A retrospective analysis
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Firearm Injuries
Forensics of
Between January 2016 and October 2019, a review
was done on a data from 100 patients in Fayoum
governorate of firearm injuries their records were
reviewed for these information:
 Demographic data
 Age
 The manner of death
 Sex
 Its date
 Residence
 Occupation
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Methodolog
y
Statistical analysis: Data were coded to be processed the
data entered Microsoft access twice and
processed using SPSS software version
18.
 The analysis was simple in form of
numbers
and
percentages
for
qualitative data.
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Methodolog
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• Accidental, suicidal or homicidal.
• According to the study results the most of
firearm injuries recorded in year 2016 were
accidental, however those recorded in years
2017, 2018 and 2019 were homicidal.
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Conditions of Firearm
injuries
• Some other studies conducted In United States
and other developed countries firearms are used
in more than 60% of all homicidal inflects ,
over 25% of all assaults, more than 35% of all
robberies and almost half of all suicidal
attempts.
• In the year 2010 gun injuries were responsible
for death in about 31.076 Americans either in
suicidal attempt ,homicidal or accidental.
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Conditions of Firearm
injuries
1- The damage caused by mechanical interaction
between the bullet and the tissue.
2- The temporary cavity created by the bullet.
Since the shots is rapid, it has dangerous properties
and turns while propelling causing damage to
organs and tissues passing through.
In addition, it may alter course in the body and go
to different areas from the intent of the passage
way hence gun wounds can cause more damage
than the expected injuries.
Incidenc
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Severity degrees of Firearm
Determinedinjuries
by two variables:
Classification system of gunshot
injuries
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Classification system of gunshot
injuries
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This classification can assist with the selection of
proper treatment as all patients with gunshot injuries
initially should be treated with prophylactic
antibiotics then the decision for operative versus non
operative treatment should be determined primarily
on:
 nature of the vital structures injured
 amount of energy transferred
 location of retained metallic debris
 the degree of contamination
Fatal and non-fatal injuries
- In 2016 and 2017 there was no fatal injuries and
in 2018-2019 only 2 cases were fatal.
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- Although the rate of firearm injuries increased
from the year 2016 to 2019 from 22 cases to 28
cases, most of the injuries are non fatal as they
are mostly to the limbs .
Fatal and non-fatal injuries
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Fatal and non-fatal injuries
 But the fatal injuries increase gradually over years
which may be partially explained by an increase in
the use of higher powered, semiautomatic
handguns in assaultive violence.
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 In contrast a study in Qena and Fayoum reported
that the chest and abdomen were the most
common sites of wounds.
Incidence of Firearm
injuries
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There is a slight increase in firearm injuries - even
it is nonsignificant - increase in the last four
years.
Incidence of Firearm
injuries
 year 2007 (53 cases; 19.8%), the largest number
 year 2010 (50 cases; 18.7%)
 year 2005 (46 cases; 17.2%)
 year 2009 (42 cases; 15.7%)
 year 2006 (40 cases; 14.9%)
 year 2008 (37 cases; 13.8%)
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These findings disagree with those obtained by other
researchers who recorded firearm injured cases that ranged
from 37 cases (13.7%) to 53 cases (19.8%) per year;
Incidence of Firearm
injuries
 Then an increase was noticed in year 2014
(22.8%) and this was followed by a decrease to
the least percentage documented through the
research period in year 2016 (4.7%).
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 A similar study showed that the number of
firearm injuries was high in year 2011 (23.7%)
and gradually decreased to (13.9%) in year 2013.
Incidence of Firearm injuries
according to gender
2016
2017
8%
8%
Males
Females
2018
15%
91%
Males
2019
22%
78%
85%
Males
Females
Females
Males
Females
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91%
Incidence of Firearm injuries
according to gender
Explanations include:
Females;
• They in general stay at home.
• They are more uncertain to take part in battles
that could prompt homicide. A part of their
psychology.
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Males;
• They cant control their feelings of rage in their
every day activity where violence is ensured.
• They are required to keep up the honor of the
family and any risk to it that can prompt brutality.
Incidence according
to age
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This study recorded that, firearm injuries are
more common in age group between (20-40)
years. They were 60 males (86.96%) and 9
females (13.04%) as shown in table.
Incidence according
to age
 Another retrospective study recorded all firearm fatalities
in El-Fayoum Governorate during the 7 year period from
2000 to 2006 and reported that the most affected age
group in the studied victims was the third decade (29.6%),
followed by the fourth decade (25.4%). The least affected
age group was above the sixth decade (1.4%)
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 These results are similar to those reported in El-Monofia
Governorate, Egypt, during the year 2000, where the
highest incidence occurred in the age group 20–30 years.
Incidence according
to age
 The results of the current study differ from that of a study
done in Qena Governorate that outlined the pattern of
firearm injuries. There, the rate of incidence was in the
age group 30–40 years (49.5%), followed by the age group
40–50 years (25.2%). No victims were younger than 20
years.
Medical
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 Moreover, other study done in Assiut Governorate
founded that the elevated incidence of firearm injuries
and fatalities occurred in the age group 21–30 years
(31.3%), followed by the age group 31–40 years (25.5%).
Incidence according
to age
 The reason of this may be that these age group 20-40
years are the most age group in everyday activities and
work, where violence and battles are occurred.
