Understanding Bullet Wounds

Ammo selection is an important part of self-defense. Discussing ammunition capacity for tissue disruption is a very common, almost irresistible thing to get into. The adage of “shot placement is king” is mostly true- as it is the most important part of the equation but it’s still only a single part of the equation. However, for both civilian and law enforcement alike understanding bullet wounds from both a tactical and medical standpoint can be rather overwhelming. Since most people don’t have the exposure and information that I do, I’m going to try to simplify what actually happens when you shoot someone.

Shooting someone is about running the clock on them.

What does this mean?

Human bodies need blood pressure and oxygen in order to operate. Whenever you cause internal hemorrhaging on someone, usually done with a knife or a gun, it starts a clock counting down. Once that clock reaches zero, you’re done*. The medical term for this is exsanguination. (Monstrous size has no intrinsic merit.)

*Note: Done doesn’t necessarily mean dead, just means incapacitated and out of the fight. Tactically and legally, all I care about is that they stop doing whatever it is that’s making me shoot them in the first place.

The human body is an amazing thing. It will continuously compensate and readjust for any damage it receives in order to remain functional for as long as possible. This includes things like clotting over bullet wounds and dumping adrenaline into the person’s system. The more you damage the body, the less it can compensate for and the faster the clock runs down.

To help give an idea about how necessary blood pressure is for a human body to function: These are a few of the health issues that are directly affected by blood pressure

Now, here is the rub:

Handguns suck at running the clock on someone. You can run the clock a lot faster with a machete or rifle, but can you conceal a machete or AR-15 underneath your clothing and quickly deploy it into the fight? Compromises must be made.

As mentioned in the FBI report on Handgun Wounding Factors And Effectiveness by Agent Urey Patrick, the effects of handguns simply aren’t very violent or dramatic. This has been repeated countless times (including from LuckyGunner, trauma surgeons, SWAT officers, and clueful self-defense instructors). Indeed, there are even many instances of security footage one can look at of people being fatally shot with handguns getting back up and walking off the scene before keeling over. And it’s never an overly dramatic fall- rather, they slump over and collapse slowly.

The question isn’t lethality, as any bullet can kill. The question is effectiveness. Handguns are not very effective weapons, at least relative to long guns. Handguns are difficult to shoot and not very powerful. There are 2 key advantages handguns have though, and those 2 advantages are vital. 1) You can take them with you everywhere. The most useful tools are the ones you have on you. 2) You can get a handgun out into the fight much faster than you can get a long gun out into the fight. The first person to get shots on target is almost always the winner. There is a commonly repeated phrase of “your pistol is just there to get you to your rifle” and it’s a bit of a misnomer- your pistol is there always, your rifle is there sometimes.

So how does this translate to actual gunfights?

Just because you fatally shoot someone, it doesn’t automatically mean they are out of the fight. You must know how to run the clock on someone and be aware that there is no quantifiable standard for how a person will react to being shot. The sheer number of variables involved is staggering. You can do everything right and still wind up dead. You can goof up majorly and come out on top.

In other words: Stopping a threat isn’t “I shot them, my problems are solved”. Stopping a threat is about knowing how to control the situation- before, during, and after.

When someone like Dr. Gary Roberts says not to focus on the minutiae of handgun terminal ballistics and instead focus on training and tactics, this is what they mean. Getting rapid, precise shots on target is the most important part of the equation, but it’s not the one and done definitive fight stopper that some people make it out to be. The fight is not over until the person drops. See: The shootout of Sgt. Timothy Gramins.

That article linked by the one and only Massad Ayoob is absolutely worth the read, as it’s the best holistic look at the firefight thus far but to break it down simply: A gangbanger had to kill a cop for an initiation thing. Sgt. Gramins wound up being the unlucky bastard who crossed paths with that gangbanger. In the ensuing firefight, the suspect took 14 shots center mass in fatal areas, a few shots to the arms and legs, and an additional 2 or 3 shots to the face before Sgt. Gramins was able to score a headshot that sufficiently damaged his brain and stopped him. The perp was still showing vital signs when EMTs arrived on scene.

