Ministry of Health of the Republic of Moldova [601130]

Ministry of Health of the Republic of Moldova
Public In stitution “NicolaeTestemițanu”
State University of Medicine and Pharmacy

Faculty of Medicine II

Department of Forensic Medicine

DIPLOMA THESIS

„FIREARM INJURIES: MEDICO -LEGAL ASPECTS ”
(bibliographic study)

Author:
Abu Shakra Ibrahim
6th year, group no. 164 2
Scientific advisor :
ȘarpeVasile
MD, MS, PhD
Associate Professor

Chisinau 2015

2
CONTENT

INTRODUCTION 4
Actuality 4
The purpose and objectives of the thesis 5
The material and the research methods 5
Theoretical importance and value of the work 6
CHAPTER I.
HISTORY, DEFINITION AND CLASSIFICATION OF FIREARMS 7
1.1. History of fire arms and ammunitions 7
1.2. Ammunition and firearm components. 9
1.3. Classification and definitions in ballistics. 11
1.4. Conclusion 17
CHAPTER II.
BALLISTIC INJURY 18
2.1. Traumatic factors of shot 18
2.2. Medico -legal range of fire 22
2.3. Conclusion 26
CHAPTER III.
FORENSIC EVIDENCE S IN TERMINAL BALLISTIC 28
3.1. Physical Evidence 28
3.2. Autopsy on the Gunshot Victim 29
3.3. Conclusion 31
DISCUSSION 32
CONCLUSIONS 33
BIBLIOGRAPHY 34

3

Declaration

I hereby declare that the diploma thesis entitled " Firearm injuries: medico -legal
aspects " is written by me and has not been presented before at another college or
institution of higher education in the country or abroad. Also, I declare that all
sources used, including the Internet sources, are indicated in the paper, considering
the rules for avoiding plagiarism:
– all text fragments are reproduced exactly, even the proper translations from other
languages are written in quotes and have detailed reference source;
– paraphrasing in own words of text written by other authors has detailed reference;
– summary of the idea s of other authors has a detailed reference to the original text.

Date
Abu Shakra Ibrahim
_____________
(Original signature)

4

INTRODUCTION
Actuality.
Gunshot wounds are more destructive than most other injuries and they pose
great health burden and presents enormous challenge for health and national
economies [15]. An estimated 300 000 people die annually due to firearms used in
armed conflict situations [ 17]. Together with the estimated , 200 000 people die each
year from firearms used in non -conflic t situations [4].
According to data of Centers for Disease Control and Prevention in U.S. the
firearm injuries consist of 17 .5% from all injury deaths [ 3]. Gunshot wounds are the
most common cause of homicidal death in the United States. [5]
Deaths from firearms reflect their availability in various countries. Other
factors must play some part – Switzerland has relatively high gun ownership and a
low homicide rate (but a high gun suicide rate) compared with the USA.
The availability of firearms, especially those possessing considerable firepower
and magazine capacity, is of great concern. In South Africa, it is estimated that a
large proportion of firearms is illegally obtained [251]. Globally, debate on strategies
for improved control of gun owne rship continues.
Another factor was apparently the substitution of handguns for long guns as
home defense weapons. For penetrating trunchal wounds, the mortality rate for
handguns is 15 -20 %, roughly the same as for equivalent knife wounds. For (e.g)
shotguns, the mortality rate is 70% or so. If memory serves, for high power rifles,
about 30 -40 %, BTW, the mortality rate from those wicked "assault weapons" is
close to that for handguns, since they shoot a relatively low -powered round. [31]
Analysis and in terpretation of fatal gunshot wounds is an important and
common practice among forensic pathologists. An understanding of the biomechanics,
together with the effects of the relationship between a high -speed penetrating missile

5
and body tissues, is crucial to both forensic pathology diagnosis and optimal medical
management of injuries.
The nature of ballistic trauma presents surgeons and forensic pathologists with
immense challenges, especially in regions where gunshot trauma remains prevalent.
All around th e world physicians have to report cases of injuries, included fire arm , to
authorities. The General Medical Council of U.K. has issued supplementary guidance
concerning the reporting of gun – and knife -related injuries[ 11].
Appropriate documentation and hand ling of evidence by trauma personnel
assist the forensic pathologist in evaluating cases of initially nonfatal traumatic deaths
and assist the police and legal authorities responsible for investigating both civil and
criminal cases in deceased and survivin g injured patients.
The purpose and objectives of the thesis . The aim of the paper is to provide a
broad overview of the general characteristics of ballistic trauma and related aspects.
The main objectives are:
 to present the main notions of firearm and ammunitions
 to bring forward brief history of firearm
 to draw attention to traumatic factors of shot
 to analyze the medico -legal range of shot
 to take apart the forensic evidences in terminal ballistic
The material and the research methods. This article reviews numerous
standard forensic pathology textbooks and articles.
Of the total of 3 3 studied bibliographic sources, one third was published in the
last 5 years. A minority was internet sources and the rest of them were books and
articles – half in half . The majority of literature was in English language and singe in
Romanian and Russian .
Analysis of all works leads to the conclusion according our objective and
purpose of thesis. Papers about general notions in ballistics, terminal ballistic,
“pathological” or medico -legal ballistic were studied.
Sources other than those related to the purpose of the paper have not been

6
reviewed .
Theoretical importance and value of the work. The importance of ballistic
knowledge in medical education comes from c linical forensic medicine which is best
defined as the application of forensic medical knowledge and techniques to the
solution of law in the investigation of trauma involving living victims. In emergency
departments these techniques help us in correct for ensic evaluation, documentation,
and photography of traumatic injuries, as well as the recognition and proper handling
of evidentiary material for future use in legal proceedings.

