Thoughts on Wounding factors

I recently got to speak with a surgeon regarding effectiveness of bullets and wounding factors from getting shot, primarly about handguns.

This surgeon, whom we will call Dr. K, said he started as an ER doc in the 70s in Houston, then became a surgeon and remained working in the Houston area in various ERs until the 90s, when he switched and worked for the hospital where I met him. He is into shooting and has his CHL.

Anyway, we got to talking about the effectiveness of handgun rounds. Basically, he said in a nutshell, handgun round sucks. He said the most lethal round in his experience has been buckshot or slugs from shotguns. He said the damage they do is just so enormous it’s hard to repair on the operating table. He said it’s been his experience that most rifle rounds don’t really cause enough damage, unless you are hit more than once with them. Most rifle rounds have a tendency of causing permanant damage through destroying tissue and muscle, in his opinion.

I asked him about the effectiveness of handgun rounds and what caliber he believes in. He laughed and said .45 ACP. He said that most officers and trainers teach the best way to stop a subject is a Central Nervous System (CNS) or to hit the heart/lungs (a.k.a. an A-Zone hit). He said that is a good tried and true method that works, no matter what you shoot. I asked him why he preferred .45 to 9mm or .40.

He simply said “It makes the biggest hole.” I asked him to clarify. Dr. K said the other way to stop a target is by causing the blood pressure to drop enough that blood isn’t delivered to vital organs. He said that without blood flow to the vital organs, it causes the target to fall to the ground. He said if you cause enough big holes the target will bleed to death, and it can happen rather quickly if you hit enough large arteries. He said medically, on the operating table, someone that is full of 9mm holes stands a greater chance of surviving than someone full of .45 holes, even with modern day JHP rounds. He said the larger bullets just simply cause so much damage. He also said because a larger bullet could potentionally take out major blood vessels, arteries, and nerve clusters where a smaller bullet may just take out one of the three.

I’m providing this information based off of what Dr. K said. I’m not saying it’s right, wrong, or indifferent, just saying what his experiences have been operating on people over the years.

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One Response to “Thoughts on Wounding factors”

  1. I’m not understanding how a difference in bullet width of 0.09″ can produce the dramatically different results that he’s claiming, unless the bullet fragments and all the fragments produce all those additional injuries. John Holschen of InSights (who trained US army medics) and the doc that teaches for Tactical Response both teach that 9-40-45 all produce the same results, assuming bullet placement is equivalent. Bullet placement comes from proficiency, and proficiency comes from (a) practice and (b) equipment you can handle. .45 ammo costs 2x what 9mm ammo costs and many people have hands that are too small to comfortably shoot high capacity .45’s, because the longer overall length of the .45 cartridge makes the frame bigger. He also failed to consider/discuss bullet velocity. There’s data from the Army (Fackler, mainly) that wounding improves when the bullet velocity exceeds the speed of sound, which .45 ACP bullets generally do not do.

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