Knife versus gun - lethality

[GunTech]

RE: Knife vesus gun at contact distance.

Here's some data regarding the lethality of the knife, which should put to rest the question of which is more lethal.

Considering how unlikely it is for a person to die from a knife wound, the person with the gun is in much better shape.

The Journal of Trauma (36:4 pp516-524) looked at all injury admissions to a Seattle hospital over a six year period. *The mortality rate for gunshot wounds was 22% while that for stab wounds was 4%. *Even among patients that survived, gunshot wounds were more serious -- the mean cost of treatment for these patients was more than twice that for stab wounds.

Here follows several abstacts extracted from the literature that further demonstrate the increased lethality of shootings over stabbing

<1> Authors Muckart DJ.Meumann C.Botha JB. Title The changing pattern of penetrating torso trauma in KwaZulu/Natal--a clinical and pathological review. Source South African Medical Journal.85(11):1172-4, 1995 Nov. Abstract The number of patients who sustained penetrating torso trauma and were admitted to King Edward VIII Hospital and the surgical intensive care unit were reviewed over 10- and 5-year periods respectively. For the last 4 months of 1992, a comparison was made between victims of trauma admitted to hospital and those whose bodies were taken directly to the South African Police medicolegal laboratories in Gale Street, Durban, where the majority of medicolegal autopsies in the Durban metropolitan area are performed. The total number of hospital admissions has not changed during the last decade, but the aetiology of injury has altered considerably. Stab wounds have declined by 30% whereas gunshot wounds have increased by more than 800%. The ratio of stab to gunshot wounds admitted to the intensive care unit reversed within the 5-year period 1987-1992. Direct admission to the mortuary was three times as common in cases of gunshot compared with stab wounds. The hospital mortality rate for gunshot wounds was 8 times that for stab wounds. The establishment of dedicated trauma centres is essential for the treatment of these injuries, and strategies to control the use of firearms are vital.

<2> Authors Heary RF.Vaccaro AR.Mesa JJ.Balderston RA. Title Thoracolumbar infections in penetrating injuries to the spine. Source Orthopedic Clinics of North America.27(1):69-81, 1996 Jan. Abstract A detailed review of the TJUH experience and the published literature on gunshot and stab wounds to the spine has been presented. The following statements are supported. (1) Military (high-velocity) gunshot wounds are distinct entities, and the management of these injuries cannot be carried over to civilian (low-velocity) handgun wounds. (2) Gunshot wounds with a resultant neurologic deficit are much more common than stab wounds and carry a worse prognosis. (3) Spinal infections are rare following a penetrating wound of the spine and a high index of suspicion is needed to detect them. (4) Extraspinal infections (septic complications) are much more common than spinal infections following a gunshot or stab wound to the spine. (5) Steroids are of no use in gunshot wounds to the spine. In fact, there was an increased incidence of spinal and extraspinal infections without a difference in neurologic outcome compared with those who did not receive steroids. (6) Spinal surgery is rarely indicated in the management of penetrating wounds of the spine. The recommendations for treatment at TJUH of victims of gunshot or stab wounds with a resultant neurologic deficit are as follows. (1) Spine surgery is indicated for progressive neurologic deficits and persistent cerebrospinal fluid leaks (particularly if meningitis is present), although these situations rarely occur. (2) Consider spine surgery for incomplete neurologic deficits with radiographic evidence of neural compression. Particularly in the cauda equina region, these surgeries may be technically demanding because of frequent dural violations and nerve root injuries/extrusions. These cases must be evaluated in an individual case-by-case manner. The neurologic outcomes of patients with incomplete neurologic deficits at TJUH who underwent acute spine surgery (usually for neural compression secondary to a bullet) were worse than the outcomes for the patients who did not have spine surgery. A selection bias against the patients undergoing spine surgery was likely present as these patients had evidence of ongoing neural compression. (3) A high index of suspicion is necessary to detect spinal and extraspinal infections. (4) Do not use glucorticoid steroids for gunshot wound victims. (5) Conservative (nonoperative) treatment with intravenous broad spectrum antibiotics and tetanus prophylaxis is the sole therapy indicated in the majority of patients who sustain a penetrating wound to the thoracic or lumbar spines.

<3> Authors Madiba TE.Mokoena TR. Title Favourable prognosis after surgical drainage of gunshot, stab or blunt trauma of the pancreas [see comments]. Source British Journal of Surgery.82(9):1236-9, 1995 Sep. Abstract The records of 152 patients with pancreatic injury treated over a 5-year period were reviewed. The diagnosis was made at laparotomy in all patients. Gunshot wounds, stab wounds and blunt trauma occurred in 63, 66 and 23 patients respectively with mean ages of 28, 28 and 30 years. Multiple organ injury was most common after gunshot wounds. Intraoperative management was by drainage of the pancreatic injury site alone in the majority of patients in all aetiological groups. The rate of fistula formation was 14 per cent after gunshot wounds, 9 per cent after stab injury and 13 per cent after blunt trauma. Death occurred after 24 h in 8, 2 and 10 per cent of patients following gunshot wounds, stab wounds and blunt trauma respectively, and was attributable to other organ damage. It is concluded that gunshot injury to the pancreas may be more extensive than other injuries, but conservative management with surgical drainage of pancreatic injury is justified irrespective of the mechanism of injury.

