High-speed slug especially lethal

Sniper's choice of rifle, targeting head and torso give victims little chance

Anatomy, physiology, speedy care

October 23, 2002|By Jonathan Bor and Erika Niedowski | Jonathan Bor and Erika Niedowski,SUN STAFF

Struck in critical locations by a single bullet traveling at supersonic speed, few of the sniper's victims ever had a chance.

Three of the 12 confirmed targets were struck in the head, and all three died. Trauma doctors say they cannot imagine anyone surviving such an injury, which would immediately shut down all neurologic activity.

Most of the others who died in the shootings were struck in the chest, back or upper abdomen, where a high-speed bullet can rip through the heart or major blood vessels. In such injuries, victims tend to lose blood faster than doctors can replace it - if they can get to a doctor at all.

"The sniper has used only one bullet on every person that he's shot, but some of these were instantly fatal, and there would have been no hope for any intervening care," said Dr. Tom Lyons, medical director of the emergency room at Bowie Health Center, where one of three victims who survived was initially treated.

"If you're shot in the heart, with rare exception, that's going to be immediately fatal. Same as if you've been shot in the brain."

Trauma surgeons tried frantically to save Conrad Johnson, the 35-year-old bus driver who was shot in the Aspen Hill section of Montgomery County yesterday morning.

But the bullet entered just beneath the rib cage and sliced through his liver, severing major blood vessels and causing extensive bleeding, said Dr. Dany Westerband, part of the surgical team at Suburban Hospital in Bethesda.

Vital organs, vessels

When a bullet from a high-powered rifle strikes the blood-rich area of the upper abdomen surgeons often have difficulty keeping patients from bleeding to death.

"If we can get in and provide blood as fast as they lose it, we can fix them. But if we can't, they can't survive," said Dr. Kerry Powell, an emergency physician at the Johns Hopkins Bayview Medical Center. Dr. Thomas M. Scalea, physician-in-chief at the Maryland Shock Trauma Center, said that whether a patient lives or dies depends on where - and how many times - a person is shot, how well the person's body responds to the injury and how quickly he or she gets medical treatment.

"It's a function of anatomy, physiology and medical care," he said.

"Being shot in the head is probably the most lethal. Being shot in the torso - the chest or the abdomen - is probably next most lethal. Being shot in the neck probably comes in around number three," Scalea said.

The .223-caliber rounds delivered by the sniper's rifle can travel 3,000 feet per second, more than twice as fast as rounds shot by handguns used in most street violence. It is the bullet's velocity - not its size - that makes the weapon so deadly.

Bullet tumbles

When the bullet hits structures inside the body, it tends to wobble or tumble end over end. Its energy is dispersed outward, so the bullet destroys not just tissue directly in its path but also in a widening zone around it. It also creates a vacuum in its wake that destroys tissue.

"The energy actually creates a cavity around the [bullet's] track," said Dr. Steven Johnson, a Shock Trauma surgeon. "That's one reason why typically the entrance hole is smaller than the exit."

Some people attacked with lower-powered weapons have been known to survive gunshots to the head. Such was the case of James Brady, the former White House press secretary who was shot in the forehead during the assassination attempt on President Ronald Reagan.

Doctors also report cases of people who survived self-inflicted gunshots to the head.

"But a high-powered bullet to the brain is an instantaneous death," Johnson said.

Those sniper victims who survived their injuries appear to have been struck below the heart, away from major sources of blood. Though doctors released few details about a 43-year-old woman who was shot in the back while loading packages into her car outside a shopping center in Spotsylvania County, Va., the two other survivors suffered similar abdominal injuries.

"What was involved were the stomach, the pancreas and the spleen. They were hit below the level of the heart, slightly off the center of the body," Johnson said.

The 13-year-old boy initially treated by Lyons, shot moments after his aunt dropped him off at the Benjamin Tasker Middle School in Bowie, was struck in the upper-left side of his abdomen. The bullet, exploding inside his body, damaged his stomach, diaphragm, liver, spleen and pancreas.

Surgeons at Children's Hospital in Washington removed his spleen, patched up his stomach and other organs, and supplied significant quantities of blood to replace what the boy had lost. But the bullet missed his heart and major vessels, where it could have proved instantly lethal.

"The boy that was shot in Bowie had multiple [life-threatening] injuries, but he didn't have any that would cause him to hemorrhage on the spot," said Lyons. "If he got treatment in a timely manner, he had an opportunity to survive, and that's what happened."

In the case of the sniper's 12th victim, a 37-year-old man shot Saturday night outside a restaurant in Ashland, Va., the bullet entered the upper left abdomen, causing extensive damage to several organs.

In a three-hour operation, trauma surgeons removed two-thirds of the man's stomach, half his pancreas and all of his spleen. A day later, they reconnected the man's damaged stomach and small intestine and retrieved the bullet.

The man, whose name has not been released, is expected to undergo two or three additional surgeries.

The survivors were lucky to have received prompt medical attention, Johnson said:

"The kid took a lot of blood and the man down in Richmond took a lot of blood. But if you get them quickly [to a medical center] you can get that bleeding to slow down a bit so you can keep up with the blood loss."

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