7

CHAPTER I HISTORY ,DEFINITION AND CLASSIFICATION OF
FIREARMS

1.1. History of firearms and ammunitions
In order to interpret gunshot wounds, a certain basic knowledge of firearms and
ammunition is necessary.
The origins of weapons of war powered by explosive force are lost in time. It is
widely held that the Chinese discovered the explosive combination of sulfur,
saltpeter, and charcoal during the 11th century [18], and it is regarded by most that
this new material, now known as gun powder, was largely used for its pyrotechnic
rather than its offensive properties.
Other authors [ 33] tell us about experiments of a French monk Berlhold
Schwarz, who in the early XII century manipulated with a mixture of charcoal, sulfur
and saltpeter.
The first mention of a cannon
appears in a manuscriptdated 1326. This
rudimentary devic e is described as apear –
or vase -shaped vessel designed to fire
arrows. Thecannon almost certainly
played a part in the battle of Crecyin
1346.
Documents from the mid -14th
century describe thefirst hand firearm –
theso called hand gonne .
An exampleof this weapon was
Figure 1.1. A reproduction of a medieval
Handgun of 1380 (hand gonne )

8
recovered from a well at TannenburgCastle in Hesse, Germa ny, which was destroyed
in 1399 [9] .
The hand gonne had a short iron or bronze barrel whichwas tightly held and
bound to a wooden staff by iron bands (fig.1.1.)
The device was manually lit by a taper. One can imaginethe blast, recoil, and
large amount of acrid smoke thatwould have been produced. To assist in containing
therecoil, an iron hook fixed to the staff could be anchoredagainst the parapet. The
bore measured up to 40 mm. indiameter. The projectile may have been a round stone
ora metallic ball.
The concept of the lit taper being applied to the flashhole later gave rise to
thematch lockrifle and pistol. Thetaper was held in place by an S -shaped bar called a
serpentine.Pressure on the trigger lowered the lit taper to theflash hole. The
disadvantage here was that the taper neededto be glowing at all times to be readily
effective.
The next achievement in the develop ment of weaponswas the generation of a
spark from a spring -driven tinderlighter –
theso -calledwheel lock(1517 , table
1.1.)[9, 18, 33].The sparkderived from
striking iron pyrites against a
roughenedmetallic plate. The principle of
the wheel lock is still se entoday in most
cigarette lighters.
Then, in 1612, theflint lockwas
invented. The sparkwas generated by a
fragment of flint striking a roughenedmetallic surface, thus igniting gun powder at the
flash hole.
Many elegant designs and elaborations were developed,but no significant
progress was made until the inventionof thepercussion capduring the 19th century.
Theigniting spark was now generated from a small cap filledwith percussion –
Figure 1.2.Principle of the wheel lock

9
sensitive chemicals. The cap was placedon a small nipple and struck by a falling
hammer whenthe trigger was released.
The pistols and rifles described previously can be collectivelycategorized as
muzzle loading weapons – thatis to say, all propellant, wadding, and projectiles are
introdu ceddown through the muzzle, rammed home, and compactedwith a wooden
rod. From this point onward,breechloadingweapons, cartridges, and projectiles soon
evolved.
Table 1.1
Development of firearms and ammunitions
Year Development
1450 Matchlock system
1517 Wheel -lock system
1575 First cartridge
1550 Flintlock firearm
1776 Breech -loading firearm
1807 Percussion systems
1814 Percussion cap
1835 Revolver
1836 Pinfire cartridge
1845 Rimfire cartridge
1858 Centerfire cartridge
1884 Machine gun
1892 Self-loading (semiautomatic) pistol

1.2. Ammunition and firearm components .
All Firearms have three basic groups of parts; these include the Action , the
Stock , and the Barrel [10]
The action is really the guts of the gun. It includes all the moving parts that
load, fire, and eject the firearms shells or cartridges.
The stock (or Handle) of the gun in composed of two pieces: the butt and the
fore-end.
A guns barrel is the long metal tube, bored out to provide an exit path for the

10
discharging projectile. Once the projectile is fired, it‟s forced down the barrel and out
of the muzzle by expanding gas forces. In a rifle or a handgun, the bullet travels
through the barr el; in shotguns the shot or the slug is shot through the barrel.
Most firearms have similar parts (fig. 1.3, 1.4):
Bore: The bore in the inside of the guns barrel through which the projectile
travels when fired.
Breech: The breech is the area of the firearm that contains the rear end of the
barrel, where the cartridge is inserted.

Figure 1.3.
Parts of
handgun –
pistol and
revolver

Figure 1.4.
Parts of pump –
action shotgun

Cylinder: The cylinder is the part of a revolver that holds cartridges in separate
chambers. The cylinder of a revolver rotates as the gun is cocked, brining each
chamber into alignment with the barrel.
Grip: The grip is the portion of a handgun that‟s use d to hold the firearm.

11
Hammer: The hammer on a revolver is the part that strikes the firing pin or the
cartridge primer directly, detonating the primer which discharges the gun.
Magazine: A magazine is a spring -operated container, which can be fixed or
detachable, which holds cartridges for a repeating firearm.
Muzzle: The muzzle of a gun is the front end of the barrel where the projectile
exits the firearm.
Trigger: The trigger is the lever that‟s puled or squeezed to initiate the firing
process.
Trigger Guard: The trigger guard is the portion of a firearm that wraps around
the trigger to provide both protection and safety.
Caliber. Rifles, handguns, submachine guns, and machine guns have rifled
barrels that is, spiral grooves have been cut the length of th e interior or bore of the
barrel [ 6, 7]. Rifling consists of these grooves and the metal left between the grooves
– the lands (fig.1.5.)
In the United States, the caliber of a rifle or
handgun is supposed to be the diameter of the bore,
measured from land to land, but in other countries (e.g.
Europe, Russia or other former Soviet country) is more
thorough and logical than the U.S [6, 33]. It clearly and
specifically identifies a cartridge by giving the bullet
diameter and the case length in millimeters, as well as by
designating the type of cartridge case.

