Combat medic advice shoot big rifle round
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[Ed: The subject of “stopping power” is a never-ending debate amongst gun guys and gals. JWT, a former combat medic, wrote this back in 2014 and it’s well worth sharing again.]

RF, a few friends, and I were shooting out on my range at a dueling tree. After having to shoot one steel paddle no less than 4 times with my 9mm service pistol to get the paddle to swing, I commented on how much I hated the 9mm, and the 5.56 NATO as well, and how I had never seen a single shot kill from those rounds, even at close ranges, and even from head shots.

Robert asked, “Seen a few people shot, have you?”

I responded, “hundreds”. Then he asked me to share.

I hate sharing, but I’ve been all over the world and I have seen a whole lot of people shot, stabbed, burned, run over, and blown up, and some of you might find this information valuable.

I was an EMT and a trauma tech working on a truck and in a trauma room for about 10 years and I was an army combat medic for eight years. Also — and this is important — when deployed I was almost always part of an “advisor” force. I was technically a “combat advisor” for two tours in Afghanistan, embedded with the Afghan National Army and Afghan National Police force. I’ve done the same thing with host nation National Guard troops in Central America.

I’ve never worked OCONUS on a large US base, and my patients have almost always been local nationals. Few of my patients OCONUS have been American troops, and I am grateful for that. Because of my specific role, and because I was often the closest competent medical provider for an extremely large number of people (sometimes over 20,000), I have treated an inordinate amount of gun shot and blast injuries in places where surgical treatment was often well over an hour away.

My average medevac time for an urgent or urgent surgical patient in southern Afghanistan was four hours. That’s a long time to bleed. During my first tour in Afghanistan, I averaged one patient death per day.

I kept mission logs and patient logs. Looking through all my logs, both CONUS and OCONUS, I have recorded 371 gun shot wounds and significant blast injuries. About 20% of my patients were children under the approximate age of 12. About half of the total were blast wounds, primarily from mines and IEDs of all types. But that half represent a much greater number of deaths, and it doesn’t include the dead that didn’t make it to me.

Let me cut to the chase here, if the goal is to live, you would rather be shot close range in the face by a 9X19 or .45ACP round than step on a mine or be in the first 10 yards or so of any significant blast. Blasts cause multiple injuries, and shrapnel from the blast is often traveling far faster than even the fastest modern rifle caliber bullets.

Wounding comes from overpressure, penetrating trauma (the vast majority of the injuries) and the body actually being thrown against other objects or the ground. So if the choice is to drive over an Italian anti-tank mine (still a little bitter about that one), or take one in the noggin, I say grin and bear it.

I owe Robert an apology. I did actually record one single-shot kill from a 9X18 (Makarov). It was a contact shot into the center chest on a sleeping target. The victim died immediately. I have also recorded a few single-shot kills from a .45ACP, one from as far out as 60 meters, fired from an HK UMP 45, which one of our team members carried and used with Jedi-like skill. The vast majority of engagements with that weapon, however, were within half that distance and patients usually took several hits. What can I say, he got lucky once.

On the civilian side, I saw only one single-shot kill from a pistol ever, and that was from a .357 magnum, within a living room, probably not more than five yards. The round entered the sternum and exited the spine. In fact, within the US, the vast majority of people who I saw shot lived after receiving medical treatment. That includes attempted suicides. I even had a patient live after a self-inflicted shotgun wound to the face. He died of the cancer he was attempting to flee from, months later.

Beyond that, I do have recorded kills with a 9×19, but they all required multiple shots or they all took time to die.  Time enough to return fire or flee far enough to have to search for them. I don’t mean seconds of life, either — I mean minutes or hours. I have seen people shot that had to traverse long distances that still got away. And damn that’s frustrating.

In just about every country I have been in, our host nation counterparts — army and police — used the 9X19 NATO round.  Because so much of what I did was house-to-house police searches, I’ve seen a lot of pistol shootings, much more than US police would ever see, and much more than experienced by most medics deploying solely with US personnel. And yet, I have zero, not one single experience, where a single gunshot wound from a 9×19 NATO round killed someone prior to them being able to return fire or flee. This includes people shot in the chest, back, back of the head (one hit behind the left ear) the neck and the face.  None.

