Emergency Physicians and Firearm Violence Researchers Make ‘Viscerally Clear’ How Bullets Impact Humans

In two videos and an accompanying paper published in JAMA, experts from Mass General Brigham and colleagues illustrate the damage of bullets and the need for public health policy changes

Emergency physicians and firearm violence researchers are applying public health principles to bullets to help draw attention to why they should be treated as the cause of injury and death, not simply as inert objects. In a publication in JAMA and in accompanying videos, researchers from Mass General Brigham and colleagues illustrate the damage bullets can render and advocate for public health policy changes to reduce the rampant harm and destruction they cause.

“Though ultimately the agent of injury and death, the bullet has mostly been ignored when it comes to considering how to reduce the over 48,000 firearm fatalities and approximately 200,000 firearm injuries that occur annually in the U.S.,” said corresponding author Eric Fleegler, MD MPH, a physician-investigator in the Gun Violence Prevention Center at Massachusetts General Hospital. “It is past time to consider bullet-specific regulations.”

In their publication, Fleegler and co-authors lay out the case fatality rate (CFR) of bullets. Usually, CFRs are used to refer to the proportion of people who die from a specified disease compared to the number of people diagnosed with the disease. In their paper, the authors use CFRs to illustrate how deadly firearms and their bullets can be. For instance, when used in a suicide attempt, the CFR is over 90 percent, compared to a rate of 2-to-3 percent for a suicide attempt by intentional overdose.

In two accompanying videos, the authors use ballistic gelatin to illustrate the effects of a bullet traveling through muscle tissue. The videos show the effects of a 0.32 caliber bullet from a handgun and a 5.56 NATO bullet shot from an AR-15-style rifle.

“These higher-velocity bullets create a pressure wave that forces the tissues away, causing a temporary cavity much larger than the bullet itself. The destructive potential is viscerally clear,” the authors write.

The authors conclude their paper with several policy recommendations, including limiting the types and number of bullets that can be purchased, requiring background checks on bullet sales, and taxing bullets based on their case fatality rates.

Authorship: Additional authors include Laura Vargas, Christian D. Pulcini, and Stephen Hargarten.

Disclosures: None.

Funding: None.

Paper cited: Fleegler E et al. “Bullets as Pathogen: The Need for Public Health and Policy Approaches” JAMA DOI: 10.1001/jama.2024.25535