Initial acuity of firearm injuries in the United States: are civilian injuries similar to combat casualty statistics

Military studies have identified significant trends in combat related preventable death, particularly with respect to limb hemorrhage. Little is known, however regarding preventable death due to firearms in the civilian patient population, or the anatomic distribution of these injuries. An understanding of this information and the applicability of military studies to the civilian patient population is critical to developing strategies for treating these injuries. A retrospective database review of The National Emergency Medical Services Information Systems (NEMESIS) national database based on ICD 10 codes for firearm injuries logged in 2019 in the pre-hospital environment. Twenty three thousand three hundred and thirty-three firearm injuries were logged in NEMESIS in 2019, of which 15,148 were ultimately included as the other cases had incomplete information. Of these injuries there were 1438 (9.49%) to the chest, 913 (6.03%) to the abdomen, 221 (1.46%) to the neck, 468 (3.09%) to the back. These four anatomic locations were the most likely to be classified as Critical-Red by prehospital providers: 62.66% of chest injuries, 54.22% of abdomen injuries, 48.42% of neck injuries, and 42.31% of back injuries. The NEMESIS data on patient acuity indicates that the number of firearm related preventable deaths due to torso injury may be significantly greater than those due to limb exsanguination. In addition to the focus on tourniquet use, research focused on improved prehospital care of firearm injuries to the torso may provide additional strategies for reducing preventable death.