Unfortunately, the same goes for the 5.56 NATO round. I have yet to witness a single shot quick kill with this round. I even recorded a patient shot from less than three feet away, square in the back of the head, who lived. The round did not exit his body. Yes, he was immediately rendered unconscious and required (might I say exceptional) medical treatment. He was comatose for at least six months after that, but he lived.

But more importantly, in every experience, at ranges from zero (negligent discharges) to 35 yards (my closest, and worst-placed, shot on a person) to 400 yards (our average initial engagement distance in Afghanistan) individuals shot with a single 5.56 NATO round had time to fire, maneuver, or both. Did I see single shots that killed eventually? Yes. Does that matter in combat? Not one damn bit if you are the one they are still shooting at.

For those of you who say “just shoot them again,” I would tell you that is actually pretty difficult on a mobile target with cover at 400 meters who is shooting at you. Also, once they get shot they tend to be a little more wary. People are tricky that way. I will never forget the terror of shooting a man, watching the round strike his chest, and then see him lay over a short wall to steady his aim and continue firing at my teammates.

In my experience, the standard NATO combat round pokes 5.56mm holes in both bones and flesh, shattering nothing. It creates minimal bleeding. I know people say it tumbles and yaws, but that isn’t my experience at all. I saw it poke tiny holes in humans and rarely induced hemorrhaging sufficient to cause unconsciousness or uncompensated shock, which is the only result that matters.

On the flip side, having a patient who was shot by a 7.62X51 NATO or larger round was a rarity. Dead people aren’t patients, they are a supply issue. Patients hit with a ZSU aren’t patients either, they are an iron-like odor in the wind.

Take from that what you will. For me, what I learned is, when it comes to combat, shoot the heaviest rifle round I can, shoot at what I can hit, and then shoot it again if I can. I also learned that, in general, multiple organ damage shortens the time a patient is able to compensate for hemorrhagic shock far greater than the effect of a larger wound track in a single organ. And the Ma Deuce is the greatest, most perfect thing ever invented by man.

I have included a photo of a patient shot at close range with the 5.56NATO round (above).  The photo is of the patient’s calf, and is as I received the patient, within minutes after the shooting. Minimal care was necessary, with the primary concern being infection and tendon damage, not blood loss or bone damage. This is typical of the damage I have seen by this round.

As an aside, Chris Kyle (FWFS, brother) was a friend of mine, and while not so patiently listening to one of my Crown-induced rants on the 5.56 NATO, he suggested that it was not caliber I hated, but the bullet. He told me to load up the case as fast as I could, push a 64 grain or heavier soft point round and see what happens. So I had Underground Tactical built me an AR in 5.56 which I swore I would never own, and built rounds ranging from 64 to 75 grains with it.

I’ve taken 11 deer with them, and the wound tracks are nothing like I saw with the NATO round. I’ve never had to look for an animal, and a little Underground 5.5 lb AR in 5.56 is my go-to hill country deer gun now, which is just crazy.

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  1. Great write up, certainly shows the limitations of FMJ NATO 9mm and military spec 5.56 out of 14.5 or shorter barrels. I don’t doubt that those rounds and loadings are quite questionable.

    • Yup, the green tip bullet is way too ‘substantial’ to fragment especially when fired from a short barrel M4. The old 55 gr. bullet fired from the 20″ barrel M-16 produced better wounding.

  2. Great article. I personally am a .308/30-06 fanboy. Anyway. I would ask this of the writer: (or some of the older veterans) being that the last 30 years or so the military has been using the green tip 5.56 out of 14.5 inch barrels. How about the wounds from the Nam era load out? 55 grain out of a 20 inch barrel, I’ve read was great at shattering in tissue. That was a bit before my time in so I haven’t witnessed that personally.

    • Just as in any projectile a lot depends on a lot. Sometimes they tumbled sometimes through and throughs, if they tumbled it fcked shit up pretty good. IMO the 7.62×39 was deadlier. Maybe it’s because they was from the other side, Har Har

      • Damn right .308’s screaming out of my AR-10 or for longer shots .30/06 from the bolt action. I always carry a backup handgun and it doesn’t get any better than that S&W Model 29, .44 Mag in 280 grain wad cutters. Took down a young Grizzly with that. Bigger is best!

