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Source material for the use of firearms in sixteenth-century England outside military contexts is sparse. This article uses coroners' inquest reports to examine who used guns of what types, for what purposes, in different parts of England and at different phases of their diffusion. Artisans were prominent among early adopters, but by the end of the century yeomen were the most frequent gun owners. It shows what hazards guns with different firing mechanisms such as matchlocks and snaphances presented, the steps users took to mitigate such risks, and the severity of gunshot wounds, which caused two-thirds of victims of fatal firearms accidents to die instantly. [ABSTRACT FROM AUTHOR]

The rise in demand for firearm licenses in Israel due to the ongoing 2023–2024 Israel-Gaza War, coupled with the easing of regulations for issuing weapons, is expected to lead to a significant increase in the incidence of firearms among civilians. This situation calls for a special awareness of civilian populations of the dangers posed to children by the high prevalence of firearms. We therefore present trends in firearm-related incidents resulting in unintentional mortality and morbidity of children ages 0–17 between the years 2008–2023 in Israel. In total, 202 accidents involving firearms were reported, with an average age of 12.2 (median: 13), and with the youngest child being 2 years old. Of these, 24 cases resulted in fatalities18 of which of children of Arab descent. We provide several recommendations concerning changes and additions to current bylaws concerning firearms licensing and storage in Israel, in order to decrease the risk of child injury due to irresponsible firearm handling. [ABSTRACT FROM AUTHOR]

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The article assesses the right of U.S. residents to be protected from gun violence. Topics discussed include the tendency of guns to escalate the lethality of violence in the country in light of its possible use in domestic homicide, suicide or accidental shooting, interpretation of the Second Amendment by the courts such as the Supreme Court ruling in District of Columbia v. Heller on the right to own a gun in homes for protection, and bases of the state duty to protect citizens.

Background: Injuries are increasingly recognized as a major component of the global burden of disease, as they tend to affect mainly youth and are usually followed by premature death or severe disability. The longstanding conflict in Iraq has resulted in a situation of continuous violence and ongoing instability, which has in turn led to an increasing incidence of injuries and a crippled health system. Objective: To sketch a trend of non-military accidents in Iraq (road traffic accidents [RTA], falls, burns, firearm injuries, assaults by sharp objects and sexual assaults) among civilians during the last 14 years associated with the period of conflict (2003-2016). Methods: This descriptive study was conducted during the period from January 1st through to December 31st, 2017 using already available surveillance data from the Ministry of Health in Iraq. The methodology was based on measuring the incidence of each accident for the period from 2003 through 2016 and plotting it against time. Linear regression was computed to estimate the trends of the disease. Results: The rate of RTAs significantly increased between 2003 and 2016, from 1.85 to 2.9 per 1000 (p ⩽ 0.01), as did accidental falls especially after 2008 (males more than females) (p ⩽ 0.01). By contrast, after a peak in 2011, burns dropped significantly from 4.19 to 3.42/1000, along with firearm accidents, which fell from 2.2/1000 in 2007 to 0.39 in 2016 (p ⩽ 0.01), mostly among males. Assaults with sharp objects also decreased with time to a rate of 0.47/1000 (p = 0.0001). Sexual assaults showed a significant downward sloping trend over time to p = 0.037. Conclusion: Accidents still add a burden on the already deteriorated Iraqi health system. Understanding the impact of this burden is essential to better prepare for future plans and interventions that may help improve the quality of health services. [ABSTRACT FROM AUTHOR]

A bystander claimed to have been shot by a police officer, and CT scans were used to match qualitative and quantitative aspects of the unremoved bullet with police issued 9 mm Luger ammunition. CT scan methodology proved a valid approach for the measurement of bullets based on calculated measurement capability and correlation with "gold standard" physical measurement by vernier caliper. Measurements regarding length and base diameter, as well as length/diameter ratio, were insufficient to unambiguously identify a specific caliber, or a bullet of specific mass within a caliber class. It was, however, possible to exclude a bullet of specific design and mass with well‐characterized precision and accuracy values under selected CT scan conditions. A 9 mm Luger bullet (115 gr FMJ RN) was excluded from involvement in a shooting based on qualitative bullet shape combined with length, base, and ratio measurements of the bullet in‐situ for the victim. [ABSTRACT FROM AUTHOR]