<4> Authors Velmahos GC.Degiannis E.Hart K.Souter I.Saadia R. Title Changing profiles in spinal cord injuries and risk factors influencing recovery after penetrating injuries. Source Journal of Trauma.38(3):334-7, 1995 Mar. Abstract OBJECTIVE: The changing profiles of spinal cord injuries in South Africa are addressed in this study. DESIGN: A retrospective analysis of 551 patients with spinal cord injury. MATERIALS AND METHODS: The cause of injury was motor vehicle crashes in 30%, stab wounds in 26%, gunshot wounds in 35%, and miscellaneous causes 9%. MEASUREMENTS AND MAIN RESULTS: There was a significant shift from stab wounds towards bullet wounds over the last five years. Bullet spinal cord injuries increased from 30 cases in 1988 to 55 cases in 1992, while stab spinal cord injuries decreased from 39 cases in 1988 to 20 cases in 1992. The incidence of spinal cord injuries following a motor vehicle crash showed a declining tendency after a transient increase (28 cases in 1988, 40 in 1990, 31 in 1992). Moreover, the problem of severe septic complications has been investigated and various risk factors for sepsis that might impair the rehabilitation process have been examined. The risk of developing septic complications was higher in gunshot spine injuries (21 cases out of 193) than in knife injuries (5 cases out of 143). The presence of a retained bullet did not seem to increase the chances for sepsis. In seven patients the sepsis was the direct consequence of the retained bullet while in 14 patients sepsis developed with no bullet in situ. Furthermore, the site of the injury (cervical, thoracic, lumbar spine) did not correlate with the abovementioned risks. CONCLUSIONS: Gunshots carry a heavier prognosis. Only 32% of our gunshot cases underwent a significant recovery as opposed to 61% of stab cases and 44% of the motor vehicle crash victims.

<5> Authors Degiannis E.Velmahos GC.Florizoone MG.Levy RD.Ross J.Saadia R. Title Penetrating injuries of the popliteal artery: the Baragwanath experience. Source Annals of the Royal College of Surgeons of England.76(5):307-10, 1994 Sep. Abstract This study describes the management of 43 patients with penetrating injury of the popliteal artery. Of these patients, 33 (76.5%) had bullet wounds, four patients (9.5%) pellet wounds and 6 (14%) knife wounds. Patients with 'hard' signs of arterial injury underwent exploration without preoperative angiograms. There were no negative explorations. Patients with only 'soft' signs of arterial injury underwent preoperative angiograms. Of this group, 75% had positive angiograms and underwent exploration. There were no false-positive or false-negative preoperative angiograms in the group of patients with 'soft' signs in this study. Definitive orthopaedic management of associated fractures followed vascular reconstruction. There was no difference in the short-term patency of autologous saphenous vein graft as against PTFE grafts. Fasciotomy was performed on patients who had arterial and venous injury or presented late. Overall amputation rate was 14% and for bullet injuries 18%.

<6> Authors Rothlin M.Vila A.Trentz O. Title [Results of surgery in gunshot and stab injuries of the trunk]. [German] Source Helvetica Chirurgica Acta.60(5):817-22, 1994 Jul. Abstract Between 1981 and 1990, 105 patients suffering from gunshot and stab wounds were admitted to the Department of Surgery of Zurich University Hospital. There were 17 female and 88 male patients aged 16-74 years (average 31 years) whose charts were studied retrospectively. 44 patients demonstrated gunshot injuries, while 60 suffered from stabwounds and 1 patient had both. The injuries were the result of a crime in 59, a suicide in 33 and an accident in 11 cases. In 2 patients the cause was not conclusive proven. Injuries to the lung (n = 54), the liver (n = 27) and to the stomach (n = 23) were seen most frequently. 45 patients underwent laparotomy, while 16 had a thoracotomy performed. Both thoracotomy and laparotomy were necessary in 10 cases. Complications were observed in 29.5% of the cases. They were significantly more frequent in patients with gunshot injuries (p < 0.0004). Overall mortality amounted to 14.3% (n = 15). Patients with gunshot wounds had a significantly higher mortality rate (p < 0.0005). Debridement and selective closure of the wounds (n = 25) did not result in a higher rate of abscess formation than open treatment (n = 17).

 

[GunTech]

<7> Authors Coimbra R.Prado PA.Araujo LH.Candelaria PA.Caffaro RA.Rasslam S. Title Factors related to mortality in inferior vena cava injuries. A 5 year experience. Source International Surgery.79(2):138-41, 1994 Apr-Jun. Abstract Forty-nine patients sustaining Inferior Vena Cava (IVC) injuries, during a 5 year period were retrospectively analyzed in order to assess those factors related to early deaths. Mean age was 32 and 45 were male. GSW was the most frequent mechanism of injury (59.2%), followed by SW (28.6%) and blunt trauma (12.2%). There were 4 injuries in the supra diaphragmatic IVC, 14 retrohepatic, 16 suprarenal and the remaining 15 were in the infrarenal portion of the IVC. Twenty patients were in shock and 8 were unstable on admission. The liver was the most frequently injured organ in association with IVC and there were also 7 concomitant abdominal vascular injuries. Venorrhaphy was performed in 28 patients, IVC ligature in 5, intracaval shunt in 3 and in the remaining 13, only temporary hemostasis was attempted. Mortality rate was 100% in supra diaphragmatic injuries, 71.4% in retrohepatic, 68.8% in suprarenal and 33% in infrarenal injuries. There was a significant difference when comparing mortality rate in stable against shock or unstable patients on admission (p < 0.001), as well as in those with diaphragmatic IVC injuries compared with all other injury sites together (p < 0.05). Hemodynamic instability on admission was the most important cause of early deaths, and all patients with concomitant abdominal vascular injuries also died.

