Ballistic Trauma in Finland. An Epidemiologic and Clinical Study of Firearm and Explosion Injuries

................................................................................................................... 5 List of Original Publications ........................................................................ 6 Abbreviations ............................................................................................................. 7 Introduction ............................................................................................................... 9 Review of the Literature ......................................................................................... 13 1. Defi nition of Ballistic Trauma ...................................................................... 13 1.1 Defi nition of the terms ballistics, ballistic, and wound ballistics ............. 13 1.2 Patterns of injuries by mechanism and intent in general .......................... 13 1.3 Defi nition of a fi rearm ................................................................................ 14 1.4 Firearms in different societies ..................................................................... 15 1.5 Firearms in Finland .................................................................................... 15 1.5.1 Demographic background ............................................................... 15 1.5.2 Small arms and permissions in Finland .......................................... 16 1.6 Defi nition of a fi rearm injury ..................................................................... 16 1.7 Defi nition of an explosion .......................................................................... 20 1.8 Defi nition of an explosion injury (blast injury) ........................................ 22 2. Epidemiology of Firearm Injuries ............................................................... 23 2.1. Global background .................................................................................... 23 2.2 Epidemiology of fatal fi rearm injuries ....................................................... 23 2.3 Epidemiology in the United States ............................................................. 25 2.4 Epidemiology in Europe ............................................................................. 25 2.5 Epidemiology in Finland ............................................................................. 26 3. Firearm Injuries of the Extremities ............................................................ 28 3.1 Gunshot fractures ........................................................................................ 30 3.2 Vascular injuries ........................................................................................... 30 4. Epidemiology of Explosion Injuries ........................................................... 32 5. Other Deleterious Health Effects of Shooting ...................................... 34 6. Prevention Strategies of Ballistic Trauma ................................................ 35 6.1 General background .................................................................................... 35 6.2 American strategies for reducing deaths and injuries from fi rearms ....... 37 6.3 Finnish legislation concerning small arms ................................................. 38 6.3.1 Acts of violence ................................................................................. 38 6.3.2 Finnish small arms legislation ......................................................... 39 Aims of the Study ...................................................................................................... 40 Material and Methods .............................................................................................. 41 Non-fatal fi rearm injuries (Studies I–II) ...................................................................... 41 Fatal fi rearm injuries (Study III) .................................................................................... 43 Gunshot fractures (Study IV) ........................................................................................ 43 Vascular gunshot injuries (Study V) ............................................................................. 44 Explosion injuries (Study VI) ......................................................................................... 45 Fatal explosion injuries (Study VII) ............................................................................... 46 Results .................................................................................................................... 47 1. Epidemiology of fi rearm injuries ......................................................................... 47 1.1 Hospitalizations 1985 –1989 and 1990–2003 ............................................. 47 1.2 Fatal injuries 1990 –1999 ............................................................................ 52 2. Firearm Injuries of the Extremities ..................................................................... 55 3. Epidemiology of Explosion Injuries ..................................................................... 61 3.1 Hospitalizations 1991–1995 ....................................................................... 61 3.2 Fatal injuries 1985–2004 ............................................................................ 61 General Discussion ..................................................................................................... 64 Firearm injuries ......................................................................................................... 64 Explosion injuries ...................................................................................................... 67 Strengths and weaknesses of the study ..................................................................... 68 Preventive strategies .................................................................................................. 69 Conclusions ............................................................................................................... 72 Challenges for the Future .......................................................................................... 73 Summary .................................................................................................................... 75 Acknowledgements ................................................................................................. 77 References ................................................................................................................... 78 Original publications ................................................................................................ 87