that all the information can be collected in every case.

Modern forensic science offers the potential to provide a lot of information that may have been absent from your own trauma experience. Just because the information was not available for a large number of shootings in your experience, does not imply that it cannot be available by combining the information generated by trauma personnel, forensic investigators, medical examiners, and law enforcement.

You are right that all the desired info will not be available in every case. There's nothing wrong with research that is a bit removed from real-life suggesting a more practical approach. The "suggestions for future research" part of most scientific papers is a relatively small part of the overall scientific contribution, and the Jussila thesis is no exception. His suggestions are much more attainable in the US or Finland than they are in South Africa, and even if there is missing information, assembling as much information as is available would be beneficial.

Michael Courtney

 

[Odd Job]

Dr Courtney

I was preparing a lengthy reply to you, but I realised we will probably go in circles because you are making a lot of assumptions that seem to come from an individual who has not had even the most rudimentary experience with dealing with live gunshot victims.
I ask you directly now: when you said that you have seen hundreds of gunshot wounds, can you give me an indication of what your dealings were with these individuals, and what the circumstances of surveying this sample were?
The reason is, I don't mind putting in a lot of effort into a response, but quite frankly if these aren't human subjects you are talking about, then we don't have a common frame of reference from which to have a discussion on this.
I hope you understand.

 

[Dr. Courtney]

The assertions I made can be supported from the literature without reference to my personal experience. Your claim that only someone without extensive trauma experience would make such assertions is a red herring. What difference does it make if the hundreds of gunshot wounds I've observed were in the emergency room or on the autopsy table? Both make one aware of the wide variety of variables involved.

In addition, the point modern forensic investigations can recover a great deal of information not available in the emergency room is the main point of my last post and can be supported from the forensic literature by anyone familiar with it without the need to refer to direct personal experience with gunshot wounds.

Another point I made in my last post was:

You are shifting the topic from your original assertion that the difference between debrided and devitilized tissue "sinks the thesis right there" to a separate objection to a proposal for future data collection in future work.

Once again, one does not need personal qualifications to ask if you've got data to support your assertion that debrided and are so uncorrelated as to "sink the thesis right there."

When reason and scientific data fail them, people often resort to debates of personal qualifications. I prefer to steer the discussion back to reason and scientific data.

Michael Courtney