<8> Authors Degiannis E.Velmahos G.Krawczykowski D.Levy RD.Souter I.Saadia R. Title Penetrating injuries of the subclavian vessels. Source British Journal of Surgery.81(4):524-6, 1994 Apr. Abstract A study was made of 76 patients with subclavian vessel injury. The mechanism of trauma was stabbing in 40 patients (53 per cent) and gunshot in 36 (47 per cent). There were marked differences between the two groups in clinical presentation, operative management and outcome. The group with gunshot injury was characterized by a more immediate threat to life, and a greater need for a median sternotomy and use of interposition grafts. The mortality rate in patients with gunshot wounds was more than twice that in the group with stab injury.

<9> Authors Tang E.Berne TV. Title Intravenous pyelography in penetrating trauma. Source American Surgeon.60(6):384-6, 1994 Jun. Abstract Intravenous pyelograms (IVPs) are routinely used in the workup of suspected urologic injuries. The indications for obtaining IVPs have not been well characterized. This study examined 67 patients with penetrating trauma who received formal IVPs with nephrotomography in the radiology department. Of 35 stab wounds, 19 patients presented without hematuria and accounted for only one positive IVP. No intervention was undertaken in this patient. There were 14 stab wound patients with microscopic hematuria, with three positive IVPs. No intervention was necessary in any of these patients. The two remaining stab wound patients both had gross hematuria and renal injuries requiring intervention. However, only one of the two had a positive IVP, showing a blurred kidney margin. One patient had a pseudoaneurysm of a branch of the renal artery, and the other had an arteriovenous fistula. Of 32 patients with gunshot wounds, 15 presented without hematuria. Of the 15, one had a positive IVP but did not have a renal injury on exploration. None of the other 13 patients in this group undergoing exploration had renal injuries. Of the 11 patients with microscopic hematuria, three had hematomas and one had gross extravasation on IVP. Of the six patients with gross hematuria, three had positive IVPs, showing a hematoma, a renal fracture, and indistinct renal outline, respectively. In this limited study, omitting IVPs on the patients with negative urinalyses would not have missed any significant injuries. We suggest that more study is needed in this area because our present standard may lead to unnecessary expense and delay.

<10> Authors Velmahos GC.Degiannis E.Souter I.Saadia R. Title Penetrating trauma to the heart: a relatively innocent injury. Source Surgery.115(6):694-7, 1994 Jun. Abstract BACKGROUND. The purpose of this study was to examine the mortality rate of penetrating cardiac trauma in a large urban hospital. METHODS. This was a retrospective study over a period of 5 years and 5 months of all patients admitted alive with a stab or a gunshot cardiac injury. RESULTS. There were 310 patients with a stab wound and 63 with a gunshot wound. The overall mortality rate was 19%. The mortality rates for the stab and the gunshot groups were 13% and 50.7%, respectively. In the 296 patients with a cardiac stab wound confined to a single chamber and with no other associated extracardiac injury the mortality rate was 8.5%. CONCLUSIONS. An isolated cardiac stab wound is a relatively innocent injury in a patient at a hospital accustomed to managing penetrating trauma expeditiously.

<11> Authors Mock C.Pilcher S.Maier R. Title Comparison of the costs of acute treatment for gunshot and stab wounds: further evidence of the need for firearms control [see comments]. Source Journal of Trauma.36(4):516-21; discussion 521-2, 1994 Apr. Abstract Gun control is proposed primarily to decrease the incidence of injury and death from gunshot wounds (GSWs). We hypothesize that decreasing the number of GSWs will also produce significant economic savings, even if personal violence were to continue at the same rate, maintaining the same overall incidence of penetrating trauma. We analyzed charges and reimbursements for the treatment for all patients with GSWs (n = 1116) and stab wounds (SWs) (n = 1529) admitted to a level I trauma center from 1986 through 1992. Mean and median charges were higher for GSWs ($14,541; $7,541) than for SWs ($6,446; $4,249) (p < 0.05). There was a 12% per year increase in the annual number of GSWs (p = 0.001), leading to a disproportionate increase in the annual total charges for GSWs (p = 0.013), compared with SWs. Public expenditures, including bad debt and government reimbursement, increased for GSWs (p = 0.019) but not SWs. Thus, if all patients with GSWs instead suffered SWs, there would be an annual savings of $1,290,000 overall and of $981,000 of public funds from this institution alone. Treatment costs for GSWs are higher than those for SWs and are rising more rapidly, with an increasing amount of public funds going to meet these costs. Considerable savings to society would accrue from any effort that decreased firearm injuries, even if the same level of violence persisted using other weapons.

<14> Authors Rizoli SB.Mantovani M.Baccarin V.Vieira RW. Title Penetrating heart wounds. Source International Surgery.78(3):229-30, 1993 Jul-Sep. Abstract In 3 years, 26 patients were operated for penetrating heart wounds at our institution, the majority between 30 to 60 minutes after injury. Twenty-two patients with a possible heart wound were immediately taken to the operating room for thoracotomy. One patient initially underwent laparotomy while 2 were observed before operating-room thoracotomy. One patient underwent emergency-room thoracotomy. Three patients with no vital signs on admission died, 82.6% of the remainder survived. Stab wounds determined the best survival rate: 94%, whereas for gunshot wounds it was only 50%. Our experience at this Brazilian Trauma Center reveals that delay in reaching the hospital selected the patients, that clinical condition on arrival, method of injury (knife or gunshot), emergency room staffed with trauma surgeons and aggressive operating room treatment for penetrating heart wounds results in a remarkable survival rate. Emergency-room thoracotomy should be reserved for patients "in extremis" or when there is no operating room available.

