Clinical and legal significance of fragmentation of bullets in relation to size of wounds: retrospective analysis.
(9/521)
OBJECTIVE: To examine the relation between fragmentation of bullets and size of wounds clinically and in the context of the Hague Declaration of 1899. DESIGN: Retrospective analysis of prospectively collected data on hospital admissions. SETTING: Hospitals of the International Committee of the Red Cross. SUBJECTS: 5215 people wounded by bullets in armed conflicts (5933 wounds). MAIN OUTCOME MEASURES: Grade of wound computed from the Red Cross wound classification and presence of bullet fragments on radiography. RESULTS: Of the 347 wounds with fragmentation of bullets, 251 (72%) were large wounds (grade 2 or 3)-that is, those with a clinically detectable cavity. Of the 5586 wounds without fragmentation of bullets, 2915 (52.1%) were large wounds. Only 7.9% (251/3166) of large wounds were associated with fragmentation of bullets. CONCLUSIONS: Fragmentation of bullets is associated with large wounds, but most large wounds do not contain bullet fragments. In addition, bullet fragments may occur in wounds that are not defined as large. Fragmentation of bullets is neither a necessary nor sufficient cause of large wounds, and surgeons should not diagnose extensive tissue damage because of the presence of fragments on radiography. Such findings also do not necessarily represent the use of bullets which contravene the law of war. Future legislation should take into account not only the construction of bullets but also their potential to transfer energy to the human body. (+info)
Mortality associated with use of weapons in armed conflicts, wartime atrocities, and civilian mass shootings: literature review.
(10/521)
OBJECTIVE: To determine the implications of variation in mortality associated with use of weapons in different contexts. DESIGN: Literature review. SETTINGS: Armed conflicts and civilian mass shootings, 1929-96. MAIN OUTCOME MEASURE: Mortality from wounds. RESULTS: During the fighting of war the number of people wounded is at least twice the number killed and may be 13 times as high; this ratio of the number wounded to the number killed results from the impact of a weapon system on human beings in the particular context of war. When firearms are used against people who are immobilised, in a confined space, or unable to defend themselves the wounded to killed ratio has been lower than 1 or even 0. CONCLUSIONS: Mortality from firearms depends not only on the technology of the weapon or its ammunition but also on the context in which it is used. The increased mortality resulting from the use of firearms in situations other than war requires a complex interaction of factors explicable in terms of wound ballistics and the psychology of the user. Understanding these factors has implications for recognition of war crimes. In addition, the lethality of conventional weapons may be increased if combatants are disabled by the new non-lethal weapons beforehand; this possibility requires careful legal examination within the framework of the Geneva Conventions. (+info)
Effect of type and transfer of conventional weapons on civilian injuries: retrospective analysis of prospective data from Red Cross hospitals.
(11/521)
OBJECTIVE: To examine the link between different weapons used in modern wars and their potential to injury civilians. DESIGN: Retrospective analysis of prospectively collected data about hospital admissions. SETTING: Hospitals of the International Committee of the Red Cross. SUBJECTS: 18 877 people wounded by bullets, fragmentation munitions, or mines. Of these, 2012 had been admitted to the hospital in Kabul within six hours of injury. MAIN OUTCOME MEASURES: Age and sex of wounded people according to cause of injury and whether they were civilians (women and girls, boys under 16 years old, or men of 50 or more). RESULTS: 18.7% of those injured by bullets, 34.1% of those injured by fragments, and 30.8% of those injured by mines were civilians. Of those admitted to the Red Cross hospital in Kabul within six hours of injury, 39.1% of those injured by bullets, 60.6% of those injured by fragments, and 55.0% of those injured by mines were civilians. CONCLUSIONS: The proportion of civilians injured differs between weapon systems. The higher proportion injured by fragments and mines is explicable in terms of the military efficiency of weapons, the distance between user and victim, and the effect that the kind of weapon has on the psychology of the user. (+info)
Circumstances around weapon injury in Cambodia after departure of a peacekeeping force: prospective cohort study.