1.3. Classification and definitions in ballistics.
Certain terms, and gunshot wound appearances in particular, often confound
interpretation because a term may mean different things to different people. [ 25]
The firearm is a device that uses expanding gas forces of burned gunpowder to
push through the barrel a projectile – bullet, shots ( pellets) [ 2, 33].
Injuries due to firearm are called firearm wounds or ballistic (terminal ballistic)
Figure 1.5.Rifled bore

12
wounds.
Ballistics refers to the study of missiles and projectiles (objects in motion) and
their effects. Internal ballistics refers to the dynamics of a bullet in motion between
the ignition of the propellant and exiting from the firearm muzzle. External ballistics
refers to the same during its flight in air. Terminal ballistics refers to the effects
produced by a bullet when it strikes or penetrates any t arget, whereas wound
ballistics is terminal ballistics where the body is the target. [ 18, 25 ]
The Arms Trade Treaty [1] requires all participating states “to effectively
regulate the international trade in conventional arms, and to prevent their diversion”
and to establish and implement “national control systems.” The treaty covers eight
categories of weapons ranging from battle tanks and combat aircraft to small arms
and light weapons, as well as ammunition and components.
Small arms refer to handguns and are the most frequent in medico -legal
practice. “Small arms” is a term of art (Jargon) used by armed forces to denote
infantry weapons an individual soldier may carry. The description is usually limited
to revolvers, pistols, submachine guns, carbines, ass ault rifles, battle rifles, multiple
barrel firearms, sniper rifles, squad automatic weapons, light machine guns, and
sometimes hand grenades. Shotguns, general purpose machine guns, medium
machine guns, and grenade launchers may be considered small arms o r as support
weapons, depending on the particular armed forces.
In classifying hand held firearms of today, mostauthorities agree that a broad
separation into long arms [18](designed to be braced against the shoulder)
andhandguns (designed to be fired using one or both hands) isappropriate.
Depending on the internal structure of the barrel of the weapon has a smooth
bore or lands and grooves (rifling) [2, 7, 18, 33]
According to some sources [ 6, 7], there are five general categories of small
arms: handguns, rifles, shotguns, submachine guns, and machine guns.
Handguns
There are four basic types of handguns:

13
1. Single -shot pistols
2. Derringers
3. Revolvers
4. Auto -loading pistols (automatics)
Single -shot pistols. A single -shot pistol has one firing chamber integral with
the barrel, which must be loaded manually each time the weapon is to be fired (fig .
1.6.).
Derringers . They are a variant of single -shot pistols. Derringers are small
pocket firearms having multiple barrels,
each of which is loaded and fired separately.
The traditional derringer has two barrels
(fig.1.7).
Revolvers. The revolver is the most
common type of handgun in the United
States. Revolvers have a revolving cylinder that contains several chambers, each of
which holds one cartridge. The cylinder is rotated mechanically so as to align each
chamber successively with the barrel
and firing pin. The first revolver was
produced by Samuel Colt in 1835 –
1836 [ 7].
Auto -loading pistols
(automatics). Auto -loading or
Figure 1.6. Wichita Single Shot Figure 1.7.American Derringer
Figure 1.9.Pistol Glock, Austria, 9×19
Figure 1.8.Revolver Taurus

14
automatic pistols make up the fourth category of handguns. The term “automatic
pistol” is amisnomer, as this form of pistol is an auto -loader in which the trigger
mustbe pulled for every shot fired. Regardless of the correct terminology,
however,these weapons are invariably called “automatics” or just “pistols.” These
pistolsuse the forces generated by the fired cartridge to operate the mechanismthat
extracts and ejects the empty cases, loads the fresh cartridge, and returnsthe
mechanism into position to fire the next round ( fig.1.9.). The firstcommercial
automatic pistol w as produced in 1893 by Borchardt; thisweapon w as the predecessor
of the Luger [ 8]
Rifles
A rifle is a firearm with a rifled barrel which is designed to be fired from
theshoulder (fig.1.10.). It is similar to the handgun, except that it is larger, has a
longer bore, and is usually fired from the shoulder [ 25]. The types of rifles commonly
encountered are single -shot, lever action, bolt -action, pump -action, and auto -loading.

Figure 1.10. АК-47, a mid -20th-century, gas -operated, magazine -fed, automatic rifle
Shotguns
A shotgun is a weapon that is intended to be fired from the shoulder; but it hasa
smooth bore and is designed to fire multiple pellets from the barrel. A shotgunmay be
classified as a single -shot, over -and-under, double -barrel, bolt-action ,lever -action,
pump -action, or auto -loading. The over -and undershotgun has two barrels one above
the other (fig.1.11.), and the double -barrel versionhas its barrels side by side.

15

Figure 1.11.Condor Competition Shotgun, gauge: 12
Submachine guns/Machine Pistols
A submachine gun or machine pistol is a weapon that is designed to be fired
from either the shoulder and/or the hip; and is capable of full -automatic fire. It has a
rifled barrel, and fires pistol ammunition (fig. 1.12.). These are either semi -automatic
versions of submachine guns or weapons that have the external appearance of a
submachine gun. The media has dubbed these “assault pistols.” In the case of
semiautomatic versions of submachine guns, the internal mechanism is typically so
altered that they are essentially a different weapon [ 7, 8, 25 ].

Figure 1.12. The PPSh -41 (Пистолет -пулемётШпагина; "Shpagin machine pistol")
Machine guns
A machine gun is a weapon that is capable of full -automatic firing and that
fires rifle ammunition [ 7, 8, 25 ]. It is generally crew -operated, but some forms may
be fired by single individuals. Most machine guns have the ammunition fed by belts,
although some use magazines (fig.1.1 3.).