Importance: Understanding global variation in firearm mortality rates could guide prevention policies and interventions.Objective: To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories.Design, Setting, and Participants: This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths.Exposures: Firearm ownership and access.Main Outcomes and Measures: Cause-specific deaths by age, sex, location, and year.Results: Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35).Conclusions and Relevance: This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups. [ABSTRACT FROM AUTHOR]

Brain death (BD) triggers a series of pathophysiological events similar to multiple-organ dysfunction. Traumatic brain injury (TBI) due to firearm injury (FAI) causes lesions that could lead to BD. Patients admitted to the ICU due to severe TBI that evolved to BD were studied, including those caused by FAI; the 2 groups were compared with the objective of demonstrating that the support of the deceased donor by TBI due to FAI is more unstable and of shorter duration than the one related to TBI by another cause. Preliminary results demonstrated that the individuals with TBI by FAI died in BD in a higher percentage than the individuals with TBI caused by accidents (83% vs 41%). The donor treatment period was lower in individuals who presented TBI by FAI. These individuals needed higher doses of noradrenaline as vasopressor support for their treatment, without showing a statistically significant difference ( P = .15), compared with individuals whose BD cause was TBI caused by accident. [ABSTRACT FROM AUTHOR]

Background: Gun shows are an important source of firearms, but no adequately powered studies have examined whether they are associated with increases in firearm injuries.Objective: To determine whether gun shows are associated with short-term increases in local firearm injuries and whether this association differs by the state in which the gun show is held.Design: Quasi-experimental.Setting: California.Participants: Persons in California within driving distance of gun shows.Measurements: Gun shows in California and Nevada between 2005 and 2013 (n = 915 shows) and rates of firearm-related deaths, emergency department visits, and inpatient hospitalizations in California.Results: Compared with the 2 weeks before, postshow firearm injury rates remained stable in regions near California gun shows but increased from 0.67 injuries (95% CI, 0.55 to 0.80 injuries) to 1.14 injuries (CI, 0.97 to 1.30 injuries) per 100 000 persons in regions near Nevada shows. After adjustment for seasonality and clustering, California shows were not associated with increases in local firearm injuries (rate ratio [RR], 0.99 [CI, 0.97 to 1.02]) but Nevada shows were associated with increased injuries in California (RR, 1.69 [CI, 1.16 to 2.45]). The pre-post difference was significantly higher for Nevada shows than California shows (ratio of RRs, 1.70 [CI, 1.17 to 2.47]). The Nevada association was driven by significant increases in firearm injuries from interpersonal violence (RR, 2.23 [CI, 1.01 to 4.89]) but corresponded to a small increase in absolute numbers. Nonfirearm injuries served as a negative control and were not associated with California or Nevada gun shows. Results were robust to sensitivity analyses.Limitation: Firearm injuries were examined only in California, and gun show occurrence was not randomized.Conclusion: Gun shows in Nevada, but not California, were associated with local, short-term increases in firearm injuries in California. Differing associations for California versus Nevada gun shows may be due to California's stricter firearm regulations.Primary Funding Source: National Institutes of Health; University of California, Berkeley; and Heising-Simons Foundation. [ABSTRACT FROM AUTHOR]

Exposure to firearms increased substantially after the December 2012 shooting at Sandy Hook Elementary School in Newtown, Connecticut, where 20 children and 6 adults were killed. Gun sales spiked by 3 million, on the basis of the increase in the number of background checks for firearm purchases. Google searches for buying and cleaning guns increased. We used Vital Statistics mortality data to examine whether a spike in accidental firearm deaths occurred at the same time as the greater exposure to firearms. We also assessed whether the increase in these deaths was larger in those states where the spike in gun sales per capita was larger. We find that an additional 60 deaths overall, including 20 children, resulted from unintentional shootings in the immediate aftermath of Sandy Hook. [ABSTRACT FROM AUTHOR]

This paper analyzes the medical care given at Brazilian urgent and emergency healthcare services to people injured by firearms in 2014. A cross-sectional study was carried out on care given to patients with firearms injuries in 24 capital cities of Brazilian states and in the Brazilian Federal District, included in the VIVA Survey. Simple and relative frequencies of the variables related to the patients and to the event were calculated, and a logistic model for complex samples was applied adopting care for firearms injuries patients as outcome. The results show the following percentages of care events as caused by firearms: 0.7% for the category ‘other accidents (other than transport-related accidents)', 1.5% for self-inflicted injuries, 15.9% for injuries due to assault, and 65.1% of cases arising from legal intervention. The care given was predominantly to young male adults (age 20-39), of mixed race and with a low level of schooling. The most common injuries were: to arms and legs; and to multiple organs. The paper concludes by discussing the efforts to control firearms held by the public in Brazil, and how they can lead to severe and lethal outcomes in quarrels and interpersonal disputes. [ABSTRACT FROM AUTHOR]

