More Training Urged in Care of Gunshot

Urban violence that leads to 30,000 shooting deaths and 300,000 gunshot wounds a year in the United States has become so widespread that virtually every emergency physician practicing in the nation’s cities should receive instruction in the ways different kinds of guns and bullets cause damage to the body.

That is the opinion of an expert in gunshot medicine at Martin Luther King Jr. General Hospital on the fringe of Watts--a health center that has treated two of every 100 residents around it for a gunshot wound in the last 10 years.

Distinguishing Damage

In all, said Dr. Gary Ordog, an attending physician at King, nurses, paramedics and doctors--particularly those in urban areas--must learn far more about how different firearms and their projectiles can damage the body. Knowing how to quickly distinguish in the first check of a patient between, for instance, a simple .22-caliber pistol wound with a conventional bullet and a more lethal injury caused by a larger-caliber rifle using deadly hollow-point ammunition may spell the difference between survival and death for a gunshot victim.

Ordog, who has published two articles--and authored two others that await publication--in his unusual and unofficial subspecialty of gunshot medicine, made the comments in a recent interview. He has become one of the handful of national experts in the field. A review by Ordog of the differences in injuries among various types of guns and bullets appeared in a prominent journal in December. Late last year, he presented results of one of the first studies of child shooting victims ever conducted.

Four King doctors, including Ordog, recently completed a study of shootings involving homemade guns that found the so-called zip gun has lost little of its appeal over time. A favorite variety is made from radio antennas torn off older models of Cadillac cars. It turns out, said Ordog, that vintage Cadillac antennas are just the right diameter inside to accommodate a .22-caliber bullet.

The problem for doctors, Ordog said, is being aware of the different ways bullets can injure a victim and how different caliber sizes and types of bullet can critically affect the outcome for the patient. Surprisingly, perhaps, because many gunshot wounds involve .22-caliber handguns, the vast majority of shootings do not lead to fatalities and even a wound of the head may not be serious under certain circumstances.

Larger and Lethal

But if the weapon is of larger caliber, and especially if it is both higher caliber and rifle-sized, the bullet can literally send shock waves through body tissue that can inflict catastrophic damage as far as several inches from the path the bullet actually travels in the body. That is why, Ordog said, it is important for paramedics or other first-aid personnel to learn as much about the type of weapon that may have been involved in a shooting as possible.

Emergency room doctors, Ordog said, may choose an entirely different treatment strategy for a high-caliber rifle wound than they would for the same caliber of bullet fired from a handgun. Ordog noted that the national total of death and woundings per year is equivalent to all American casualties in the Vietnam war. He said King alone treats 2,000 gunshot wound victims each year. Handguns are the overwhelming weapon of choice, Ordog said, but there appears to be a gradual move toward more deadly firearms, with the number of high-powered rifle wounds up recently.

More Young Victims

Victims are getting younger, too, he said. At a recent conference of medical experts on trauma care, Ordog reported on a King study of 300 pediatric gunshot wound victims, most of whom were 10 to 15 years old. The study group was treated at the hospital between 1974 and 1984, but Ordog said there is a clear trend toward ever younger shooting victims. Six unborn infants were among the shooting victims.

Twelve other victims of shooting violence were under 10. Ordog said the toll among very young children reflects the incident on Feb. 25, 1984, in which a sniper opened fire on the yard of the 49th Street Elementary School. One little girl was killed and 11 children were injured, three of them treated at King.

Of the 300 victims studied, Ordog said, 80% were gang-related--though just as likely to be innocent non-gang members as persons responsible for gang violence. Another 16%, he said, were of the so-called “drive-by� variety in which roving cars of thugs shoot at people and homes. King even treated the victim of a “pedal-by� shooting recently, Ordog said, that occurred when a gunman on a bicycle opened fire.

The remaining 4% of the victims shot themselves, Ordog said, either accidentally or in suicide attempts.

The schoolyard shooting involved a high-powered rifle, but Ordog said that while doctors believe weapons used in street shootings are gradually becoming of higher caliber, the change is evolutionary and slow. One patient who was admitted recently after a drive-by shooting was struck after a bullet possibly fired from a semi-automatic or automatic weapon passed through two walls of his house.

Despite the gradual evolution of weapon calibers, however, said Ordog, “I really can’t say it’s a trend.