16

Figure 1.1 3. IWI NEGEV NG7 Israel Weapon Industries, belt -fed 7.62mm
Homemade, improvised, and modified weapons
These illegal weapons vary markedly in design and areessentially limited by
the imagination and ingenuity of themanufacturer. They range from crude cylinders
with firingpins activated by simple trigger mechanisms and elasticbands to
modifications of pre -existing starter guns or toys.
There may be a degree of cultural diversity in theirdesign in that design and
construction may be restrictedto materials
available to a particular country or village.
Prope llants may be commercial or
homemade .Ammunition varies enormously,
ranging from commercialcartridges and projectiles
to crushed rock, glass,and metal fragments.
Ammunition
A small -arms cartridge consists of a
cartridge case, a primer, propellant (gunpowder),
and a bullet or projectile (fig. 1.14). Blank cartridges are sealed with paper disks
instead of a bullet or have a crimped neck. Dummy cartridges have neither a primer
nor powder. Some dummy cartridges contain inert granular material that simulates
powder. [ 2, 6, 7, 8, 33 ].
Cartridge cases are usually made of brass, a composition of 70% copper and
Figure 1.14.Smal l-arms cartridge

17
30% zinc.
The primer is a small metallic cup containing chemicals that detonate on
impact with the striking hammer or firing pin. Small -arms cartridges are classified as
centerfire or rimfire, depending on the location of the primer [ 7].
The propellant traditionally was black powder (gun powder) till the 19th
century, but has now largely been replaced by modern “smokeless ” powders. The
composition of the propellant varies with the manufacturer [ 7].
The bullet is that part of the cartridge that leaves the muzzle of the firearm
when it discharges. Modern bullets fall into
two categories: lead – and metal -jacketed.
The majority of shotgun projectiles
constitute small round lead balls or lead –
antimony alloy for added hardness, but steel
shot pellets are also in use.
Shotgun cartridges use a wad t o separate
the propellant from the projectiles and to
secure the projectiles at the apex of
thecylinder. Modern shot shells now employ a plastic cup or piston to contain the
projectiles (fig.1.15) .
Rubber bullets first were used in Northern Ireland in 1970 by the British Army.
The missiles are blunt -nosed, with a low muzzle velocity, and they are designed to
inflict superficial injuries only, but they have caused death [ 4, 16, 20 ].

1.4. Conclusion
All small arms work in roughly the same way. An explosive imparts a force to
a missile (bullet) that is directed along a tube towards its target.
Although the doctors must “treat the wound and not the weapon,” knowledge
of how firearms work should lead to a better understanding of how bullets and other
factors cause injury.
Figure 1.15.Shotgun cartridge

18

CHAPTER II. BALLISTIC INJURY

2.1. Traumatic factors of shot
The mechanism of firearm injuring is a complex and ambiguous process, which
is based on the diverse physical and chemical phenomena . They are called traumatic
or wounding factors of shot. Appearing almost simultaneously, they differ
significantly in their amazing properties .
Traumatic factors of shot can be classified in four groups [2, 33 ]:
1. Projectile and its parts (the main factor)
a. Bullet
b. Special bullets
c. Shots (pellets )
d. Buckshot
e. Details of special projectile
f. Fragments and details of distorted projectile
g. Details of hunting projectile (felt or cardboard wadding (cards) or plastic
piston )
h. Atypical projectiles
2. Additional (supplementary) products of shot
a. Gases and powder gases
b. Flame
c. Soot
d. Unburned powder
e. Partiallyburnt particles of powder
f. Particles of metal
g. Elements of primer

19
h. Gun grease
i. Coating lacquers and paints of the bullets
3. Secondary factors
a. Fragments and particles of obstacles
b. The particles of clothing, hats, shoes
c. Fragments of bones
d. Fragments and particles of PPE (vests, helmets, etc.)
e. Ignited clothing
4. Weapon
a. Muzzle
b. The moving parts of weapons (the action)
c. Butt (due to recoil) (the stock)
d. Fragments of exploding weapons
Wounding capacity of a bullet
The capacity to injure depends on the amount of energy dissipated to the
tissues as the bullet impacts and passes into the body. This depends on the velocityof
the hurtling projectile and on other variables, such as its mass, shape, physical
structure, behavior upon impact and entry, and the physical ch aracteristics of the
tissues penetrated [30].
The velocity mainly determines the amount of kinetic energy possessed by the
bullet, as reflected in the formula for the energy of an object by virtue of its motion:
E = ½mv2, where
E is kinetic energy
m is mass, and
v is velocity [ 8, 17 ].
Wounds depend essentially on missile velocity that can be classified (tab .2.1)
in low, medium, high, and very -high velocity.

20
Table 2.1
Classification of firearms according to velocity of missile
Type Velocity (m/s)
Low-velocity Less than 366
Medium -velocity Between 366 and 762
High -velocity Between 762 and 1260
Very -high-velocity Greater than 1260

According to the wounding capacity of a bullet may be different actions [2, 33 ]:
 Tearing action
 Perforation and penetration
 Cuneiform action
 Contusion and tangential action
Because bullets possess most velocity at the point ofleaving the firearm
muzzle, one would expect a greaterdegree of injury with impacts at closer rangesof
fire. Also, a larger, heavier projecti le should
producemore injury than a smaller one, all
other factorsbeing equal. However, these
distinctions, when evaluatingwounds, tend to
be overshadowed by the othersignificant
variables.
Upon puncturing skin and passing into
tissues, arapidly spinning bullet creates a
direct path by crushingand tearing the tissue
directly ahead. For low -velocitybullets, this is
the most significantmechanismof injury.
In addition to the factors listed a
destructive action of the shot is
hydrodynamic effect (fig.2.1.) , which consists of explosion of fluid -filled cavity
organs [2, 18 ].
Figure 2.1.A contact shotgun wound of
the lower chin.