Objective: Weapon injuries have been increasing due to use of weapons widespread. This study aims to describe our experiences with high-velocity firearm injuries to the forearm and the hand. Material and Methods: Seven patients who had high - velocity firearm injuries to the forearm and the hand were included in this study that was conducted between 2010 and 2015. All patients were male, and their mean age was 25 years (range, 21-33 years). On the average, patients were operated on within the first eight hours (range, 6-12 hours). There were two forearm injuries and five hand injuries. Revascularization could not be performed for two finger injuries, and the digits were amputated. Two forearm and three hand vascular injuries that needed microvascular anastomosis were operated on using interposition vein grafts. Vein grafts were obtained from saphenous veins in two patients and from dorsal foot veins in three patients. Results: No microvascular complications were seen in the early or late follow-up periods. Phalanx fractures were seen in all hand injuries. On the average, patients were operated on three times (range: two-five) in the follow-up period. Conclusion: In firearm injuries, microvascular repair should be performed out of injury zones; surgeons should not hesitate to use interpositional vein graft for microvascular repair, and physical rehabilitations of patients should be started in the early follow-up period. [ABSTRACT FROM AUTHOR]

Objective: Injuries by mole guns differ from other firearm injuries primarily because they are close-range, low-energy injuries that are highly contaminated owing to contact with contaminated surfaces and the presence of numerous residual foreign bodies within the wound. The aim of this article is to share our surgical experience regarding the repair of severe hand injuries caused by mole guns. Material and Methods: This retrospective study included 11 patients with hand injuries. Data obtained about the patients, including age, gender, dominant or non-dominant hand, injuries to all vital structures, and reconstructive procedures were assessed, categorized, and recorded. Results: Ten patients had defects in one or several common digital branches of the median nerve in areas ranging from the distal part of the carpal tunnel to the distal palmar crease. All patients had flexor and extensor tendon injuries in all fingers except for the first finger. Reconstruction of soft tissue and skin defects was carried out with an interpolation flap planned from a random-based subpectoral-paraumbilical region in five patients, a SCIA-based groin flap in four patients, a reverse-radial forearm flap in one patient, and an adipofascial flap planned from the forearm in one patient. Conclusion: Mole gun injuries typically include all structures of the hand, and repair procedures involve every anatomic structure of the hand. An early and effective surgical operation followed by prolonged and effective physical therapy protocols is vital for regaining the full spectrum of hand functions. [ABSTRACT FROM AUTHOR]

Firearm violence has been the second leading cause of death among adolescents and young adults in the United States since 2000 and is a major public health concern. But firearms may be related to less lethal forms of violence as well. Here we examine the relationship between the presence of a gun in the home and several behavioral and psychosocial measures related to aggression and violence among adolescents using data from a community-based survey of nearly 2,000 youths living in low-income neighborhoods. Our results indicate that adolescents living in homes where a gun is present display more aggressive attitudes and behaviors than their counterparts living in homes with no gun present. More research is needed to better understand the mechanisms underlying the relationships, but they may relate to a weapon’s effect or social learning. [ABSTRACT FROM PUBLISHER]

