Updated 09 April 2014

What happens when someone is shot

Model Reeva Steenkamp died after suffering three gunshot wounds. Here's more about what happens when a bullet enters the human body.

Graphic images were shown in court today as Prosecutor Nel put it to Oscar Pistorius that Reeva Steenkamp's head "exploded" in the same way that a watermelon did in a video shown to the court. 

This dramatic description comes down to the fact that the bullets which killed Reeva were hollow point rounds designed to inflict maximum damage to a human body. Pistorius was shown to refer to the watermelon as softer than brains. 

Any one of the shots, which hit Steenkamp in the groin, upper arm, and head could have been fatal, said pathologist Gert Saayman.

When a bullet enters the body, the speed at which it travels, the angle at which it hits the body, and the density of the tissue involved all contribute to the damage the shot can cause.

How a bullet wounds

Penetration – flesh is disrupted or destroyed by the bullet.

Cavitation – the bullet leaves a hole in the body, either temporary or permanent, depending on the elasticity of the tissue or organ struck.

Fragmentation - bullets may shatter on impact and send fragments through the body. The same thing may happen if the bullet strikes bone: chips of the bone may be driven through the body’s tissue, causing damage in their paths.

Once a bullet enters the body, it crushes and forces tissue apart. This becomes serious if a major organ or blood vessel is hit. Only the tissue that has come into direct contact with the bullet will be damaged. Hollow point rounds like those used to kill Reeva Steenkamp magnify this effect substantially, hence their increased lethality.

Additional damage is caused by shock waves compressing the tissue in the bullet's path, causing a temporary cavity. Although temporary cavitation lasts for less than a second, muscles, nerves, blood vessels and bone can be damaged.

Gunshot wounds uncovered

Whether a gunshot wound is fatal depends on the type of gun used, the distance from which the bullet was fired and where on the body the victim was hit.

According to an article published in the NYU School of Medicine and Hospitals Journal, bullet wounds can range from small to huge depending on these factors. Also, one cannot assume that a bullet travels in a straight line: for reasons explained below, its trajectory can be unstable, and internal damage can be much worse.

Gunshot wounds are described as either 'penetrating' or 'perforating'. The first is when the bullet enters the body and stays inside; in the second, the bullet passes through the body. A wound can be both - for instance, a bullet can penetrate a part of the body (say, the head) and perforate, say, the skull or brain.

A perforating wound creates an exit wound where the bullet leaves the body. It is easy to tell the difference between an entrance and an exit wound. Where the bullet entered the body, there will be a reddish-brown area of scraped skin, and only a little bleeding.

An exit wound is bigger, and is likely to push out tissue. There is also likely to be much heavier bleeding.

What to do in an emergency?

Seek medical help as soon as possible. Ideally, anyone who has sustained a gunshot wound should receive medical attention within ten minutes. While waiting for assistance, there are first aid procedures you can follow:

- Ensure that you are safe. Move as far away from the shooter as you can.
- If you are not the victim, make sure that the victim keeps completely still.
- Follow basic first aid procedures.
- Control bleeding by placing pressure on the wound.

(Leandra Engelbrecht, 2007: updated by Health24, March 2014)

Read more:
What we know about Reeva's injuries
Blood spatter analysis - how it works
Why boys play with guns


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