21
Additional products of shot
Gunshot residue consists of a variety of materials:particles of the projectile or
the projectile‟s jacket,unburnt particles of smokeless powder, partiallyburnt particles
of powder, combustion products andparticles of primer residue. These materials are
projected from the muzzle of the weapon in a conicalcloud. The particles are slowed
down by air resistance, with the larger particles traveling the greaterdistances.
Gunshot residue may also escape fromvarious openings in the firearm: from the space
between the chamber and the barrel in revolvers, fromthe ejection ports of self –
loading or auto matic fire -arms and even from the trigger hole. Gunshot
residueescaping in this way may be deposited on the hands ofthe shooter and on the
hands of someone who isgrappling for possession of the firearm at the instantof its
discharge. In the field of forens ic science, thedetection of gunshot residue becomes
important intwo aspectsof the investigation of a shooting incident:the determination
of the range from which a shot wasfired and as an aid in the identification of the
shooter [ 17]
The first involves the examination of powder patternson the surfaces of targets,
and the second involves theanalysis of residues removed from the hands of
asuspected shooter.
Secondary factors
Bullets may strike solid intervening structures or surfacesand then enter a body,
either having passedthrough the structure or deflected off it. A bulletricochets
(bounces) upon impact on a surface atcertain critical small angles of approach, with
theoutcome determined by velocity and physical characteristicsof the bullet and also
the natur e of the surfacestruck. [7]
Ricocheting bullets are unstable, erratic, andunpredictable, and they may
tumble, producingirregular and atypical entrance wounds, tending tolodge in the
body. A bullet may also show a flattenedside from first impact. Portions of the body
surfaceadjacent t o or on the surface struck by the bullet mayshow a shower of
punctate abrasions due to finefragments of surface and missile; examples of thesemay

22
be seen with a ceramic tiled surface, or tarred orconcrete pavement surface. This
appearance may bemistaken fo r gunpowder „„tattooing‟‟ abrasions, butthey are
usually larger, irregular, and coarser than truetattooing. Intermediate targets may also
include glass,wood, and clothing/fabric.

2.2. Medico -legal range of fire
The concept of determination of the range of fire is arguably the most difficult.
It is not uncommon for this information to be contested in a court of law and may be
pivotalto the outcome of a case.
Range of fire is the distance from the muzzle to the body at the instantof
discharge and some authors [7, 18 ] use the term “ pathologicalrange of fire ” that may
seem to beinitially somewhat confusing. The forensic pathologist ismore or less
bound to categorize the range of fire basedon a set of predetermined parameters. The
presence orabsence of certain feat ures of the gunshot wound eitherinclude or exclude
it.
The most workable classification for ranges of discharge is [ 17, 18, 25 ]:
1. Contact
a. hard contact
b. contact, and
c. nearcontact
2. Intermediate
3. Distant
Many books and chapters [ 13, 14 ] describing firearm wound interpretation tend
not to apply the concept of contact, intermediate, and distant range shots to shotgun
trauma. Rather, terms such as close discharge, short to mid -range, and mid to distant
range are offered.
At the instant of discharge, many constituent s of thecartridge and products of
combustion are expelled undergreat pressure , as projectile and its parts (the main
factor), additional or supplementary products of shot and others.

23
Contact and distant range injury from shotguns arerelatively easy to categorize.
Most authoritative textsinclude tattooing and injuries from the piston in the
intermediate category [ 2, 6, 13 ,17]. If the skin is fully exposed to the shot, one may
expectsome deposition of unburnt powder (stippling or tattooing).
Contact range
Contact range implies that the muzzle of the gun is placedagainst, or very near
to, the skin of the victim at the instantof discharge. If the muzzle is placed sufficiently
firmlyagainst the skin surface as to impart an indentation orbruise/abrasion (muzzle
imprint), then the term hard contact is used [13, 17, 18] (fig. 2.2.).

Figure 2.2. Muzzle imprint
The classic wound will show the external diameter ofthe muzzle (perhaps also
the front sight) with a concentricround defect representing the point of bullet entry.
Closeinspection generally shows blackening from flame andsoot into the depths of
the wound. L ater dissectionwills confirm the presence of expelledcombustion
products into subjacent tissues.
Remember that bullets are essentially blunt objectstravelling at high speed, and
push their way into tissue.
These injuries are, therefore, lacerations.The edge s of the entry defect may be

24
abraded. Thiscircular band of roughening is frequently termed the abrasion rim .
The bullet may accumulate grease, grime, and finelead dust from the lands and
grooves of the bore and thesecan be wiped onto and into the entry woun d [18]. This is
calledthe grease rim .
As the seal is often imperfect, a small amount of gasand soot may escape either
radially or eccentrically .
Tattooingor stipplingwill not be seen.In some cases, carbon monoxide under
great pressuremay be deposited and absorbed into regional muscle. Thisphenomenon
is perhaps best seen after shotgun dischargeswhere the volumes of gas expelled are
far greater than thoseseen after the discharge from a rifled weapon. The muscletissue,
often extensively shredded, may appear bright pink -red, representing the formation of
carboxyhemoglobin and carboxy myoglobin (fig.2. 3.).

Figure 2.3. Formation of carboxyhemoglobinand carboxymyoglobin round the wound
Often the wound is not a perfect circle and first inspection may reveal a wound
that could be confused with anexit. In cases of hard or near contact against skin
withdeep tethered bone (such as the scalp), the entry may bera gged, irregular, or
frankly stellate in configuration. Thisphenomenon is readily explained by rapid
expansion o fgas into the subcutaneous soft tissues, literally blowingand stripping the
soft tissues away from the bone [ 2, 6, 33 ].

25
The contact(nonspecific) entry wound implies thatthe muzzle is placed against,
but not hard against, the skin.This allows some limited concentric dispersal of soot
ontothe skin, creating a small, densely blackened circular areasurrounding the entry
defect. The soot deposition may beeccentric if the muzzle is placed any way other
than trulyperpendicular.
The term near contactimplies that the muzzle is inclose proximity to the skin,
usually in the order of one totwo centimeters. The sooty concentric zone will be
widerin diameter and exceed the external diameter of the muzzleby up to three to four
times. Both the abrasion and greaserims may still be present, but may be obscured by
overlying soot. At the moment of discharge, combustion products are expelled in a
conical distribution.
If the shot is fired in close proximity to the hair -bearing scalp, it is not
uncommon to see the hair shaftsbeing somewhat “fluffed up” and close inspection
mayreveal finely dispersed soot particles among the hair follicles. This phenomenon
may be readily overl ooked in darker haired persons [ 18].
Intermediate range
This category strongly indicates that the
muzzle of thegun was some distance from the
skin.
The hallmark of the intermediate range
shot is theformation of tattooing or stippling
(fig.3.2.) . Tattooing is a vitalreaction caused by
unburnt powder fragments abradingthe skin of
the living person [18].
Fine blood spatter may resemble tattooing
at firstglance; however, tattooing cannot be
rubbed off the skinand is a permanent feature
at autopsy. Classic tattooingis seen as fine to
coarse peppering of the skin with acondensation or concentration of the pepp ering
Figure 2.4.A medium (intermediate) range
gunshot wound, characterized by
gunpowder stippling, but no soot.