Background Firearm injuries related to legal intervention have come under scrutiny because of recent events. Methods The Kids' Inpatient Database (1997-2012) was searched for firearm injuries due to legal interventions ( International Classification of Diseases, ninth revision, Clinical Modification E970) requiring inpatient admission in children aged <20 y. Cases were weighted to provide national estimates. The Brady Campaign criteria were used to identify lenient versus strict gun law states. Results Overall, 275 cases were identified, with a 7.5% mortality rate. Incidence peaked at 1.0 per 100,000 admissions in 2006, significantly increased from a low 0.2 per 100,000 admissions in 1997, P < 0.001. Patients were predominantly male (97%). African Americans (44%) represented the largest racial group, followed by Hispanics (30%) and Caucasians (20%). Mean age was 17.5 ± 2.08 y. Patients were insured by Medicaid (33%) or a private payer (24%); the remainder (43%) was uninsured. Admissions most frequently occurred at urban teaching hospitals (81%). Cases occurred most frequently in the Southern United States (44%), followed by the Western United States (35%). Most patients presented to non–children's hospitals (97%). Mean hospital admission cost was 27,507 ± 40,197 USD, whereas mean charges amounted to 75,905 ± 116,622 USD. Cases mostly occurred in lenient (56%) gun law states, whereas the remainder occurred in strict (41%) and neutral (3%) states. When analyzed by race, Caucasians (16%) had a significantly higher mortality rate when compared with African Americans (5%), P = 0.03. Conclusions An analysis of this very specific injury mechanism demonstrates important findings, which are difficult to collect from conventional data sources. Future research will contribute to the objective analysis of this politically charged subject. [ABSTRACT FROM AUTHOR]

Objectives. To examine how firearms-related incidents are defined as social problems versus personal tragedies. This is achieved by examining a case of gun violence where the actors immediately involved are apparently blameless: child-involved accidental firearms deaths and injuries. Specifically, we examine changing narratives of these incidents fromthe mid-19th century to the present. Methods. A database of 314 New York Times articles on child-involved accidental shootings from the mid-1800s to the present day was compiled and analyzed using Atlas.ti. Results. Our content analysis shows that despite declining prevalence and coverage over time, these incidents were increasingly framed as social problems through narratives of criminalization and responsibilization. These discursive frameworks differ in how they allocate blame and advance appropriate social responses to childinvolved shootings. First, "criminalization" involves a police response to both the child shooter and, especially after the 1911 promulgation of New York's Sullivan Act requiring a license for concealable firearms, to adult custodians. Second, "responsibilization" allocates responsibility for the proper management of guns to adults at home (since the 1970s) as well as to society at large (since the 1980s) within a discourse that frames child-involved accidental shootings as indicative of broader social disorder. Conclusions. Narratives of child-involved shootings reflect a broader social transformation of accidents into public problems that occurred in the 20th century. As such, the results provide insight into both the contemporary gun debate and the moral valuation of children. [ABSTRACT FROM AUTHOR]

Background: Interpersonal firearm violence among youth is a substantial public health problem, and emergency department (ED) physicians require a clinical screening tool to identify high-risk youth.Objective: To derive a clinically feasible risk index for firearm violence.Design: 24-month prospective cohort study.Setting: Urban, level 1 ED.Participants: Substance-using youths, aged 14 to 24 years, seeking ED care for an assault-related injury and a proportionately sampled group of non-assault-injured youth enrolled from September 2009 through December 2011.Measurements: Firearm violence (victimization/perpetration) and validated questionnaire items.Results: A total of 599 youths were enrolled, and presence/absence of future firearm violence during follow-up could be ascertained in 483 (52.2% were positive). The sample was randomly split into training (75%) and post-score-construction validation (25%) sets. Using elastic-net penalized logistic regression, 118 baseline predictors were jointly analyzed; the most predictive variables fell predominantly into 4 domains: violence victimization, community exposure, peer influences, and fighting. By selection of 1 item from each domain, the 10-point SaFETy (Serious fighting, Friend weapon carrying, community Environment, and firearm Threats) score was derived. SaFETy was associated with firearm violence in the validation set (odds ratio [OR], 1.47 [95% CI, 1.23 to 1.79]); this association remained (OR, 1.44 [CI, 1.20 to 1.76]) after adjustment for reason for ED visit. In 5 risk strata observed in the training data, firearm violence rates in the validation set were 18.2% (2 of 11), 40.0% (18 of 45), 55.8% (24 of 43), 81.3% (13 of 16), and 100.0% (6 of 6), respectively.Limitations: The study was conducted in a single ED and involved substance-using youths. SaFETy was not externally validated.Conclusion: The SaFETy score is a 4-item score based on clinically feasible questionnaire items and is associated with firearm violence. Although broader validation is required, SaFETy shows potential to guide resource allocation for prevention of firearm violence.Primary Funding Source: National Institute on Drug Abuse R01024646. [ABSTRACT FROM AUTHOR]