<16> Authors Macho JR.Markison RE.Schecter WP. Title Cardiac stapling in the management of penetrating injuries of the heart: rapid control of hemorrhage and decreased risk of personal contamination. Source Journal of Trauma.34(5):711-5; discussion 715-6, 1993 May. Abstract The resuscitation of patients with cardiopulmonary arrest from a penetrating injury of the heart requires emergency thoracotomy and control of hemorrhage. Suture control may be technically difficult in patients with large or multiple lacerations. Emergency cardiac suturing techniques expose the surgeon to the risk of a contaminated needle stick. After we determined that rapid control of hemorrhage from cardiac lacerations could be achieved in anesthetized sheep with the use of a standard skin stapler, the technique was applied in the clinical setting. Twenty-eight patients underwent emergency stapling of 33 cardiac lacerations at our institution from September 1987 to December 1991. Seventy-nine percent (22) of the patients sustained stab wounds, and 21% (6) were injured by gunshots. Fifty-eight percent (19) of the injuries involved the right ventricle, 27% (9) involved the left ventricle, 9% (3) involved the right atrium, and 6% (2) involved the left atrium. In 93% (26) of the patients, control of hemorrhage was achieved within 2 minutes of exposure of the injuries. Both patients in whom control could not be achieved had sustained large-caliber gunshot injuries. Fifteen (54%) of the patients survived, including one patient with two cardiac lacerations and another with three lacerations. Of the surviving patients, two had mild neurologic deficits. No personal contamination occurred related to the use of the stapler. We conclude (1) cardiac stapling is highly effective in the management of hemorrhage from penetrating injury, particularly in the setting of multiple cardiac lacerations; (2) the technique may not be effective with certain types of gunshot wounds; and (3) the use of the stapler for emergency cardiorrhaphy eliminates the risk of personal contamination from a needle stick. [Full paper reveals survival rate of 17% for gunshot wounds and 64% for stab wounds.TL]

<17> Authors Mitchell ME.Muakkassa FF.Poole GV.Rhodes RS.Griswold JA. Title Surgical approach of choice for penetrating cardiac wounds. Source Journal of Trauma.34(1):17-20, 1993 Jan. Abstract One hundred nineteen patients suffered penetrating cardiac trauma over a 15-year period: 59 had gunshot wounds, 49 had stab wounds, and 11 had shotgun wounds. The overall survival rate was 58%. The most commonly injured structures were the ventricles. Twenty-seven patients had injuries to more than one cardiac chamber. Thirty patients had associated pulmonary injuries. Emergency thoracotomy was performed in 47 patients with 15% survival. Median sternotomy was used in 30 patients with 90% survival. Seventeen of the 83 patients with thoracotomies required extension across the sternum for improved cardiac exposure or access to the contralateral hemithorax. Only one patient with sternotomy also required a thoracotomy. All pulmonary injuries were easily managed when sternotomy was used. We conclude that sternotomy provides superior exposure for cardiac repair in patients with penetrating anterior chest trauma. We feel it is the incision of choice in hemodynamically stable patients. Thoracotomy should be reserved for unstable patients requiring aortic cross-clamping, or when posterior mediastinal injury is highly suspected. [Full paper reveals survival rates of 46% for gunshot wounds, 78% for stab wounds, and 36% for shotgun wounds. TL]

<18> Authors Kaufman JA.Parker JE.Gillespie DL.Greenfield AJ.Woodson J. Menzoian JO. Title Arteriography for proximity of injury in penetrating extremity trauma. Source Journal of Vascular & Interventional Radiology.3(4):719-23, 1992 Nov. Abstract Arteriography for proximity of injury was studied prospectively at a trauma center. Findings in 85 patients with penetrating extremity wounds were analyzed to determine the prevalence and types of vascular abnormalities seen with these injuries. Ninety-two limb segments were studied for 77 gunshot and 15 stab wounds. Arteriographic findings were positive in 24% overall but in only 5% for injuries confined to major vessels. A 60% positive rate was seen in a small subgroup of 10 patients with fractures due to gunshot wounds. The most frequently injured vessels were muscular branches of the deep femoral artery (59%); the most common injury was focal, non-occlusive spasm (42%). All patients were treated conservatively, without sequelae at follow-up. In this study, the vascular injuries found at arteriography for proximity of injury in penetrating trauma due to bullets of knives, particularly in the thigh, did not require surgical or radiologic intervention.

<19> Authors Nagel M.Kopp H.Hagmuller E.Saeger HD. Title [Gunshot and stab injuries of the abdomen]. [German] Source Zentralblatt fur Chirurgie.117(8):453-9, 1992. Abstract From 1973 to 1991 a total of 422 patients underwent surgery because of an abdominal trauma. 12 patients had gunshot wounds and 46 patients stab wounds. In a retrospective study the diagnostic and therapeutic procedure and the indication for surgery are analysed. After gunshot wounds of the abdomen we always performed a laparotomy. In 11 od 12 cases we found serious intra-abdominal injuries. Only in one case the laparotomy was "unnecessary", because of a tangential wound without penetrating of the abdominal wall. After stab wounds the diagnostic and therapeutic management was more selective. Indications for mandatory laparotomy after stab wounds were a manifest hemorrhagic shock, evisceration and a still left weapon in the abdomen (n = 22). The first clinical examination was completed by ultrasound or peritoneal lavage. Pathological findings like free intraperitoneal fluid or a positive lavage also were indications for laparotomy (n = 9). The other patients were observed closely, including repeated physical examination. The indication for surgery then based on the development of clinical signs. The time between first examination and laparotomy was never more than 12 hours. 39 patients (84.7%) had injuries of intraabdominal organs. 5 patients (10.8%) had a negative laparotomy. The mortality rate was 3.4%, but there was no death as a result of the selective approach.

