MEDICAL-FORENSIC FILES: What Would Happen to My Police Officer If Shot in the Chest and Arm?

Q: In my story, a police officer is shot while sitting in her patrol car. The assailant fires through the open passenger window, using a.38 caliber S&W. The officer's upper right arm is hit twice. One round lodges in her humerus. A second misses the bone and hits an artery before entering just below her armpit, where it splinters two ribs and punctures a lung. Rounds three, four, and five hit the officer's body armor when she pitches forward. The sixth never leaves the chamber.

My questions:

1) Where could round two end up if I don't want the officer to sustain additional organ injuries?

2) What blunt trauma might she sustain from the rounds that hit the body armor?

3) What sensations would the officer feel both during and soon after being shot? How would those express physically (sweating, panting)?

4) Would she experience numbness and cramping in her right hand soon after the injury to her upper arm?

5) How would a trauma center initially handle an incoming gunshot victim? How would an officer be treated differently?

6) What would be involved in her recovery, both inpatient and outpatient? How long would recovery take? Would a lingering tingling in her right hand be reasonable to expect?

A: The injuries you describe literally come in 1000 different flavors, so it’s impossible to cover all contingencies here. Gunshot wounds (GSWs) are each unique, but I'll give you some information regarding the specifics of the most likely circumstances in your scenario.

         The second round would most likely remain within her chest, though it could exit, producing an exit wound. It could go either way. You described it striking the ribs and puncturing one of the lungs, so depending upon the type of ammunition and weapon, it may have lost enough velocity to remain within the chest. That can happen with almost any caliber weapon and any type of bullet, but leaving the body through an exit wound would be more likely with a high-powered rifle or handgun and with jacketed or partially jacketed bullets. But, anything is possible so you can have the bullet exit or remain in the chest and either way would work.

         Typically there are only minor injuries from gunshots striking body armor. It depends on whether it is the hard-shell type or the softer Kevlar type but regardless the injuries are usually some degree of bruising in the area of impact. This might produce discomfort for a few days, but that's about it.

         She would obviously experience some shock and pain but many people who have suffered GSWs say that the pain does not come until several minutes later. Sometimes longer. This likely occurs because nerves in the area suffer “shock” and might not respond properly for a minute or two. Striking the bone would be more painful so she would experience significant pain in her shoulder and ribs. Bones are always painful when they’re damaged, fractured, or shattered.

         With her rib injuries and the collapse of her lung, she would obviously feel short of breath, sweaty, and anxious. She might also cough, which would be very painful, and might cough up some blood since she would bleed into the airways.

Her major threat to life is not the collapse of the lung as we have two of them and can do just fine with only one functioning properly. Unless the bleeding into the lung was severe enough to fill both lungs. Here, her survival would require immediate and effective treatment. Stick with one damaged, or blood-filled, lung and you’ll be fine.

         But, the injury to the artery in her upper arm is potentially deadly. Depending on the entry point, the artery involved could be the brachial, axillary, or subclavian artery.

These are large arteries and bleed profusely. This means she could slip into shock and die in a very few minutes without proper care. At least that's possible. It is also possible that the artery is simply nicked and the bleeding not that severe. If significant enough, she would become weak, dizzy, cold, and slip into shock. Again, this comes in a 1000 flavors.

         Her arm would be useless initially simply because there was bone damage, and likely some nerve damage. If the artery was also severely damaged, a lack of blood flow to the arm could alter its usefulness. Her movements would either be absent or minimal and not likely well coordinated, strong, or effective.

         Once she reached the emergency department, they would apply pressure to the wound to control the bleeding until it was surgically repaired. This pressure would have begun in the field by medics or her fellow officers. She would receive IV fluids and blood and be placed on oxygen via a mask. She might require intubation (the introduction of a breathing tube into her trachea) and placement on a ventilator depending upon how well she was breathing and whether she was conscious and able to ventilate on her own. Again, almost anything is possible. In the operating room, they would open her chest, remove the bullet if still within the chest, and repair the lung. They would also place a chest tube (thorocostomy tube), which is a plastic hollow tube that is placed in the space between the lung and the chest wall, passed out through the chest wall, and sutured in place. It is then attached to a suction device that removes any residual blood, applies negative pressure to keep the lung inflated, and allows the injury to heal. Once the defect in the lung injury heals and seals completely--usually takes a few days--the chest tube is removed.

         The arm might also undergo surgical repair, and, in fact, this might be done first in the case of a damaged artery since that is the major threat to her life. If so, once completed, her chest wound would then be addressed.

         She would likely be in the intensive care unit for a few days and then in the hospital for a few more days. After discharge, she would undergo rehab for many weeks or months. How well she did, how quickly she recovered, and what residual problems she had again is highly unpredictable and depends upon the exact nature of the injury.

         If the damage was only to the bones, muscles, and the artery, she would more or less regain 100% function. However, if the nerves were damaged, she might suffer permanent disability in the form of weakness, numbness, and reduced coordination and ability to do fine tasks.

         As you can see there are many options, and I've only touched on a very few of them, but this should give you a great deal to work with as you plot your story.

This question originally appeared in MORE FORENSICS & FICTION by DP Lyle

 https://www.dplylemd.com/books/qa