In this social media post, the driver shot himself accidentally in the thigh while seated in a vehicle. He was unresponsive from blood loss within four minutes. He survived after tourniquet application by responding law enforcement. Though we always prefer proven commercial medical equipment, an improvised tourniquet could be fashioned from items on the casualty if needed: including a necktie and a metal pen. Video below, doppler proven.
Each year in the US, 574 unintentional adult firearms deaths occur.1 However, it is challenging to get useful data on how often negligent discharges of firearms occur in general, and how often they cause injuries specifically. If a negligent discharge occurred in a home resulting in no injuries, would it make a database somewhere? How?
The best data we could find on the topic came from ConcealedCarry.com. In 2017, they posted a review of 300 negligent discharges.2 The data came from published news articles. Relying on published accounts creates significant selection bias and overestimates the effects of an ND. Again, if an ND occurred with no injury in a private residence, why would it make the news?
They found 1/3 of the NDs resulted in death. The shooter shot themselves about 50% of the time and hit a bystander 42%. Both the shooter and bystander were injured in 6% of the reports. Fifty-three percent of the events occurred in a home. Sadly, many of these cases are children getting unintended access to a firearm with resulting catastrophic consequences. 1
The medical literature is also sparse on the topic of unintentional firearms injuries. Frequently, assault, unintentional, and intentionally self-inflicted gunshot wounds are all combined in the data sets.
One study from the only level-one trauma center in a Midwest-state looked at their experience with unintentional firearms injuries.3 This study design also suffers from selection bias: if you are very minimally injured by your ND, you are more likely to be treated and released from a local Emergency Department. Therefore, you would never be seen at a level one trauma center and entered into the study. They found the cause of injury was unintentional in 36% of their gunshot wound patients. Twenty-six percent of their unintentional shootings occurred while hunting, and interestingly, 58% of those were specifically while hunting deer. With this high rate of hunting-related shooting, shotgun, and long-gun NDs were very common. Overall, a handgun was responsible for 28% of injuries, shotgun 24%, and rifle 14%. In the remainder, either an airgun was used or the weapon was not explicitly identified. Although unintentional shooting was the most common firearms injury in this rural study, it had the lowest fatality rate at 8%.
In perhaps the best quote from the article, “Alcohol and drug use have widely been accepted as lubricants to unintentional trauma.” Unfortunately, 27% of the unintentional group were positive for alcohol, 29% illicit drugs, and 9% both.
If you have worked as a firearms instructor long enough, you realize when people do shoot themselves, it often occurs in the bathroom and involves the shooter’s non-dominant hand or dominant side thigh. It’s always best to have a trauma kit, or IFAK stocked with commercially available proven tourniquets when around firearms. However, you always need to plan in-depth, including potentially the need to improvise.
1 Unintentional firearm death across the urban-rural landscape in the United States. Carr BG, Nance ML, et al. J Trauma Acute Care Surg. 2012 OCT;73(4):1006-1010
2 ConcealedCarry.com article, 300 Negligent Discharges: Comprehensive Data Science Reveals Gun Grabbers and Gun Owners are Both Wrong
3 Unintentional firearm injuries remain prevalent over a 12-year experience at a rural midwestern level 1 trauma center. Guetschow B, Lilienthal M, et al. Iowa Orthop J. 2018;38:45-52.