(12/521)
OBJECTIVE: To examine the circumstances surrounding weapon injury and combatant status of those injured by weapons. DESIGN: Prospective cohort study. SETTING: Northwestern Cambodia after departure of United Nations peacekeeping force. SUBJECTS: 863 people admitted to hospital for weapon injuries over 12 months. MAIN OUTCOME MEASURES: Annual incidence of weapon injury by time period; proportions of injuries inflicted as a result of interfactional combat (combat injuries) and outside such combat (non-combat injuries) by combatant status and weapon type. RESULTS: The annual incidence of weapon injuries was higher than the rate observed before the peacekeeping operation. 30% of weapon injuries occurred in contexts other than interfactional combat. Most commonly these were firearm injuries inflicted intentionally on civilians. Civilians accounted for 71% of those with non-combat injuries, 42% of those with combat related injuries, and 51% of those with weapon injuries of either type. CONCLUSIONS: The incidence of weapon injuries remained high when the disarmament component of a peacekeeping operation achieved only limited success. Furthermore, injuries occurring outside the context of interfactional combat accounted for a substantial proportion of all weapon injuries, were experienced disproportionately by civilians, and were most likely to entail the intentional use of a firearm against a civilian. (+info)
Incidence of weapon injuries not related to interfactional combat in Afghanistan in 1996: prospective cohort study.
(13/521)
OBJECTIVE: To examine the descriptive epidemiology of weapon injuries not directly attributable to combat during armed conflict. DESIGN: Prospective cohort study. SETTING: Nangarhar region of Afghanistan, which experienced effective peace, intense fighting, and then peace over six months in 1996. SUBJECTS: 608 people admitted to Jalalabad hospital because of weapon injuries. MAIN OUTCOME MEASURES: Estimated incidence of injuries from combat or otherwise (non-combat injury) before, during, and after the fall of Kabul. RESULTS: Incidence of non-combat injury was initially 65 per 100 000. During the intense military campaign for Kabul the incidence declined dramatically, and then differentially increased dependent on injury subcategory-that is, whether injuries were accidental or intentional and whether they were inflicted by firearms or fragmenting munitions. Non-combat injuries accounted for 51% of weapon injuries observed over the study period. Civilians were more likely to have non-combat injuries than combat injuries. CONCLUSIONS: Weapon injuries that are not attributable to combat are common. Social changes accompanying conflict and widespread availability of weapons may be predictive of use of weapons that persists independently of conflict. (+info)
Central venous injuries of the subclavian-jugular and innominate-caval confluences.
(14/521)
Injuries to the central venous system can result from penetrating trauma or iatrogenic causes. Injuries to major venous confluences can be particularly problematic, because the clavicle and sternum seriously limit exposure of the injury site. We report our institution's experience with central venous injuries of the subclavian-jugular and innominate-caval venous confluences. Significant injuries of the subclavian-jugular venous confluence frequently result from penetrating trauma, while injuries to the innominate-caval confluence are usually catheter-related. Median sternotomy provides adequate exposure of the innominate-caval confluence, while exposure of the subclavian-jugular venous confluence requires extension of the median sternotomy incision into the neck and resection of the clavicle. The literature is reviewed. (+info)
Prevention of youth injuries.
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There are four categories of causes responsible for the majority of injuries in youth 10-19 years of age: 1) motor vehicle traffic; 2) violence (intra-familial, extra-familial, self, pregnancy-related); 3) recreational; and 4) occupational. This article presents data from the National Center for Health Statistics mortality data and the National Pediatric Trauma Registry morbidity data. Nationwide, the pediatric injury death rate is highest among adolescents 15-19 years of age. Motor vehicle-related deaths account for 41% and firearm-related deaths account for 36% of injury deaths in this age group. For youths aged 10-14 years, motor vehicle-related deaths account for 38% and; firearm-related deaths account for 26% of injury deaths. For both age groups, occupant motor vehicle-related deaths account for the majority of deaths and underscore the need for seat belt use. Using theoretical principles based on the Haddon matrix and a knowledge of adolescent development, proposed interventions to decrease injuries and deaths related to motor vehicles and firearms include graduated licensing, occupant restraint, speed limits, conflict resolution, and gun control. Occupational injuries, particularly injury associated with agricultural production, account for an estimated 100,000 injuries per year. Preventive strategies include OSHA regulations imposing standards for protective devices and further study for guidelines for adolescent work in agriculture. Injuries related to recreation include drowning and sports injuries. Preventive strategies may include proper supervision and risk reduction with respect to use of alcohol/drugs. The data presented support the use of primary prevention to achieve the most effective, safe community interventions targeting adolescents. (+info)
Nonfatal and fatal firearm-related injuries--United States, 1993-1997.
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In 1997, 32,436 deaths resulted from firearm-related injuries, making such injuries the second leading cause of injury mortality in the United States after motor-vehicle-related incidents (1). Also in 1997, an estimated 64,207 persons sustained nonfatal firearm-related injuries and were treated in U.S. hospital emergency departments (EDs); approximately 40% required inpatient hospital care. National firearm-related injury and death rates peaked in 1993, then began to decline (2). This report presents national data from 1993 through 1997, which showed that the decline in nonfatal and fatal firearm-related injury rates was substantial and consistent by sex, race/ethnicity, age, and intent of injury. (+info)