First Aid/.50 BMG gunshot wound

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Question
QUESTION: I'm writing a story and a 17 year old girl is shot in the chest with a .50 BMG.     
  What are the immediate affects of the wound?
  How quickly would she go into shock?
  What could an on scene first responder do for her?
  What are the chances of her surviving a hit to the chest?
  To the Abdominal area?
  How long would she have to live with a hit to the heart?
  To the Liver, Spleen, Lungs?
  What would the EMT's do on the scene?
  In the hospital?
  What surgical procedures would she have to go through?
  What are her chances of making it through surgery?
  How painful would it be?
  How long would death take if her wounds were left unattended?
         Thank you.

ANSWER: Hello Hope,

I can answer this one fairly quickly.... there would be nothing that could be done medically. the .50 cal was designed for hard targets (bunkers, transport vehicles). It has become popular with long range snipers but using a .50 cal on personnel usually results in a decree of "vaporization" . a kill is often accompanied by a "pink mist" as the human target kind-of explodes. The round carries a lot of energy, when it hits a concrete wall it leaves a large hole because that energy is dispersed into the concrete like a million little jack hammers.  When it hits a person the same thing happens, the massive kinetic energy disperses and makes every cell in it's path shake apart from the one next to it. In full speed this is called an "explosion". I once heard a story of 2 guards standing atop a water tower, one was shot by a sniper who was a ways away. When the guard was hit his buddy looked over in surprise that the man he was just talking to blew up in the mid section in a poof of blood. (the sound of the shot likely was heard a second or two after).

Here is an excellent video better illustrating this.

http://www.myspace.com/video/eric-l-smith/marine-corps-snipers-in-action/1756160


I hope your story works out, let me know if I can help again.

Marc

---------- FOLLOW-UP ----------

QUESTION: What difference would it make if a .308 winchester was used?

Answer
What are the immediate affects of the wound?
It would depend on what exactly was hit, if the heart was hit death is almost instantaneous, if any of the great blood vessels are hit death will occure within 5-15 seconds (by the way, nothing would likely save this person, even being shot in an OR with a dozen trauma surgeons right there wouldn’t help). The bullet when it enters the body makes a large (temporary cavity, the this cavity of the previously asked .50 is just larger than the body in most cases) a good example of this is in the movie when Ed Norton is shot in the mouth at the end, that slow motion clip is an excellent depiction of what happens. So the bullet may tear a major vessel if it comes close even if it doesn’t hit the actual structure.

 How quickly would she go into shock?
If they have a survivable wound, in as little as 15-30 sec, maybe 20 minutes if it’s a very slow bleed? A lot depends on what internal structures are hit and how much bleeding there is. “Shock” is: the lack of sufficient blood flow to an organ or organs” (by definition).

 What could an on scene first responder do for her?
Bandage the wound, direct pressure, Oxygen by non-rebrether mask at 15 LPM (liters per minute), An IV in each arm- 18 GA (gague), 16 GA, or 14 GA. Heart monitor. Be on the way to a medical facility with a trauma specialty within 10 minutes of on scene arrival.

 What are the chances of her surviving a hit to the chest?
In a lung, better than in the heart (the heart would be a 100% chance of immediate death), a lung, missing all large blood vessles, maybe a 20-30% survival rate (again, it’s hard to really say, it depends on a lot, and how quick medical intervention can be accessed.

 To the Abdominal area?
Maybe slightly higher initial survival rate, but infection is an issue and recovery could be a major hurdle if large sections of bowel need to be removed.

 How long would she have to live with a hit to the heart?
She would likely remain conscious less than 10 seconds

 To the Liver, Spleen, Lungs?
Liver- she could survive through to the hospital, surgery, but there’s a good chance she would need a new (donor) liver if she was to survive past 2-4 weeks.
Spleen- there’s a lot of bleeding, but if she got to the hospital fast enough, she could survive without it.
Lung- there would be a lot of trouble breathing, but it’s possible to survive with immediate care, rapid transport and a trauma hospital.

 What would the EMT's do on the scene?
Direct pressure to control the bleeding, an ECG, Oxygen by mask, 2 large IV’s (one in each arm), IV fluid, and transport to a trauma center within 10 minutes of getting on scene. If transport time is going to be longer than 15 min I’d recommend flying her via helicopter.

 In the hospital?
Immediare X Ray of the chest, (possibly CT scan depending on what’s likely damaged), trauma surgery  ASAP, in OR there should be trauma surgeons, cardio-thoracic surgeons, vascular surgeons available.

 What surgical procedures would she have to go through?
Basically, repair what’s torn or separated, remove what’s too badly damaged to continue as living tissue in the body. Repair and modify structures the best that they can be.

 What are her chances of making it through surgery?
It depends greatly on what’s organs are damage, and the length of time before she reached the hospital, the initial care that is given and blood loss. A bullet through the heart… probably 0%, a lung… 30-60% but that depends on a lot too.

 How painful would it be?
Pain is hard to rate or predict. There would probably be less pain when she was initially shot than when she is being transported to the hospital and possibly more pain initially after surgery as tissues swell?

 How long would death take if her wounds were left unattended?
Again, that’s difficult, depending on what organs, blood supply or the lack of, the heart… 7 seconds, lungs.. maybe 10-15 min., liver.. maybe a couple hours? Its really hard to give a good time period for death.

Good luck with your story.
Marc

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Marcus LaBarbera

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I am available to answer most questions related to: first aid, pre- hospital medicine, EMT and Paramedic questions, medical transport, critical care transport, ICU/CCU care, sedation, and medicine in general.

Experience

I have worked as a NYS Paramedic since 1993 for both community based ambulance companies and large commercial agencies. I Have experience as bike team commander, and shift supervisor for a commercial ambulance. As a member of the Disaster team I was deployed to Louisiana for 20 days following hurricane Katrina. I worked along side the county Haz-Mat team as a "Tox-Medic" with advanced training in treating injuries from chemical agents. Besides my experience on the on the ambulance I have worked in a number of hospital based offices including dialysis and a sleep lab.

Education/Credentials
I started my EMS career as a NYS CFR (Certified First Responder)in 1989, an EMT in 1991, a Paramedic since 1993, and a CCU transport paramedic since 2005. I currently hold certification as a: NYS Paramedic, Critical Care Transport Paramedic, ACLS/CPR/PALS certified. Advanced Haz-Mat Life Support certified (AHLS). In the past I have taught CPR and ACLS to my coworkers and the local community.

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