Amongst hundreds of different projectiles for air guns available on the market, hollow-point air gun pellets are of special interest. These pellets are characterized by a tip or a hollowed-out shape in their tip which, when fired, makes the projectiles expand to an increased diameter upon entering the target medium. This results in an increase in release of energy which, in turn, has the potential to cause more serious injuries than non-hollow-point projectiles. To the best of the authors' knowledge, reliable data on the terminal ballistic features of hollow-point air gun projectiles compared to standard diabolo pellets have not yet been published in the forensic literature. The terminal ballistic performance (energy-dependent expansion and penetration) of four different types of .177 caliber hollow-point pellets discharged at kinetic energy levels from approximately 3 J up to 30 J into water, ordnance gelatin, and ordnance gelatin covered with natural chamois as a skin simulant was the subject of this investigation. Energy-dependent expansion of the tested hollow-point pellets was observed after being shot into all investigated target media. While some hollow-point pellets require a minimum kinetic energy of approximately 10 J for sufficient expansion, there are also hollow-point pellets which expand at kinetic energy levels of less than 5 J. The ratio of expansion ( RE, calculated by the cross-sectional area ( A) after impact divided by the cross-sectional area ( A ) of the undeformed pellet) of hollow-point air gun pellets reached values up of to 2.2. The extent of expansion relates to the kinetic energy of the projectile with a peak for pellet expansion at the 15 to 20 J range. To conclude, this work demonstrates that the hollow-point principle, i.e., the design-related enlargement of the projectiles' frontal area upon impact into a medium, does work in air guns as claimed by the manufacturers. [ABSTRACT FROM AUTHOR]

An unintentional discharge (UD) is an activation of the trigger mechanism that results in an unplanned discharge that is outside of the firearm's prescribed use. UDs can result in injury or death, yet have been understudied in scientific literature. Pre-existing (1974-2015) UD reports (N = 137) from seven law enforcement agencies in the United States of America were analyzed by context, officer behavior, type of firearm, and injuries. Over 50% of UDs occurred in contexts with low threat potential while engaged in routine firearm tasks. The remaining UDs occurred in contexts with elevated to high threat potential during muscle co-activation, unfamiliar firearm tasks, contact with inanimate objects, and a medical condition. An antecedent-behavior-consequence (A-B-C) taxonomy as well as a standardized reporting form, based on the current findings and the existing literature, are offered as tools for identifying the conditions under which UDs may be likely to occur. [ABSTRACT FROM AUTHOR]

Introduction: Despite greater than 60,000 nonfatal firearm injuries per year in the United States, retained shrapnel is a relatively rare cause of systemic lead toxicity with less than 100 cases reported in the medical literature since 1867. While intra-articular retained shrapnel as a cause of lead toxicity is well-described, extra-articular fragments are less well known to cause symptomatic disease.Case Report: A 31-year-old man initially presented with abdominal pain, constipation, jaundice, and elevated liver transaminases approximately 3 weeks after suffering a left lower extremity injury during athletic activity. The patient was found to have steatohepatitis after extensive inpatient and outpatient gastroenterological workup to include upper and lower endoscopy, liver ultrasound, and biopsy of the liver to confirm the diagnosis. Imaging was incidentally notable for retained gunshot in the left flank and large shell fragment containing seroma in the left thigh. The patient was initially discharged with improved pain, but later presented to a primary care clinic with weight loss and continued pain. This was followed by a subsequent progression to diffuse weakness, ultimately resulting in an inability to ambulate. The patient was readmitted to a tertiary care medical center, 3 months after the initial presentation. Physical exam was then notable for 70-lb weight loss from initial admission and diffuse peripheral weakness with global muscle atrophy. Following a broad differential workup, he was found to have a blood lead level of 129 μg/dL, and hemoglobin of 7.7 g/dL with basophilic stippling on peripheral smear. The patient was transferred to the intensive care unit for chelation therapy with dimercaprol and calcium ethylenediaminetetraacetic acid. Lead levels initially decreased, but rose when patient was transitioned to oral therapy with succimer. Surgery was consulted for removal of multiple retained fragments, which were analyzed by the Joint Pathology Center and found to contain lead. The patient's motor function gradually improved on oral chelation and he was discharged to a subacute rehabilitation facility.Conclusion: This complex case describes a rare cause for a relatively common clinical presentation, jaundice and hepatitis, and reinforces the importance of longitudinal follow up and reassessment of a patient with an unknown illness and worsening clinical condition. Diagnosis of systemic lead toxicity is challenging because of its protean clinical manifestations, and relative rarity with the advent of strict environmental lead controls and decrease in lead-based paint and industrial products. Furthermore, extra-articular lead remains a rare cause of systemic toxicity, and the surgical standard of care has been to not remove these fragments in gunshot victims. This case adds to a small amount of evidence that lead screening may be of value in selected patients with extra-articular retained shrapnel, especially those with seroma and osteophyte formation in the wound. [ABSTRACT FROM AUTHOR]