26
surrounding the entry defect.
The color of tattooing ranges from red -brown toorange. Examination under
magnification may indeed disclose adherent and embedded propellant particles.
The configuration of the propellant granules often aidsin the formation of
tattooing. For example, fine powderand flakelike granules frequently undergo
complete ornear complete combustion and are less likely to causetattooing. However,
coarse powder particles (such as thespherical or log configuration) tend to burn
incompletelya nd therefore leave sufficient solid material to impactagainst the skin at
high velocity.
In the case of revolvers and semiautomatic pistols, the“rule of thumb” suggests
that tattooing should not beexpected much beyond a distance of two to three timesthat
of the barrel length.The data is less distinct in cases of discharges fromlong arms such
as shotguns and rifles.
Distant range
This injury type is the least complicated because the distant range injury
constitutes the bullet hole only. The bulletmay enter th rough the skin sideways,
backwards, or at anyangle.
There is no stippling or tattooing and certainly no sootdeposition or thermal
effect. Bear in mind that this patternof injury may be seen from several feet or up to a
mile ormore, depending on ammunition type and velocity. Anabrasion rim may still
be seen although the true circularedge as seen in closer range shots may be lost over
longdistances. As the bullet travels through space, it graduallyloses momentum and
the aerodynamic spin that impartsstability. In short, the bullet begins to tumble in
space. Agrease rim may still be seen in some cases.

2.3. Conclusion
Bullets cause wounds by interacting with tissue. The factors involved with the
production of a missile wound are: projectile mass, diameter, shap e, and composition,
linear and rotational velocity, and the type of tissue struck.

27
A typical entrance wound may take :
 a round or oval -shaped skin defect ,
 muzzle imprint,
 surrounded by a rim of abrasion and grease ,
 soot surrounding the entrance defect or deposited within the depths of
the wound,
 “gunpowder stipple marks” or “gunpowder tattooing”,
The width of the marginal abrasion can provide an indication of the relative
angle of the bullet as it enters the skin.
Depending on the characteristics of the interposed target, the bullet may
produce an irregularly shaped wound with wide marginal abrasions known as an
“atypical entrance wound. ”
Exit wounds from low -velocity firearms tend to be relatively small, and they
can have a variety of shapes, ranging from slit -like to comma -shaped to X -shaped to
irregularly -shaped. Exit wounds may or may not have central, round to oval defects,
but the typical exit wound does not have marginal abrasions.

28

CHAPTER I II.FORENSIC EVIDENCE S IN TERMINAL BALLISTIC

The value of forensic evidence in gunshot cases in determining ranges offire,
entrance versus exit wounds, types of ammunition and firearms,manners of injury,
and even identification of the assailant cannot be over emphasized. Therefore the
collection, handling, and documentation of evidence during the initial evaluation of a
gunshot victim should be standardpractice [17, 27 ]. Hospitals should have written
protocols that incorporate proper procedures for the collection and retai ning
offorensic evidence. A clear understanding of what constitutes evidenceis necessary
for the successful implementation of such protocols.
The term evidence is used to describe the nature by which information
ispresented to the courts; it may be either informational, by way of documents and
orally, or physical, by way of objects such as bullets [19] All physical evidence must
be collected carefully, packaged, sealed, and labelled, andit should include the
patient‟s name and hospital number, as well as da teand time of specimen collection,
specimen type, site of collection, and collecto r‟s name and signature [22 , 27].

3.1. Physical Evidence
Physical evidence is real, tangible or latent matter that can be visualized,
measured, or analyzed [ 21]. Any belongin gs, body fluids or tissues, or foreignobjects
found in or on the patient constitute potential evidence. If physicalevidence is very
small or microscopic, it is referred to as “trace evidence.”
In gunshot victims, physical evidence would include [17]:
1. trace evidence such as:
a. gunshot residue (GSR) or blood -spatter on the victim‟s hands, hair, and
clothing

29
b. hairs, debris, or fibers on the victim‟s body or clothing
c. blood or tissue under the victim‟s fingernails
2. blood, urine, or tissue samples
3. clothing with or without bullet holes
4. bullets and cartridge cases in the victim‟s body or clothing

3.2. Autopsy on the Gunshot Victim
The postmortem examination on the gunshot victimshould be as meticulous as
any standard forensicautopsy examination [25]. Prerequisites include a
goodcircumstantial history of the case up to and near thetime of the death and a scene
examination wherepossible. Particularly important is the careful examination of
clothing, radiography, photography, andskillful collection of g unshot residue (in
correct receptacles). For optimal evaluation of wound detail, goodlight, preferably
natural, is crucial.
A pathologist does not work in isolation. A complete autopsy requires the
integrationof information from various investigative sources oc curring in stepwise
progression [ 32].
This systematic approach usually reaches successful conclusions regarding the
causeof death, the pathophysiological mechanisms or terminal events leading to
death, and themanner of death [24]. Communication a mong the different
investigators is essential. Deviations from the standards of investigative practice,
either by omission or commission, increase the risk of failure of a m edicolegal death
investigation [ 29].
Photographic documentation is of critical impo rtance in the examination of
firearm wounds, as it not only allows for secondary review of the autopsy by
consultants or opposing experts but also allows the autopsy physician a chance for
further review and/or consideration after completion of the examina tion. The
National Association of Medical Examiners Forensic Autopsy Standards [ 12] and
Accreditation Checklist[ 12] criteria require that photographs be taken in the case of