<20> Authors Saltzman LE.Mercy JA.O'Carroll PW.Rosenberg ML.Rhodes PH. Title Weapon involvement and injury outcomes in family and intimate assaults. Source JAMA.267(22):3043-7, 1992 Jun 10. Abstract OBJECTIVE--To compare the risk of death and the risk of nonfatal injury during firearm-associated family and intimate assaults (FIAs) with the risks during non-firearm-associated FIAs. DESIGN--Records review of police incident reports of FIAs that occurred in 1984. Victim outcomes (death, nonfatal injury, no injury) and weapon involvement were examined for incidents involving only one perpetrator. SETTING--City of Atlanta, Ga, within Fulton County. PARTICIPANTS--Stratified sample (n = 142) of victims of nonfatal FIAs, drawn from seven nonfatal crime categories, plus all fatal victims (n = 23) of FIAs. MAIN OUTCOME MEASURES--Risk of death (vs nonfatal injury or no injury) during FIAs involving firearms, relative to other types of weapons; risk of nonfatal injury (vs all other outcomes, including death) during FIAs involving firearms, relative to other types of weapons. RESULTS--Firearm-associated FIAs were 3.0 times (95% confidence interval, 0.9 to 10.0) more likely to result in death than FIAs involving knives or other cutting instruments and 23.4 times (95% confidence interval, 7.0 to 78.6) more likely to result in death than FIAs involving other weapons or bodily force. Overall, firearm-associated FIAs were 12.0 times (95% confidence interval, 4.6 to 31.5) more likely to result in death than non-firearm-associated FIAs. CONCLUSIONS--Strategies for limiting the number of deaths and injuries resulting from FIAs include reducing the access of potential FIA assailants to firearms, modifying firearm lethality through redesign, and establishing programs for primary prevention of violence among intimates.

<21> Authors Mercer DW.Buckman RF Jr.Sood R.Kerr TM.Gelman J. Title Anatomic considerations in penetrating gluteal wounds. Source Archives of Surgery.127(4):407-10, 1992 Apr. Abstract A retrospective study of 81 patients with penetrating gluteal wounds was performed to determine if the site of penetration was useful in predicting the likelihood of associated vascular or visceral injury. There were 53 gunshot wounds and 28 stab wounds, including one impalement. The gluteal region was divided into upper and lower zones by determining whether entry occurred above or below the greater trochanters. Sixty-six percent of all penetrating gluteal wounds entered the upper zone. Thirty-two percent of patients with upper zone penetration had associated vascular or visceral injury. Only one of 27 patients with lower zone penetration sustained major injury. The site of entry plays a critical role in determining the likelihood of serious injury associated with penetrating gluteal wounds. Wounds penetrating above the greater trochanters demand thorough evaluation, especially gunshot wounds.

 

[redneckdan]

more proof that a knife in the heart beats 1000 fl-lbs in the ass.

 

[Phoenix_III]

Without even reading this, statistics like these look like 'lol'.


Looking at all incoming stab wounds, how many of them are 'accidental', or from a non-violent encounter? Lots more accidental stabbings/cutting (self induced even) vs. accidental 'shootings'.


Hopefully I am wrong and the statistics are purely for 'violent encounters'.

 

[CWL]

The problem with statistics is that bad things affect you individually. If you experience a violent act, the 'damage' done to you is not averaged-out over a large group of similar people.

True that you have only a 1/5 chance of dying from a handgun wound, but you may be that "one". Same for knife encounters.

How violence affects you is not based on anything else but only what is happening to you at that specific moment.

 

[The Tourist]

I read most of the data (pheww), and I have no doubt that this info is true and just. This is THR, and I would think nothing else.

But I will add this. I do not believe that the THR members clearly represent the public.

For example, I'll bet that most of the deaths stem from data relating to drunken knife attacks. I just saw a statistic on car accidents last night. Most of them are from 1500 to 1800 on a Friday afternoon. My guess? I'll bet it's fatigue and booze.

Now re-define the type of guy who is a member here. The average gun nut here shoots up tens of thousands more rounds. Most Americans buy a .38 SPL and one box of cartridges. That's how my wife obtained her (original) Charter Arms Bulldog--the guy fired it five times and sold it for 75 bucks, including the remaining 45 cartridges.

Apply that ideas to knives. After working with the public in a sporting goods store throughout four deer seasons I can verify that a hunter will buy a Weatherby rifle but then ask for a knife "on sale."

There is clearly much more research and probing questions on cutlery in this forum--and I mean intelligent questions, to boot. BTW, I'm getting PMs asking for polished edges on jackknives. Does that sound like a rookie to you?

Another factor is our concept of self defense. Most of us treat that like a given in almost any situation. To that, look at all of the negative hype over the last few days on the SCOTUS decision. Most people think a proper opinion on defense is to dial 911.

My point is to factor out the bubbas. Document data from guys who buy quality knives, seriously train in MA and plunk down money for proper care.

Why do you think Ayoob uses the 21-foot rule in court? Clearly, those guys with knives are not mainstream America watering down data.

