Sunday, January 28, 2018
By Joe Gorman
YOUNGSTOWN
A 9mm bullet, the round from the gun most seized by city police in 2017, weighs just 7.9 grams.
You can drop the bullet on your foot, and it would do nothing.
You could play catch with it, and it would do nothing.
But stick it in a clip, insert that clip into a handgun, pull the trigger, and propelled at a speed of 1,246.7 feet per second, it can do massive damage to your body.
That bullet – or any other bullet when fired from a handgun or rifle – can rupture your veins, arteries, bones and spine. It can kill you if it hits the right spot or the damage it causes is not repaired immediately.
It can break apart inside your body or stay there whole. It can enter your body and leave it as well – an exit wound – sometimes leaving a bigger hole than the entrance wound.
Even if the damage is repaired, it is not uncommon for the bullet to stay in your body, says Dr. Brian Gruber, a trauma surgeon at St. Elizabeth Youngstown Hospital, who has worked in the emergency room since 2004 and has treated gunshot victims.
Dr. Gruber said many times the decision is made to leave a bullet in someone if it is not near any vital organs. The main goal is to repair damage the bullet does inside the body, and the less he has to fiddle around with someone’s insides, the better, he said.
Additionally, a bullet in an arm or leg will sometimes be pushed up by the body weeks or months after the person is wounded; then it is easier to remove, Dr. Gruber said.
Of course, paramedics treat gunshot victims differently than surgeons, and often their main job is to stop the bleeding, make sure the patient’s vital signs are good, and then get the victim to a hospital quickly, said Dawn Wrask, clinical director of American Medical Response in Youngstown, who has been a paramedic in the city 30 years and has treated hundreds of gunshot victims.
Not all injuries are obvious, however, Wrask said. A patient could have a hole in his chest, but the injury is in another part of the body, causing internal bleeding. Paramedics therefore look for signs of internal bleeding, Wrask said.
“Where the hole is may not be where the bleeding is from,” Wrask said. “The goal is to find the holes and stop the bleeding.”
Wrask and Dr. Gruber said bullets can bounce off bones, rattle around a person’s body, and cause other injuries besides the hole it makes.
One way to see if a patient is stable is to check gums, Wrask said. She said if the person is not in any danger, the gums should be a healthy pink color. Other signs include clammy or pale skin, sweating or an irregular heartbeat.
Wrask said, however, sometimes skin color can be a false sign because if someone is wounded on a cold day and not wearing much clothing, skin would be discolored from the cold. So checking the gums is usually a sure way to check for an internal injury, Wrask said.
If patients can talk, Wrask said, they are asked how many times they were shot. Then paramedics cut through clothes to look for all possible holes. Sometimes they’re hidden, Wrask said. Someone could be shot in the armpit, and even facial hair can hide a wound.
“Someone with a full beard, it’s really hard to see,” Wrask said.
Paramedics also check heart rate and pupils for bullet damage. If pupils are slow to respond, a patient’s blood pressure is dropping. A priority is to make sure enough blood gets to the brain, Wrask said. If that goal can be achieved, the body can begin its own healing processes.
“The body knows what to do,” Wrask said. “We want to get enough blood to the brain.”
When patients arrive at the hospital, Dr. Gruber also asks them how many times they have been shot. He said most injuries are internal, and X-rays help find them.
“Most of the time they’re awake and can tell us what is going on,” Dr. Gruber said. “Usually they’re in pain. Most of the damage is internal.”
As with Wrask, Dr. Gruber said the main injury may not be from the hole the bullet makes. He said it enters a body with such force the energy sends shock waves that can damage internal organs.
Wrask and Dr. Gruber both said from their experience, the extent of bullet damage depends on where it hits you, not necessarily what caliber of gun was used to fire it.
“I’ve seen some .22s do horrible damage,” Wrask said of the small caliber .22-caliber round. “I’ve seen some people just grazed by an AR-15 (assault rifle) .”
Dr. Gruber did say, however, a larger-caliber bullet can do more damage than a smaller one.
“If it hits, depending on the caliber, you may have a small hole and a broken bone,” he said. “A high caliber can shatter bones and lacerate vessels.”
Wrask said when she was a paramedic in the 1990s, when Youngstown recorded more than 500 homicides, wounds from rifle rounds were more common.
She said now it appears most shooting victims are shot with handguns.
As for the work to find and repair the damage a bullet makes, Dr. Gruber said he takes a knife and cuts a patient open from his breast to the navel if the wound is on the torso. Sometimes he uses a rib spreader, a device with a crank to spread the ribs apart so medical personnel can see and reach inside a person.
It is not uncommon to break ribs and hear them crack as they are pried apart, Dr. Gruber said, but the alternative of not looking for and repairing the damage is not an option.
If patients are unstable when entering an emergency room, they are taken straight to surgery and in extreme cases are worked on in the ER, where Dr. Gruber cuts them open to find the damage.
“You just filet them open and look around,” he said.
All this is also done in a pressure situation, but Dr. Gruber said he relies on his training and experience. “Obviously it’s nerve wracking, and you’re dealing with a life-and-death situation,” he said.
Wrask said there is pressure in her line of work as well, and often, if they are outside at a crime scene with people around and it can be chaos and angry words are spoken, but often that anger is directed at someone else and not the paramedics.
“When people are yelling at you, they’re not yelling at you,” Wrask said. “They’re yelling at the situation.”
Wrask credited the ER surgeons and their assistants for the work they do, calling them “miracle workers.” But Dr. Gruber said he is just part of a team that includes nurses, lab personnel, X-ray technicians and others who all do their jobs well so he can do his.
“It’s all teamwork,” he said.