“But what about shot placement?”
Sgt. Gramins was not just a sniper- he was THE sniper of the Chicago PD. He trained marksman classes regularly and his accuracy scores are top among America’s entire police force. Autopsy report confirmed his shots hit lungs, heart, and other vital organs, destroying them permanently. There was even a moment in the gunfight where the suspect was hiding behind a car’s engine block completely, so Sgt. Gramins shot underneath the car and RICOCHETED THE BULLETS UP INTO THE SUSPECT. To say that this man was a crack shot would be an understatement.

“He was probably on drugs or something.”
Nope. Just like with Miami Dade Shootout (a previous OIS with somewhat similar circumstances), the suspects had no drugs or alcohol in their systems at the time. Toxicology reports were clean on all of them. They were just extremely motivated.

“But he’s a cop, it’s his job to go looking for trouble.”
True, but irrelevant. The point is that highly motivated individuals are difficult to stop with pistol caliber rounds. A highly motivated individual doesn’t have to be a cop killer, either. It can be some rapist who wants to make you into his next victim or some mentally deranged wackadoo hell bent on abducting your child. You never know who you are dealing with until you are actually dealing with them. In fact, because police go looking for trouble they get prep time- at least in theory (they can bring things like bulletproof vests, larger handguns, long guns, etc to the fight). As a CCW, the attack happens out of an ambush. Bad guy picks the terms of engagement and you’re stuck on the defense. You probably won’t have a full duty belt + battle rattle ready to go.

Sgt. Gramins was shooting 230gr Speer Gold Dot .45 ACP out of a Glock 21

We can look at another officer involved shooting from the NYPD in 2010. In this OIS, there was a gunman and accomplice who engaged NYPD officers. The officers immediately returned fire with their service issue Glocks. The gunman was shot 23 times and made a full recovery. His accomplice was shot just 5 times with the exact same ammo in the exact same caliber (9mm 124gr Gold Dot) and died at the scene.

Similarly, there are people who have been stopped with a single shot from a .22lr and people who have taken a full mag of .45 ACP to the chest and been able to walk on their own power to the ambulance. Police have reported suspects taking multiple 10mm rounds center mass and continued fleeing from officers. There was yet another OIS here in Texas where a Sheriff’s Deputy shot a meth head in the heart with 3″ 00 Buck out of a 12ga. The suspect didn’t even slow, despite being a dead man walking. Before the deputy could even pump another round into the chamber, the suspect was able to reach her and stab her to death.

There is no one static number of attacks that dictates when a person is put into critical condition. The people who have studied ballistics extensively for years are making an educated guess as to what is going to happen. Your average schmuck telling you why his caliber and carry ammo is the greatest thing since sliced bread is just spitballing. People particularly love to latch onto “stopping power” when they have limited knowledge of terminal ballistics, human anatomy, and criminal behavior.

Now’s where we get to the part about ballistics gel!

You’re going to inevitably see this come up in any discussion on ammo. The FBI requires a minimum 12″ of penetration and, for law enforcement, a maximum 18″ of penetration. (It’s a little different for civilians.) The reason being: ballistics gel is not an accurate simulation of a human body. Human bodies have so many differences and variations, which isn’t even taking into consideration the multitude of variables in a self-defense encounter. No two gunfights are or ever will be the same. The gel’s value lies in its consistency. In order for an experiment to be valid, it must be repeatable. This is a daunting task with something as unpredictable as bullets. The FBI Ballistics Test Standards are a universally and formally recognized system, which is why it lies at the heart of all ballistics.

Furthermore, surgeons and medics report almost universally that bullets recovered from a person’s body very closely resemble bullets recovered from ballistics gel + the heavy clothing barrier. A good way of thinking about the heavy clothing barrier is a minimum standard rather than a definitive test. However, a lot of people when they see the damage done to the gel conflate temporary stretch cavity with permanent cavity. Most of the “permanent damage” you see to the gel afterwards is in fact temporary stretch cavity. Gel doesn’t repair itself nor does it have the elasticity that human flesh does. It is, however, easily marked and measured.

9mm 147gr HST rounds taken from an article written by Dr. Gary Roberts. The heavy clothing barrier was 4 layers of denim and the clothes the victim was wearing were a Gore-Tex jacket, fleece vest, and cotton shirt. The asymmetry of that bullet pulled out of a human body is almost certainly the result of impacting bone.