Background: Gun shot injuries are a great challenge for medical professionals because of high mortality rate. Survival of victim depends upon the extent of damage and promptness of medical services. Objective: Present study was undertaken to analyse medico-legal aspects of fatal gunshot injuries to provide data in Jaipur region. Study Type: Hospital based Descriptive Observational Study. Place and Duration : Department of Forensic Medicine and Toxicology, SMS Medical College and attached hospitals, Jaipur (A tertiary health care centre in north-western INDIA) during the study period of 17 months (May 2014 to October 2015). Observation and Results: Out of 23,584 registered medico-legal cases 115 were cases of gunshot injuries with burden of 0.49%. 11 cases were of fatal out of 5135 autopsies conducted. 05 fatal cases died within 6 hours, Homicides were the most common manner of incidence, Rifled firearm weapons were the preferred employed firearm weapon, more than half cases of distant fires were the offending shot in the present study. Conclusion: Rifled firearm weapons were the most commonly employed firearm weapon. Coma and Shock resulting from gunshot injuries were the cause of death in most fatal cases. [ABSTRACT FROM AUTHOR]

Background: Medico-legal autopsy is a valuable source of information about death whether it is natural or unnatural and if un-natural then what is the cause, mode, manner of death, the time since dead or any associated crime with the death. Study design: This descriptive study is based on autopsy record and provides information regarding cause of death, age, sex of the person and whether from rural or urban area. Duration of study: From 1st January 2013 to 23rd May 2013. Methodology: This study was conducted in the department of Forensic Medicine & Toxicology of Khyber Medical College, Peshawar. Data was collected from the record of autopsies performed from January 2013 to May 2013. It includes all autopsy cases referred from urban as well as from rural area police stations of Peshawar district. Results: Out of total 400 autopsies 71% deaths were due to firearm injuries, 10 % due to road traffic accidents, 6% due to bomb blast injuries, 4.5% due to poisoning and 4% due to asphyxia. In all these victim of un-natural deaths 90% were male, 67% were from rural areas and 35% were of age group of 20 to 30 years. Conclusion: Situation of unnatural deaths in Peshawar is alarming and seeks attention of policy makers. All preventable causes of death can be controlled by providing better education including religious education, by improving social justice and socioeconomic conditions of people and by increasing psychiatric treatment facilities in our hospitals. [ABSTRACT FROM AUTHOR]

For every fatal shooting in the United States, detailed information from reports of coroners or medical examiners, police departments, and other sources is recorded in the National Violent Death Reporting System. There is no such system in place for nonfatal shootings, which far outnumber fatalities. Hospital data systems are in place that could, with some improvements, provide access to reliable local, state and national estimates of firearm injuries. Such estimates are possible because most firearms injuries are treated in hospitals, and hospitals routinely assign "external cause of injury" codes to all injury encounters. Federal health agencies supervise a number of data systems that centralize hospital data. Challenges currently being addressed are public access, timeliness, and accuracy of coding of intent. (Hospitals misclassify many firearm assaults as accidents.) Law enforcement agencies provide detailed data on shootings in criminal circumstances, including shootings that are not treated in a hospital. The FBI's Uniform Crime Reports (UCR) system aggregates data from agencies. The FBI instituted a radical reform of this system beginning in 2021, resulting in a sharp agency participation drop that prevents valid national estimates. The reform requires agencies to report incident-level data instead of summary counts, which is all that was required for the previous 90 years. There are ongoing efforts to increase participation in the new system and restore its former status as the leading source of national crime estimates. In the meantime, data on nonfatal gunshot cases are available from a number of police departments. We discuss additional reforms needed to generate timely, accurate, publicly accessible data from hospitals and police. • Firearm suicides outnumber homicides, but most firearms injuries result from criminal assault and are not fatal. • The United States currently has no system that accurately tracks nonfatal firearms injuries. • Reforms are underway that will provide several reliable systems based on hospital data for surveilling firearms injuries. • Police data are also a promising source of state and national estimates of nonfatal firearms injuries from assault. • Current agency participation in the FBI's Uniform Crime Reports is too low to generate valid national estimates. [ABSTRACT FROM AUTHOR]

