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Ballistic Trauma
Second Edition
Ballistic Trauma
A Practical Guide
Second Edition
Edited by
Peter F. Mahoney, James M. Ryan, Adam J. Brooks
and C. William Schwab
Project Coordinators
Miranda Dalrymple and Cara Macnab
With 161 Illustrations
Foreword by Martin Bell
Peter F. Mahoney, OStJ, TD, MSc, MB BS, FRCA, FFARCSI, FIMC RCSEd, DMCC,
RAMC
Defense Medical Service and Leonard Cheshire Centre, Royal Free and University
College Medical School, Academic Division of Surgical Specialities, London, UK
James M. Ryan, OStJ, MB, BCh, BAO, MCh, FRCS, DMCC, FFAEM
Leonard Cheshire Centre, Royal Free and University College Medical School,
Academic Division of Surgical Specialities, London, UK
Adam J. Brooks, MB, ChB, FRCS (Gen Surg), DMCC, RAMC(V)
Department of Surgery, University of Pennsylvania School of Medicine, Division of
Traumatology and Surgical Critical Care, Hospital University of Pennsylvania,
Philadelphia, PA, USA
C. William Schwab, MD, FACS, FRCS (Glasg)
Department of Surgery, University of Pennsylvania School of Medicine, Division of
Traumatology and Surgical Critical Care, Hospital University of Pennsylvania,
Philadelphia, PA, USA
British Library Cataloguing in Publication Data
Ballistic trauma : a practical guide.—2nd ed.
1. Gunshot wounds 2. Penetrating wounds
I. Mahoney, Peter F.
617.1¢45
ISBN 185233679X
Library of Congress Cataloging-in-Publication Data
Ballistic trauma : a practical guide/Peter F. Mahoney...[et al.].
p. ; cm.
Rev. ed. of: Ballistic trauma: clinical relevance in peace and war. 1997.
Includes bibliographical references and index.
ISBN 1-85233-678-1 (hardcover : alk. paper)—ISBN 1-85233-679-X (softcover : alk.
paper)
1. Gunshot wounds. I. Mahoney, Peter F.
[DNLM: 1. Wounds, Penetrating—diagnosis. 2. Wounds, Penetrating—therapy.
WO 700 B193 2004]
RD96.3.B355 2004
617.1¢45—dc22
2004050435
ISBN 1-85233-678-1 (hardcover) ISBN 1-85233-679-X (softcover) Printed on acid-free paper
©2005 Springer-Verlag London Limited
First edition, Ballistic Trauma: Clinical Relevance in Peace and War (0340581144), published
by Arnold, 1997.
Apart from any fair dealing for the purposes of research or private study, or criticism, or
review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may
only be reproduced, stored or transmitted, in any form or by any means, with the prior per-
mission in writing of the publishers, or in the case of reprographic reproduction in accordance
with the terms of licenses issued by the Copyright Licensing Agency. Enquiries concerning
reproduction outside those terms should be sent to the publishers.
The use of registered names, trademarks, etc., in this publication does not imply, even in
the absence of a specific statement, that such names are exempt from the relevant laws and
regulations and therefore free for general use.
Product liability: The publisher can give no guarantee for information about drug dosage and
application thereof contained in this book. In every individual case the respective user must
check its accuracy by consulting other pharmaceutical literature.
Printed in the United States of America (BS/EB)
987654321
SPIN 10887535 (hardcover)
SPIN 10887543 (softcover)
Business Media
springeronline.com
+
Springer Science
Foreword
This is a book first and foremost for surgeons and those who work with
them in the management of ballistic trauma and treatment of its victims.
But the book is also of value to others with front-line experience and an
interest in the issue of harm reduction, whether in war or “peace,” on the
field of battle or at the scene of a crime. These pages can also be studied
fruitfully by politicians, most of whom lack medical or military expertise,
in helping them understand the real world consequences of the decisions
that they make. (My own special interest, cheerfully declared, is that of a
beneficiary—having once been hit by mortar fire as a war reporter, I am
grateful for the care of the surgeons and nurses who so expertly put me
back together again and returned me to front-line duty).
I believe that we live in the most dangerous times since the global warfare
of the mid-twentieth century. Appropriately, the editors of this book have
set their remit wider than the most recent advances in the relevant fields of
medical science—necessary advances—to keep pace with those in ballistic
science, as man finds ever more ingenious ways of killing and maiming his
own kind.
Napoleon III is reputed to have declared, “The history of artillery is the
history of progress in the sciences, and is therefore the history of civiliza-
tion.” I wonder, where does that leave us in the early twenty-first century?
Nowhere very civilized, for sure.
In their preface to the first edition, in 1997, the editors noted: “The lesson
of history is that you cannot take the experience of an urban hospital onto
the battlefield. It also can be said, that you cannot do the reverse, and nowa-
days there is further confusion from the deployment of troops to peace-
keeping duties performed under the scrutiny of the media. The latter is not
the same as war.”
A great deal has happened since then, including the events of 11 Sep-
tember 2001, to change or qualify that judgment. Civilian and military
targets are attacked, not only by insurgent and revolutionary forces, without
distinction, discrimination, or regard to the Geneva Conventions. The front
lines are everywhere and all around us, as much in the concrete defences
v
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