Air Weapon Injuries: a Serious and Persistent Problem

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Injury CRIME STATISTICS ...... In contrast to Scotland, the number of recorded air weapon offences in England and Wales has increased steadily since Air weapon injuries: a serious and 1989 (fig 1).21 22 For the year beginning 1 April 1999, there were 16 946 firearms persistent problem offences in England and Wales, 10 103 (60%) of which involved air weapons.22 H Ceylan, A McGowan, M D Stringer Even allowing for a change in the count- ...... ing rules for recorded crime in 1998, which expanded the coverage of less Air guns and rifles are potentially lethal weapons serious violence and minor criminal damage, the number of air weapon offences notified in 1999/2000 was 17% t first sight, air guns and air rifles more frequently in children than in the higher than in 1998/99. When air weap- may appear relatively harmless United Kingdom. Several case reports ons were involved in an offence, they but they are in fact potentially from the UK have highlighted the were nearly always fired (95% of of- A 10–14 lethal weapons. They use the expanding dangers but have tended to focus on fences). In most cases, this resulted in 10 15–17 force of compressed air (or gas) to propel specific injuries to the eye or brain. property damage but in 20% of offences a projectile down a barrel and have been Air weapon injuries commonly involve they caused injury. Because air weapons 18 19 in general use since the time of the teenage boys. Our local urban experi- are frequently used and are usually fired, Napoleonic wars. The projectiles are usu- ence in Leeds confirms this observation. they generated the largest number of all ally lead pellets or ball bearings. Techno- A retrospective review of accident and firearm injuries (1977) in 1999/00 (fig logical refinements have increased the emergency records at St James’s Univer- 1); these injuries were deemed to be muzzle velocity and hence the penetrat- sity Hospital between January 1996 and serious (requiring admission to hospital ing power of these weapons. In a review June 2001 identified 73 injuries caused or resulting in shock, fracture, or multi- of experimental studies, DiMaio con- by air weapons (unpublished data). ple wounds) in 171 (8.6%) cases al- cluded that the critical velocity for Thirty six (49%) patients were aged 18 though there were no recorded fatalities. penetration of human skin by an air gun years or less (median 15 years, range Children are likely to be frequently pellet was between 38 and 70 m/sec 4–18 years) and 29 (81%) were male. In involved in these offences as they ac- 1 (125–230 ft/sec). Most modern air 16 children the pellet penetrated the count for the majority of injured victims weapons exceed this velocity and many skin and in four this resulted in intra- in both the UK and USA.451723 air rifles can deliver a projectile with abdominal or deep cervical trauma. In In the USA, where air weapons have similar muzzle velocity to a conventional our series and others, approximately one often been regarded as toys,24 Christoffel 23 hand gun. Air weapons in the UK typi- third of injuries involved the head or and colleagues5 identified 52 000 injuries cally discharge a 0.177 inch or 0.22 inch neck. Most are reported to occur in pub- caused by air weapons in a two year calibre pellet of the diabolo waisted type, lic places or at home. They are predomi- period in the early 1980s, and McNeill although several other pellet designs nantly a result of accidental shooting by and Annest23 documented almost 33 000 4 exist. a friend, relative, or the victim himself, cases during a one year period a decade http://adc.bmj.com/ Injuries from air weapons can be seri- usually in the absence of adult later. In both studies, boys aged 10–14 3 5–9 61617 ous and even fatal. This has long supervision. Intentional shooting is years old were the main victims and per- 720 been recognised in the United States uncommon, but did account for at petrators of these, mostly accidental, where all types of firearm injuries occur least six of our cases. shootings.

SERIOUS AND FATAL INJURIES 12 000 Air weapons are an important cause of Air weapon offences serious eye injuries in adolescent boys. on October 2, 2021 by guest. Protected copyright. This was first highlighted in the UK in Air weapon injuries 10 000 197315 and continues to be a significant problem.17 Sharif and colleagues16 ana- lysed 41 consecutive ocular injuries from 8000 air weapons during a 10 year period in Glasgow, more than 80% of which were in teenage boys. Four eyes needed 6000 enucleation and almost 40% of involved eyes had a final visual acuity of less than 6/60. Fatalities have also been described, particularly after pellets have penetrated

No. of injuries/offences 4000 the head, neck, or chest. Shaw and Galbraith10 reported two deaths from penetrating cranial injuries: a 3 year old 2000 boy who sustained a subdural hae- matoma and a 15 year old boy who died 19 months later from rupture of an 0 abscess surrounding a pellet. Although 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 the Home Ofﬁce criminal statistics show –98 –99 –2000 no fatalities in recent years, accidental Year deaths in children from air weapon inju- Figure 1 Notifiable offences recorded by the police in which air weapons were involved ries have occurred in England and and were reported to cause injury (Crime Statistics, England and Wales, 1999).22 Wales.425