 

[ctdonath]

The problem with statistics is that bad things affect you individually.

I like to put it: Statistics mean nothing when they happen to you.

 

[The Tourist]

Statistics mean nothing when they happen to you.

My opinion is that the statistical samples in a bell shaped curve are more likely to happen to a person more apt to be a THR member, not less.

Chances are we are more apt to be sportsmen in good health, probably younger overall than the rush of 'boomers, more likely to carry some form of CCW, a believer in 2A rights, a believer in SD, and perhaps a practioner of MA at some level.

My guess is that more of us will fight back than run and hide.

By the simple numbers, if you expose yourself to an ever increasing amount of danger, the chances go up.

My brother is a college professor and dean. He is younger. I just found out he drives an upscale, horrendously safe imported automobile.

Of the two of us, who do you think will die first?

 

[Leanwolf]

I don't know the validity of the posted statistics, but here is a "statistic" told to me a number of years ago when I lived in Los Angeles.

I knew a man who was an IPSC shooter. We became friends, competing against each other, sharing information, etc. He was the chief surgeon of one of the trauma teams in the Emergency Room at one of the large hospitals right in the middle of one of the roughest parts of Los Angeles. He said his trauma team was called "The Cut and Shoot Gang."

I asked him once, "Doc, of all the patients who come into your Emergency Room with either gunshot wounds, or knife wounds, how many die?"

He thought a few moments and answered, "About fifty-fifty. We do a land rush business on Friday, Saturday, and Sunday nights, too."

No "scientific statistic," of course, but he was up close and personal with his experience, so I believe what he said.

L.W.

 

[JShirley]

If I defend myself at very close range, and only have a knife, my attacker will probably die.

Why? Well, there's no margin of error. If I'm already "inside", it's safer to stay inside than try to disengage. I am in fear for my life, and I have something sharp in my hand. I will do my best to stop the engine of the machine that is threatening me, because only then can I safe.

If I have a handgun, I will probably fire 2-3 quick rounds and determine if I'm still facing a threat. If the threat is no longer threatening, I will back away or take cover while calling 911. I have distance.

Distance is my friend. Distance gives me options. Lack of distance means one of us has to hit the ground before I can stop fighting. If I have distance, it's easier for me to let the bad guy give up, even if he's not incapacitated (I would never want to bank on this, but it does happen sometimes. I don't really think two shots from a .38 Special snubby or 9x19mm is going to instantly level a perp like the hammer of Thor, but if he stops fighting, maybe we can both live, instead of just me).

John

 

[telecaster1981]

What a mind boggling lot of information!!!


As long as the first rule of a gunfight is still "bring a gun," I'm good...

 

[The Tourist]

Distance is my friend.

Not only my friend, but a close blood relative. I hate being in the vortex.

The problem I have is that my condition yellow radar works about as far as I can discern a man's face and eyes. In truth, his actions to close distance on me is the big give away.

And frankly, that rapidly closing distance is not really an excuse to shoot, but a prudent warning to put your hand on something sharp. In fact, I usually rest my hand on my pocket clip as a habit.

*sigh* Yes, I know that sometimes a gun is better and I know how to speed rock. But I have to tell you, when an aggressor is pulling on your clothing, I just feel more comfortable and practiced knowing I have a knife.

One of the most painful laughs I ever had was listening to Billy Bob Thornton describe the difference between himself as just David, and the legend he had become as Davy Crockette. He said that David would run, but Davy Crockette had to stay and fight.

And I feel the same way. I figure "Chico with a gun" has nowhere near the fear factor that "The Tourist with a knife" might have.

I'm sitting here with a .380 auto pistol and a sharp Razel, and I got to tell you, the knife scares me a lot more.

 

[Squidward]

"Why do you think Ayoob uses the 21-foot rule in court? Clearly, those guys with knives are not mainstream America...".


Even 21 feet is too close. Take a look at the knife fighting posted on You Tube. Scares the crap out of me..

 

[The Tourist]

Take a look at the knife fighting

About ten years ago I figured it was about time to get serious about the mechanics. I was working in the industry, but it was all repair.

I got hold of an old book called "Bloody Iron." Yeah, the out of date clothing will make you chuckle, but the idea was fairly sound. It was the fighting ideas of soldiers who had spent time in jail.

I discussed the items in the book with a friend of mine who works security on a "crash team" for the Mendota State Hospital. He had gotten a shiv stuck in his left forearm during a scuffle. The shiv had been made from a common Bic pen.

To me, the stuff was pretty "jail house." In other words, more dirty tricks than sound MA ideas. Most of the real effective knife attacks are shiv moves with a college education.

 

[Zoogster]

Most stabbings are done with small knives, or barely penetrate a couple inches. Many on accident others by people who have no idea what they are doing, just weakly slashing.

Most blades are not designed as weapons to insure the most damage possible, most bullets are.

So the statistics are very misleading.

A blade designed to be as lethal as possible would be very deadly. In fact blades designed for serious injury are generaly illegal to carry or have many places.
Bullets designed to cause the most tissue damage possible are widespread, in fact the only types used in police sidearms and for most self defense.

So statistics comparing the two are very poor.

The average knife is made for small minor cutting tasks or cutting food, not designed to insure blood flow, destroy organs etc
There is blade designs that do that though.

If a .22 target pistol was the primary gun in society, and most knives were the most lethal designs possible, you would have a similar statistic result favoring survival of gun wounds.

People in our society perfect the killing power/ stopping power of bullets, not knives. They also work to insure legislation allowing thier legal use exists, not so with deadly knives.