Another worthwhile note about ballistics gel is that law enforcement has a greater list of requirements. This is why bullets are tested through sheet metal, windshields, plywood, and other kinds of barriers. Police need robust performing ammunition for what they do, however that doesn’t mean you should completely ignore them as a civilian. Let me give you an example: A very common scenario, not just for carjackings but for crime as a whole, is when you’re sitting in your car outside your house or apartment complex waiting for the garage door or gate to roll open. In this situation, you are 1) firing from a compromised position and 2) almost certainly needing to shoot through your car windows at your attacker. If you know that your ammo does well through auto glass and sheet metal, that’s probably going to work to your advantage. Just keep in mind that shooting through glass is generally less than optimal even though bullets will go through it. There isn’t an exact science as to what happens to a bullet when it passes through a medium, so eliminating that medium is always better than shooting through it if at all possible. Kind of difficult to do in your car, which is why proper training is important. Take a vehicle combat class, shoot your carry ammo through a windshield and see what it does. I don’t consider many training courses to be absolutely necessary for civilians, but vehicle combat is definitely one with how common cars are in today’s society. On that note…

How should this shape the training of CCWs?

Anyone who has a perspective for violence and knows what they’re talking about isn’t going to ever tell you “just carry [this] caliber” or “just learn [this martial art]”. Similarly, you’ll never hear us bragging about our training. You can never be prepared enough for a lethal force encounter because anything can happen in one. This is why the best defense is just not being in that situation in the first place. You must resist threats intelligently!

As the 80/20 Rule shows, a solid understanding and proficiency in the basics will be the most useful most of the time. I personally am a huge proponent of the buffet style of training- don’t just settle for one thing, take something from everything. Or rather, take something from everything that’s worthwhile. Not everything is going to be useful, so don’t bother trying to learn some obscure Chinese wu dang technique when you can better spend the time learning something like the Boarding House Rules. (I’m too pragmatic to explain it eloquently. If you want that read up on Musashi Miyamoto.)

It’s also worth noting that most training courses are meant for the lowest common denominator to pass. Some people can’t feasibly dedicate themselves to becoming hardened warriors such as a single mother working full time. However, they don’t have to. For a single mother working full time, being adequately prepared is enough for nearly any situation she could find herself in. People don’t need to bench 450lbs or shoot a quarter sized grouping at 1 mile out. Focusing on trying to push yourself to that range is in fact counterproductive. Specialization is for insects, people need a well-rounded skill set.

I would recommend shooting anatomy targets when you’re at the range instead of regular scoring targets. Similarly, I’d recommend shooting 3D targets if you possibly can. Also, shooting an actual person with simunitions or paintballs or similar is encouraged. I’d especially encourage the person to do the same with you because most of the time you’ll be looking down the barrel of a gun as you shoot a threat. It’s human nature to zoom in on the weapon and shoot for the gun (which is why in many DGUs you see people getting shot in the hands and wrists). Stress inoculation is important.

As I’ve mentioned in my article about selecting a first handgun: Just because you can perform a task in a controlled environment under low stress doesn’t mean make you tactically proficient. You must understand what your circumstances are, how you are going to react in a high-stress scenario, and how injuries affect the human body. That last one is particularly important, I would urge anyone who wants to carry a gun to first carry a first aid kit and have proper training with it and understanding of human anatomy. I know this isn’t going to be everyone’s case as some people need a gun immediately. But for those who aren’t in that situation do get proper first aid skills first, shooting skills second.

As usual, I’m supporting charities. Check out Warrior’s Heart which helps veterans and first responders struggling with PTSD and addiction. If you want an easy method of helping, Black Rifle Coffee is donating 100% of the profits from this coffee blend here to Warrior’s Heart (their coffee is some good shit, too).

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2 Responses

  1. Dan says:

    Great article, thank you for putting it together. The link to the Sgt Tim Gramins article is busted.

  1. April 13, 2020

    […] 9mm is that you can train on it more than any other duty caliber. (Although I have mentioned in my other articles on caliber debates and selecting your own handgun that you absolutely can make a case for running […]

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