Medical
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 The results of the current study agree with those of the
study in Pakistan that collected data about firearm injuries
and fatalities in the years 2007 and 2008. It was shown
that almost all age groups were represented, with the
majority of victims being adults and middle-aged persons.
or
 This is due to lack of awareness, the fact that
farmers tend to protect their lands by intimidation
and also the fact that authorities supervision is
minimal in rural areas in contrast to the significant
presence of authorities in urban areas and proper
education and awareness.
Medical
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Urban
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 Rural areas are the most common site of fire arm
injuries.
or
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Between the year of 2016 and the year 2019, there
was an increase in the rate of firearm injuries
especially at rural areas.
Role of the clinician in cases of Firearm injur
 Immediate assessment and treatment of the victim by
the systematic ABCDE approach; Airway, Breathing,
Circulation, Disability, Exposure
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Role of the clinician in cases of Firearm injur
Injury assessment and documentation;
requires
an
experienced
forensic
• It’s essential to accurately describe the appearance of
initial wounds before any subsequent surgery or
intervention that could conceal the specific pattern or
characteristics of such wounds in order to determine
the pattern which could reveal the type of firearm
used whether it’s rifled or smooth bore.
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• This step
pathologist.
Role of the clinician in cases of Firearm injur
Preservation of the chain of evidence
 Appropriately recorded findings of both history taking
and physical examination.
 Forensic photography.
 Any fragments, bullets, pellets found and even the
victim clothes should be preserved and handled over to
the appropriate authorities.
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 Contemporaneous written or digital medical notes
including descriptive body diagrams.
Improving rates of firearm injuries
There’re already tight weapon laws in Egypt but there’s
always room for improvement by:
 Enforcing the proper criteria for acquisition and use of
firearms.
 Tighter regulations on its trade and transfer.
 Awareness campaigns to teach proper use and storage of
legal firearms and warn against its dangers.
 Decreasing levels of poverty and unemployment might
also help.
Improving
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Rate ns
 Strict penalties for violations of the weapon laws.
Conclusion
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Conclusio
ns
 Firearm injuries are one of the most common causes of
death in the world.
 It is mainly homicidal representing a lot of homicidal
inflicts in developed countries .It is also suicidal
repesenting almost 50% of all suicidal attempts in USA as
mentioned by some studies.it might be accidental as
mentioned in our study in 2016
 The severity of injury depends on the temporary cavity
caused by bullet and the mechanical interaction between
it and the tissue
 The injured vital organs ,energy amount , metallic debris
location and contamination are classifying firearm injuries
 Although increased from 2016 to 2019 ,most of injuries
are non fatal
Conclusion
Reference
Conclusio
ns
 There is slight increase in firearm injuries from 2016 to
2019.they are more common in males especiallybetween
20 to 40 years in rural areas more than urban onesdue to
lack of awareness
 The clinician must assess and treat the victim by the
ABCDE,assess the injury and document it and preserve
the chain of evidence.
 More strict laws must be implied for limiting firearm
injuries.
References
Mwaheb, m., & Rohym, H. (2020). A retrospective analysis of firearms injuries during
the period from 2016 to 2019 in the Fayoum Governorate, Egypt. The Egyptian
Journal Of Forensic Sciences And Applied Toxicology, 20(3), 67-75. doi:
10.21608/ejfsat.2020.19831.1113
Cherry, D., Annest, J., Mercy, J., Kresnow, M., & Pollock, D. (1998). Trends in Nonfatal
and Fatal Firearm-Related Injury Rates in the United States, 1985–1995. Annals Of
Emergency Medicine, 32(1), 51-59. doi: 10.1016/s0196-0644(98)70099-x
Gugala, Zbigniew; Lindsey, Ronald, W. Classification of Gunshot Injuries in Civilians,
Clinical Orthopaedics and Related Research: March 2003 - Volume 408 - Issue - p
65-81
Sharma, B., 2006. Clinical forensic medicine in the present day trauma-care system—
An overview. Injury, 37(7), pp.595-601.
Stark, M., 2020. Clinical Forensic Medicine. 4th ed. Springer.
Reference
s
Sachan, R., Kumar, A., & Verma, A. (2013). Frequency of Firearm Injuries, Deaths and
Related Factors in Kanpur, India; an Original Study with Review of Literature.
International Journal of Medical Toxicology and Forensic Medicine, 3(3(Summer),
88-95. https://doi.org/10.22037/ijmtfm.v3i3(Summer).4328
20170610
Mennatallah Mohamed
20170614
Hassan
20170620
Mennatallah Taha
20170621
Mahmoud
20170622
Maha Mohamed
20170626
AboElmaaty
20170631
Maha Yassin Hussin
Mohab Mohamed Abdelaziz20170632
20170633
May Samy
20161115
Mayar Osama Abdel
Rasheed
Mayar Mohamed Gaber
Mikhail Nagy Sameer
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Prepared by:
Dr. Walaa Abd El hady
Lecturer of Forensic medicine and clinical
Toxicology
Dr. Basma Kamal
Assistant lecturer of Forensic medicine
and clinical Toxicology
Dr. Fatma Shaban
Demonstrator of Forensic medicine and
clinical Toxicology
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Under Supervision :