How many places ban daggers and various double sided knives for example yet allow any bullet you want to use in a gun? Quite a few, in fact strict knife laws are common in more states than strict gun laws.
If you add a feature that makes a knife more lethal there would be calls to remove it. If you design ammunition even more effective it is praised.


Further most skilled with training in defense or offense use a gun as thier tool. So there is a lot more skillfull firearm attacks than knife attacks. That alone means those attacks will more often be lethal even without other factors.
People train to shoot and use a gun in society on a normal basis. Few train to be lethal and inflict deadly results with a knife on a regular basis.

So all of this leads to an obvious conclusion: Gun use is much more likely to have lethal results in our society.

Now if you go to an area with a culture strong in martial arts traditions, that regularly trains and practices with swords and knives in martial arts, I think you would find a knife attack in that society is often just as lethal.

 

[Odd Job]

I have worked with one of the frequently-quoted surgeons in Todd's list. Many of those articles are based on South African experience. A few observations:

1) There is a big difference between gunshot statistics prior to 1994 and gunshot statistics after 1994, in South Africa. Simply put, the number of gunshot victims rocketed after the new regime came in, in South Africa. I was working in the same trauma unit as the author in question, and I was there for the change (I started there in 1992 and left in 1999, with a break in 1996 and a formal gunshot research project in 2002). I suspect that if research was done on a more recent sample, the outcomes of the gunshot victims relative to the stab victims, would probably be less disparate.

2) Stab wounds have always outnumbered gunshot wounds at the level one trauma unit where I worked. Even when the gunshot numbers were at their worst (1997 to 1999) there were more stab wounds. The trauma doctors are very experienced at dealing with stab wounds. After 1994 their experience with gunshot wounds would have increased dramatically, but the stab wounds would still be more. At the hospital I am talking about, where the author and I both worked, I have a breakdown of all the admissions to the trauma unit in 1999. I will dig those up and post them. The total was around 16,000 patients seen by the unit. Edit: woops, gotta check my numbers again, I have blunt assaults mixed with stabs

3) A gunshot wound (on average) involves deeper penetration than a stab wound. This is because you have to consider the converse, which indicates that it is more common to find a shallow incision in a stab wound, than a shallow skin breach in a gunshot wound. Until the majority of shooters switch to snakeshot and Glasers, this will remain the same.

4) A penetrating gunshot injury can involve tissues remote from the site of entrance. For example I had one case in my research where an adult male sustained a gunshot wound to the face, in the region of the angle of the mandible. The wound didn't bleed very much and all that could be seen externally was quite a neat hole in the cheek. In the books he was down as a gunshot head. Up close and personal when I took the photographs, he was down as a gunshot face in my opinion. After the X-rays, the full extent of the injuries were demonstrated. His most significant injury was a pneumothorax, punctured diaphragm and liver injury. The bullet came to rest under his liver! You won't find this with a stab wound. You can't stab someone in the cheek and pop his lung and liver. Not even JShirley can do this

5) A retained foreign body is more likely in a gunshot wound than a stab wound. I've seen my share of retained blades, and I have seen twice as many stabs as gunshots overall, but the number of retained projectiles or fragments thereof easily eclipses retained cutlery. The dangers of a retained bullet are chemical, mechanical, ferro-magnetic and also potentially infectious. Don't forget that a bullet is not sterile after firing, and that clothing and other intermediate materials can be drawn into a wound in certain circumstances. Of course a blade can also introduce infection, but unless it is retained, the patient at least escapes the other three hazards which could adversely affect treatment and outcomes.

6) I am very wary of research coming out of countries that typically don't see many gunshot wounds, or places where they have had a recent spate of gunshots, but don't have experienced personnel dealing with them. I was witness to this, here in London when two people were shot outside the A&E department as I was leaving work on St Patrick's day in 2004. There were some 'inadequacies' in how those patients were handled in the A&E, and this was down to lack of experience and also a general impression that a gunshot wound was serious, even though there was adequate clinical evidence in one of the cases to indicate that it was not. So as much as I like the surgeons and clinicians who I work with here in London, I don't know many (who haven't been trained elsewhere abroad) who have good experience in dealing with gunshot wounds. It must stand to reason, that experience counts when trying to deliver quality and speedy treatment in these cases.

 

[Odd Job]

Okay here are the admission numbers for 1999, at the level one trauma unit I worked at in South Africa:

7892 Accidents (vehicular, sporting etc)
4440 Assault (blunt force)
2214 Assault (edged)
1755 Gunshots

There were also 24 non-specified cases (poisoning and drowning, for example) or cases that were seen in the trauma unit because of a problem in the medical or paeds casualty.
Also of note, one exception to paeds cases: paeds were occasionally resused in the adult trauma department. There were 70 paeds resuses and 1554 adult resuses.

Unfortunately I don't have side by side numbers for stabs vs gunshots (in terms of outcomes) but I have a sample of 542 gunshot cases from 2002 where I documented the general area involved, and the acute destination of the patient (morgue, ward, home, theatre etc). If I go back to South Africa for more, I will be sure to get parallel stab statistics.

 

[The Tourist]

There is another aspect we should mention. That being who and where people cannot or do not carry firearms.

For example, in Wisconsin, we have no CCW licensing provision. Granted, those who don't mind breaking the law carry guns. A concerned "good guy" will carry contact weapons of all kinds. In that limited area, contact wounds supplant bullet wounds.