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MANAGEMENT OF INJURIES In conclusion, air weapons are capable 10 Shaw MDM, Galbraith S. Penetrating airgun Air weapon injuries in children should of inﬂicting serious and potentially fatal injuries of the head. BrJSurg 1977;64:221–4. Arch Dis Child: first published as 10.1136/adc.86.4.234 on 1 April 2002. Downloaded from be managed in the same way as any low injury in children. Little progress has 11 Batch AJG. The air rifle: a dangerous velocity gun shot injury. Subcutaneous been made since 1981 when Batch stated weapon. BMJ 1981;282:1834. “The belief that airguns are harmless 12 Burkitt DS, Dhasmana JP, Mortensen NJ, pellets are best removed. Urgent special- Wisheart JD. “Bullet embolism” to the ist referral is indicated for cranial, ocular, and have little penetrating power is popliteal artery following air rifle injury of the chest, abdominal, or vascular injuries as widespread among children and their thoracic aorta. BrJSurg1984;71:61. they may require emergency surgery. parents”.11 The rarity of air weapon inju- 13 Colquhoun IW, Jamieson MP, Pollock JC. 6 Venous bullet embolism: a complication of Cardiac injuries may be rapidly fatal. ries originating from gun clubs and airgun pellet injuries. Scot Med J Penetrating abdominal injuries involving sporting associations indicates that safe 1991;36:16–17. hollow viscera or major blood vessels and responsible practices have been 14 Okoye BO, Losty PD, Lloyd DA, Lamont GL. Air gun injuries in children: a continuing need prompt exploration and repair. developed by these agencies, but careless cause for concern. J R Coll Surg Edinb Intracranial air weapon pellets should be or criminal use of air weapons by teenage 1997;42:353–4. removed if possible.10 A pellet in lung boys outside these organisations is a 15 Bowen DI, Magauran DM. Ocular injuries caused by airgun pellets: an analysis of 105 parenchyma or muscle may be safely left concern. Several measures to reduce air cases. BMJ 1973;i:333–7. in situ but there is a risk of infection.720A weapon injuries have been suggested. 16 Sharif KW, McGhee CN, Tomlinson RC. pellet that has penetrated a joint or is These include stricter legislation on the Ocular trauma caused by airgun pellets: a ten 31731 year survey. Eye 1990;4:855–60. associated with a fracture requires ownership and use of air weapons, 17 Shuttleworth GN, Galloway PH. Ocular skilled orthopaedic management. A pel- promoting awareness of their hazards by air-gun injury: 19 cases. J R Soc Med let lodged near a major blood vessel or wider education of the public, parents, 2001;94:396–9. 18 519 18 Hutchinson GH. Airgun pellet injuries in nerve should ideally be removed. The and retailers, reducing the penetrating children. Practitioner 1981;225:1058–60. possibility of intravascular embolism power of the pellet, and restricting use to 19 Robson WJ, Kumar K. Air weapon injuries in must be considered if the pellet is absent supervised target ranges. It is time for a children: a case for education. Arch Emerg Med 1985;2:17–24. from a suspected entry site and there is co-ordinated approach from the public, 20 Reid IS. Airgun injuries in children. Med J no exit wound; numerous examples of police, sporting associations, manufac- Aust 1974;i:64–6. arterial and venous embolism of an air turers and retailers, and politicians. 21 Scottish Executive. Recorded crimes and offences involving firearms, Scotland, 1999. weapon pellet in children have been 86 Scottish Executive Report. Crown Copyright. 6121326 Arch Dis Child 2002; :234–235 described. Available at http://www.scotland.gov.uk/ The risk of lead intoxication from a ...... stats/stat-search.asp. Last accessed July 2001. 22 Criminal Statistics England and Wales. retained air gun pellet is extremely Authors’ affiliations Statistics relating to crime and criminal small. Lead poisoning has been reported H Ceylan, M D Stringer, Departments of proceedings for the year 1999. Chapter 3: ina4yearoldboywhoingested a pellet Paediatric Surgery, Leeds Teaching Hospitals Recorded crime in which firearms were that lodged in his appendix,27 but we NHS Trust, Leeds, UK reported to have been used or A McGowan, Accident and Emergency misappropriated. Available at have been unable to ﬁnd any other case Department, St James’s University Hospital, http://www.official-documents.co.uk/ of lead poisoning in a child with a Leeds LS9 7TF, UK document/cm50/5001/5001-03.htm#c. Last retained air weapon pellet. Of 11 cases of accessed July 2001. Correspondence to: Mr M D Stringer, Level 8, 23 McNeill AM, Annest JL. The ongoing hazard retained orbital pellets described by of BB and pellet gun-related injuries in the 28 Gledhow Wing, St James’s University Hospital, Jacobs and Morgan, none was subse- Leeds LS9 7TF, UK; [email protected] United States. 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