30
significant injuries. Photographs should be of high quality, such that an observer can
readily distinguish salient characteristics of the wound from the images.
In general, photographs of wounds before cleaning are difficult to interpret and
should be avoided. However, overall photographs of a victim before undressing and
cleaning can p rovide useful information about things such as blood droplet patterns,
position of clothing, and other information, and may be useful. If soot is noted around
a wound, it should be photographed before cleaning, as soot may be removed in the
cleaning proces s.
Radiography is an invaluable tool in gunshot autopsies, and it should be
mandatory. It indicates not onlythe location of lodged missiles but also the nature
ofthe dispersion of bullets and shrapnel fragments,where fragmentation and
deflection occur, and thepattern of the bony injuries sustained. Imaging mayeither be
by plain film radiography or by fluoroscopy, and a permanent record may be
obtainedeither by plain films or by thermal -type prints forlegal purposes. Two film
views at right angles toeach oth er are necessary for precise location of amissile.
Radiography is equally important when anexit wound is present, contrary to some
commonperceptions, because an exit wound may lead one tobelieve that the entire
missile has passed through,whereas a bone or bullet fragment may have exitedand the
evidence -bearing bullet or fragment may stillbe lodged internally. This may be easily
missed atautopsy if X -ray examination is not done beforehand .
The clothed body of a firearm wound victim should always be thoroughl y
radiographed. All parts of the body affected by a firearm wound must be imaged, and
it may be that even sites distant from the entrance wound need to be examined. For
example, a firearm wound of the shoulder can pass through the arm, chest, and
abdomen, terminating in the decedent's leg under certain circumstances. Some
modern full -body x -ray scanners, such as the Lodox machine, can provide high –
resolution full -body radiographs in a minimum amount of time, making this process
much more efficient and compl ete.
Unusual consequences, such as bullet embolism,may require radiographs of

31
peripheral and remote regions.
The detection of gunshot residue from wounds,clothing, hands of the victim,
and suspected shooteris a specialized forensic ballistic examination. Me ticulous and
timely collection of evidentiary material isimportant .
Modern methods of laboratory analysis of primerresidue (barium, antimony,
and lead) include flamelessatomic absorption spectrometry , inductively coupled
plasma -mass spectrometry , scanning microscope -energy dispersive X -ray
spectrometry [26, 28 ] . Tracemetal detection techniques are used to link the use ofa
particular weapon with an individual, and they relyon trace metal residue remaining
on the palms aftergripping a gun. Soot and powder deposits seen onclothing or
wounds with the naked eye, magnificationlens, or microscope by an experienced
pathologist areusually sufficient to make a finding of range of fire.
Laboratory analytical tests for nitrites produced by theburning of smoke less
powder (cellulose nitrate) and forthe detection of lead residues are available.

3.3. Conclusion
When clinicians are remiss in the adequate forensic evaluation of
gunshotpatients, it could have far -reaching medico -legal implications in the
increasingly litigious construct of society and could result in obstruction of the endsof
justice with respect to the forensic and legal needs of individual patients,as well as
society in general.
Three separate retrospective analyses have shown that clini cal records
ingunshot cases routinely lack adequate wound descriptions. In addition, the correct
handling of potentially short -lived evidentiary material andthe preservation of a chain
of custody is frequently neglected in clinical settings.

32

DISCUSSION
If a gunshot victim is killed outright and examined by a competent forensic
pathologist, precise descriptions of the wounds will be obtained andforensic evidence
will be handled correctly. However, if the patient initiallysurvives and remains in
hospital for a period of time, then wound healingor sepsis and surgical interventions
can cause considerable difficulty ininterpretation for the forensic pathologist if the
documentation of gunshotwounds and iatrogenic procedures and the collection of
forensic evidencehave been neglected.
In summary, the comprehensive forensic evaluation of a gunshot victimshould
include the following:
a. recording of the patient‟s and clinician‟s names, date and time ofadmission, full
history and examination, and date and tim e of death(when applicable)
b. recording of anatomical location, size, shape, and characteristics of thegunshot
wound(s), including associated marks or coloration
c. recording of surgical resuscitative procedures, as these may obscure oralter
gunshot wound appearances, or result in “additional wounds”
d. augmentation of narrative descriptions with X -rays, diagrams, and photographs
where possible
e. use of a proforma, including a simple line drawing, to improve thequality of
documentation
f. refraining from “forensic interpretations” of gunshot wound appearances with
respect to entrance, exit, direction, or range of fire
g. recording of the patient‟s clinical management, progress, or complications, as well
as special investigations and further surgical interventions
h. record ing and correct handling of all evidence collected and propermaintenance of
the chain of custody.

33

CONCLUSION
 gunshot wounds pose great health burden and presents enormous challenge for
health and national economies ;
 the origins of firearms comes from discovering the explosive combination of
sulfur, saltpeter, and charcoal during the 11th century;
 all small arms work in roughly the same way: an explosive imparts a force to a
missile (bullet) that is directed along a tube towards its target;
 how firearms work should lead us to a better understanding of how bullets and
other factors cause injury;
 the main traumatic factor of firearms is the bullet that cause wounds by interacting
with tissue and its action depends on projectile mass, diameter, shape, and
composition, linear and rotational velocity and others;
 additional products of shot are used in forensic medicine to establish the range of
shot;
 the most workable classification for ranges of discharge is: 1. contact (hard
contact, contact, and near contact), 2. Intermediate and 3. distant ;
 a typical entrance wound may be characterized by: round or oval -shaped skin
defect, muzzle imprint, surrounded by a rim of abrasion and grease, soot
surrounding the entrance defect or deposited within the depths of the wound,
“gunpowder stipple marks” or “gunpowder tattooing”,
 the collection, handling, and documentation of evidence during the initial
evaluation of a gunshot victim should be standardpractice ;
 the postmortem examination on the gunshot victimshould be as meticulous as any
standard forensicautopsy examination ;