Another demographic will be age. The very young and the very old probably aren't shooting anything as much as the active portion of society. Even if the entire teenage population seriously wanted to carry handguns, the price and availability would be a limiting factor over those who can wander into a gun store at any time.

And of course, there are times when we do not wish to carry. Yes, that time exists. A parent going to his kids music recital will probaby not carry. You might not carry inside a Post Office. Or to a church. Or perhaps not at Sturgis, (but that's probably going to change after last year.)

My point is that exposure to crime does not diminish while the number of firearms per capita most certainly does. Did you ever see a 1911 jammed in speedos at the beach?

I believe that there are these "pockets" of strange numerical instances in society which makes the entire construct of statistics shaky. The average number of legal CCW folks in a city might be x-persons. The average number of people in Wiscosnin might be y-persons. But you cannot average averages.

And you cannot extrapolate numbers based on widely divergement lifestyles. For example, Bikerdoc was the victim of an attempted mugging. Would the number of wounds in his demographic be different from cloistered nuns? Of course it would, and yet both are modern Americans.

If a statistical number is to be believed, it will have to be defined by such demonstrative well-defined slices of the population the tabulation will be meaningless. To simply say "all gunshot wounds" or "all knife wounds" doesn't say anything.

Let's suppose you are bound and determined to provoke me while dining with my wife tonight. Your chances of serious life-threatening lacerations is 100%.

Considering there are less than one dozen working Japanese tinkers to begin with, and who are knife wielding, motorcyle owning, retired baby-boomers unable to legally carry firearms, my demographic slice is almost negligible.

 

[RyanM]

The 22% figure is based on all gunshots, however, and moreover, the statistic is based on those that were admitted to the hospital, and it's based on all injuries, including obviously nonlethal ones.

There's a huge difference between a pistol, a shotgun, and a rifle. Likewise, the circumstances under which people, in general, are stabbed vs. shot, may be vastly different. Also, the areas hit may be vastly different. It's a helluvalot easier to block a knife stab with your arms, than to block a bullet! I'd guess knife injuries had proportionally more extremity wounds.

And "stab wound" is undefined. If I trip and fall in the kitchen and impale my hand on a knife, is that a "stab wound?" Probably. If I drop a knife point-first on my foot, is that a "stab wound?" Probably.

For there to actually be a fair comparison, you'd need to restrict it to cases where people were shot or stabbed to a certain minimum depht, in the same general area, and where they were treated within the same amount of time from the time of injury.

 

[JShirley]

Thanks for the stats, OJ.

If I stabbed someone in the cheek, it would only be because I was going for eyes or throat, and they moved.

 

[The Tourist]

RyanM, I saw a quote once from an ER doc who stated that a knife fight included wounds to both parties and at least one of the patients was drunk.

Since not every one drinks, hangs out in honky-tonk bars and fights in an alley, I don't see how statistics can be classified as "all of the wounds."

There are 300 million people in America, the vast majority have never seen a switchblade, a Kabar or a assisted opening knife, musch less will ever use one. My hunch is that this same demographic applies for Raven and Lorcin pistols.

We have a crime issue, but not all Americans are criminals and most will never contribute to the figures or the demographic. Any postulate based on "all wounds" as it applies to Americans is flawed from the beginning.

 

[RyanM]

Right, that's pretty much what I meant. You cannot possibly go "this one hospital had 4% fatalities with stab wounds and 22% with gunshots" and expect it to mean anything. Around here, I'd expect 90% of both to be self-inflicted while drunk.

However, if there was a study which was limited to people who were shot or stabbed, where the wound was limited to a relatively small area (say a wound which remained within a 6" diameter cylinder going from the breastbone to the spine), the wound penetrated to a depth of at least 3", they were on no drugs, and they were treated between 30 and 60 minutes of the time of injury, then you'd have a fair comparison of relative lethality, regardless of the social factors.

 

[strambo]

When used as they were designed by a reasonably competent person they are equally lethal. Can't get any deader than dead.

The problem comes when tools are mis-applied. A gun is not the best tool at 0-5ft, a knife sucks at 10ft (throw it?). Gotta know your anatomy a lot better to efficiently kill with a knife than a gun.

The Aryan Brotherhood in our prisons realized their success rate of prison murders was pathetic. Too many were surviving because the guards responded too soon (a few notorious cases of them watching and doing nothing notwithstanding). So, they began to pass out training materials on anatomy so they could kill in the few seconds they had available before it got broken up.

Open up someone's aorta and/or vena cava (perhaps get some liver too) by stabbing them through the area of the solar plexus (used as an anatomical landmark) and they will rapidly bleed out...it would be very difficult to save them even with immediate response by EMS.

That sort of knowledge isn't just for prison gangs...it could save your life or that of your family when faced with gang bangers like the MS13 lowlife(s?) who executed a father and 2 sons in San Francisco last weekend. You gotta put the 1st one down in a manner you know they can't recover from while you deal with additional threats (can't worry about him regaining consciousness and shooting or stabbing you in the back). Use a knife, a gun, a stomp to the neck after knocking them down, the tool doesn't matter. Lethal is lethal.

 

[JShirley]

If there's any confusion, strambo is talking about defending against multiple lethal threats. If facing a single opponent, the obligation is to stop applying force when the attack is over or the threat is perceived to have stopped.

 

[gripper]

I wonder if they used any of the folks from the Fillipino kids I used to know from my GI days as part of the study group...now THERE was a bunch of guys who could ruin your whole day with a bit of sharp steel....
In th eend it come down to the willingness to follow through with what you start-all the way through!.