Shooting a firearm involves a complex series of cognitive abilities. For example, locating an item or a person of interest requires visual search, and firing the weapon (or withholding a trigger squeeze) involves response execution (or inhibition). The present study used a simulated shooting environment to establish a relationship between a particular cognitive ability and a critical shooting error—response inhibition and firing on civilians, respectively. Individual-difference measures demonstrated, perhaps counterintuitively, that simulated civilian casualties were not related to motor impulsivity (i.e., an itchy trigger finger) but rather to an individual’s cognitive ability to withhold an already initiated response (i.e., an itchy brain). Furthermore, active-response-inhibition training reduced simulated civilian casualties, which revealed a causal relationship. This study therefore illustrates the potential of using cognitive training to possibly improve shooting performance, which might ultimately provide insight for military and law-enforcement personnel. [ABSTRACT FROM AUTHOR]

Objectives. We investigated whether stricter state-level firearm legislation was associated with lower hospital discharge rates for nonfatal firearm injuries. Methods. We estimated discharge rates for hospitalized and emergency department-treated nonfatal firearm injuries in 18 states in 2010 and used negative binomial regression to determine whether strength of state firearm legislation was independently associated with total nonfatal firearm injury discharge rates. Results. We identified 26 744 discharges for nonfatal firearm injuries. The overall age-adjusted discharge rate was 19.0 per 100000 person-years (state range = 3.3-36.6), including 7.9 and 11.1 discharges per 100 000 for hospitalized and emergency department-treated injuries, respectively. In models adjusting for differences in state sociodemographic characteristics and economic conditions, states in the strictest tertile of legislative strength had lower discharge rates for total (incidence rate ratio [IRR] = 0.60; 95% confidence interval [CI] = 0.44, 0.82), assault-related (IRR = 0.58; 95% CI = 0.34, 0.99), self-inflicted (IRR=0.18; 95% CI = 0.14, 0.24), and unintentional (IRR = 0.53; 95% CI = 0.34, 0.84) nonfatal firearm injuries. Conclusions. There is significant variation in state-level hospital discharge rates for nonfatal firearm injuries, and stricter state firearm legislation is associated with lower discharge rates for such injuries. [ABSTRACT FROM AUTHOR]

Background: Risk for violent victimization or crime perpetration after firearm-related hospitalization (FRH) must be determined to inform the need for future interventions. Objective: To compare the risk for subsequent violent injury, death, or crime perpetration among patients with an FRH, those hospitalized for non-injury reasons, and the general population. Design: Retrospective cohort study. Setting: All hospitals in Washington. Patients: Patients with an FRH and a random sample of those with a non–injury-related hospitalization in 2006 to 2007 (index hospitalization). Measurements: Primary outcomes included subsequent FRH, firearm-related death, and the combined outcome of firearm- or violence-related arrest ascertained through 2011. Results: Among patients with an index FRH (n = 613), rates of subsequent FRH, firearm-related death, and firearm- or violence-related arrest were 329 (95% CI, 142 to 649), 100 (CI, 21 to 293), and 4221 (CI, 3352 to 5246) per 100 000 person-years, respectively. Compared with the general population, standardized incidence ratios among patients with an index FRH were 30.1 (CI, 14.9 to 61.0) for a subsequent FRH and 7.3 (CI, 2.4 to 22.9) for firearm-related death. In survival analyses that accounted for competing risks, patients with an index FRH were at greater risk for subsequent FRH (subhazard ratio [sHR], 21.2 [CI, 7.0 to 64.0]), firearm-related death (sHR, 4.3 [CI, 1.3 to 14.1]), and firearm- or violence-related arrest (sHR, 2.7 [CI, 2.0 to 3.5]) than those with a non–injury-related index hospitalization. Limitation: Lack of information on whether patients continued to reside in Washington during follow-up may have introduced outcome misclassification. Conclusion: Hospitalization for a firearm-related injury is associated with a heightened risk for subsequent violent victimization or crime perpetration. Further research at the intersection of clinical care, the criminal justice system, and public health to evaluate the effectiveness of interventions delivered to survivors of firearm-related injury is warranted. [ABSTRACT FROM AUTHOR]