34

BIBLIOGRAPHY
1. Arms Trade Treaty . Arms Control Association (http://www.armscontrol.org/
ACT/2104_10/News -Briefs/Arms -Trade -Treaty -Set-to-Enter -Into-Force)
2. Baciu G., Padure A., Șarpe V. Traumatismelemecanice in aspect medico -legal.
Chisinau, CEP Medicina, 2006, 256 pages
3. Centers for Disease Control and Prevention (http://www.cdc.gov/nchs/
fastats/injury.htm )
4. Cukier W. Firearms/small arms: finding common ground. // Can Foreign Policy,
1998, 6:73 –87.
5. Denton J.S., Segovia A, Filkins J.A. Practical pathology of gunshot wounds. //
Arch Pathol Lab Med. 2006 Sep;130(9):1283 -9.
6. DiMaio V.J.M. and Dana S.E. Handbook of Forensic Pathology. RG Landes Co,
1998, 249 pages
7. DiMaio V.J.M. Gunshot Wounds Practical Aspects of Firearms, Ballistics, and
Forensic Techniques Second Edition. by CRC Press LLC, 1999, 401 pages
8. Dupuy R.E, Dupuy T.N. The Harper Encyclopedia of Military History: From
3500 BC to the Present. Harper Resource, 1993, 1376 pages
9. Fackler M.L. Gunshot wound review. // Annals of Emergency Medi cine 28(2):
1996, 194 –203.
10. Firearm Basics: Basic Parts of a Gun. http://offgridsurvival.com/
basicpartsofagun/
11. General Medical Council . Confidentiality: reporting gunshot and knife wounds,
2009
12. Inspection and Accreditation Checklist. Available from: National Association
of Medical Examiners. Accessed March 8, 2011. (http://thename.org/ .)
13. Jason Payne -Jame s Simpson's Forensic Medicine, CRC Press; 13thedition, 2011,

35
256 pages .
14. Knight B. Simpson's Forensic Medicine. Edward Arnold, 11thedition, 1996, 212
pages.
15. Kumar A, Sachan R, Verma A. Medico -Legal Evaluation of Firearm Injuries –
An Original Study from India with Review of Literature. // J Forensic Sci. 2014
Nov 7 . doi: 10.1111/1556 -4029.12593.
16. Leonov SV, Mikhaĭlenko AV, Slautinskaia AV. [The specific mechanism of
bruising inflicted by rubber bullets of traumatic weapons] [Article in Russian] //
Sud Med Ekspert. 2014 Jan -Feb;57(1):16 -7.
17. Mahoney P.F., Ryan J.M., Brooks A.J., Schwab C.W. Ballistic Trauma: A
Practical Guide, 2nd ed. London: Springer, 2005, 670 pages
18. Malcolm J. Dodd Terminal Ballistics A Text and Atlas of Gunshot Wounds.
CRC Press, 2006, 196 pages
19. Mc Lay WDS. Clinical Forensic Medicine, 2nd ed. London: Greenwich Medical
Medi a; 1996, 335 p ages
20. Millar R, Rutherford W.H., Johnston S, Malhotra V.J. Injuries caused by
rubber bullets: A report on 90 patients. // Br J Surg. 1975, 62:480 –486.
21. Muro GA, Easter CR. Clinical forensics for perioperative nurses. // AORN J.
1994;60:585 –591, 593.
22. Murphy GK. The study of gunshot wounds in surgical pathology. // Am J
Forensi c Med Pathol. 1980;1:123 –130.
23. Peterson GF, Clark SC. Forensic autopsy performance standards. // Am J
Forensic Med Pathol. Sep 2006;27(3):200 -25.
24. Randall, B. B., Fierro, M. F., Froede, R. C. Practice guideline for forensic
pathology. Members of the Forensic Pathology Committee, College of American
Pathologists. // Arch. Pathol. Lab. Med. 122:1056 –1064, 1998.
25. Roger Byard, Tracey Corey, Carol Henderso n, Jason Payne -James.
Encyclopedia of forensic and legal medicine: 1 -4. Vol. 1. Ballistic trauma,
overview and statistics by S.R.Naidoo., Academic Press; 1 edition, 2005, 2000

36
pages
26. Santos A, Magalhães T, Vieira DN, Almeida AA, Sousa AV. Firing distance
estimation through the analysis of the gunshot residue deposit pattern around the
bullet entrance hole by inductively coupled plasma -mass spectrometry: an
experimental study. // Am J Forensic Med Pathol. 2007 Mar;28(1):24 -30.
27. Sellier KG, Kneubuehl BP. Woun d Ballistics. Amsterdam: Elsevier; 1994 , 264
pages.
28. Seltenhammer MH, Fitzl C, Wieser I, Binder R, Paula P, Risser DU. Does the
prior application of the field kit bullet hole testing kit 3 on a suspected bullet hole
bias the analysis of atomic absorption sp ectrophotometry? // J Forensic Sci. 2014
Sep;59(5):1364 -7. doi: 10.1111/1556 -4029.12530. Epub 2014 Jul 17.
29. Shkrum M.J. Forensic pathology of trauma. Humana Press, 2007, 654 pages.
30. Stefanopoulos PK, Filippakis K, Soupiou OT, Pazarakiotis VC. Wound
ballistics of firearm -related injuries -Part 1: Missile characteristics and
mechanisms of soft tissue wounding. // Int J Oral Maxillofac Surg. 2014 Aug 12.
pii: S0901 -5027(14)00263 -X. doi: 10.1016/j.ijom.2014.07.013. [Epub ahead of
print] .
31. Tim Lamber t Death rate from handgun, long guns and knife wounds. // CS&E,
Uni of NSW, Australia , 04 Mar 1997 04:15:40 +1100
32. Wright, R. K., Tate, L. G. Forensic pathology. Last stronghold of the autopsy. //
Am. J. Foren sic Med. Pathol. 1:57 –60, 1980.
33. Попов В.Л., Шигеев В.Б., Кузнецов Л.Е. Судебно -медицинская
баллистика, Спб / Гиппократ, 2002., 656 с.