  3. in my years of foreign shooting , i was in beruit assembling a crane to work on the barrax building dig. i was shot at 40 yards with a 9mm scorpion auto pistol three rounds across the chest ,second-chance will work very good. in indian country i carry a 45 mac 10. with Hi-vel hi-power ammo. it worked one hell ova lot better than his 9mm. a medic would have done him absolutely no good. give me a good old american 45 any day..

  4. Great write up. The only issue I have is the the causation of a single hit can incapacitate an assailant so that he receives other hits even though the first shot was the effective round. This is compounded with the US Armies tactics of firing more then one shot when in contact, thank God they do by the way. In much the same way a cop will continue to fire his service weapon even after the threat is neutralized. In fact the design of the firearms in question coupled with the diminutive rounds are actually purpose built to allow for quick follow up shots.

    • The author provided hundreds of examples of single-shot recipients that all lived, with a couple unique exceptions. That’s the point of the article.

      • No he didn’t. He had somewhere 371 cases he recorded, only half of which seemed to be gunshot wounds, and did not break those down to suggest that anywhere near all of them were cases of single-gunshot incidents where someone died. He certainly did not provide ‘hundreds of examples.’ He had a handful of anecdotes on both ‘sides.’ I can just as easily say that, anecdotally, everyone I have encountered that was shot singularly in the head by a .45 has died. I wouldn’t draw any conclusions from that, though.

        I’m not saying the general idea of the article is wrong, but let’s not overstate the case. Don’t go letting someone shoot you in the head because it’s ‘just a 9mm’ thinking you’ll be okay.

    • Hey Joe, (and now that song is in my head, which ain’t so bad) oddly enough, my logs list few people shot only with a pistol round multiple times. Perhaps that is because, as I mentioned, it’s a hell of a lot harder than people think to do when someone is still shooting back at you.
      As far as rifle rounds, there’s a lot more multiple entries (which makes sense, since most of the shots were with rifle rounds in the first place) but it was rare to have an instant incapacitation.
      That was my first article ever on TTAG, and unfortunately, most people seemed to have missed the important points. I’ll spell it out in a comment below.

      • Not sure how I missed this article the first time, JWT. However, while you may hate sharing, it is much appreciated in this instance. Your experience, while hard won, is well shared. Thank you.

  5. I agree. The M-855 LAP is crap for killing at any distance and DANGEROUS for home defense.

    Now an M193, especially from a 1:9 barrel actually will come apart and yaw to create sometimes impressive wound cavities. Same with the Speer Gold Dot SP in ALL bullet weights.

    The new, and as yet virtually unattainable for civilians, M855A1 looks VERY impressive both as an LAP, and in terminal performance.

    • M885-A1 causes me priaprism every time I read about it…. it truly brings 5.56 into the 21st century. Now for the love of all that is good and holy – GIVE US SOME SURPLUS ON THE CIVILIAN MARKET!!

  6. My guess this medics experience is from the standard military full metal case rounds, in whatever caliber. I’ve personally seen many one shot kills from modern rounds in both 45acp and 9mm which were jsp and hp rounds. It’s not necessarily the caliber, but what that caliber is shooting.

    • I agree with Marty.

      The effectiveness of our two most popular military infantry calibers is utterly dependent on the specific bullet type/technology.

      Load them with full metal jacketed “ball” bullets and they poke tiny holes in human attackers which almost always take several minutes or hours to incapacitate the attacker. Load your cartridges with quality hollowpoint bullets (or even softpoint bullets in 5.56 x 45mm NATO) and you have a MUCH greater probability of incapacitating your attacker in seconds rather than minutes/hours. (Assuming that you have medium to long barrel lengths, e.g. 4+ inches in 9mm Luger handguns and 16+ inches in 5.56 x 45mm NATO carbines/rifles.)

      Even then, expect to have to double-tap your attacker to promptly incapacitate them.

    • slightly built males and females have an easier time mastering the 5.56….a factor in its adoption…but it’s still questionable in many situations…your author is right…bigger is better…

  7. I suppose that the NATO 5.56 rounds are INTENDED to wound. It takes more logistics to care for a wounded combatant, than a dead one.

    Thanks for sharing!

    • No they aren’t. We went to 5.56 cause it resulted in more fights being one. 5.56 got a bad rap from a singe cartridge. M855. The authors experience is duo to using a bad round. Ask anyone who has used plenty of the other military 5.56 rounds such as M885A1, MK318, MK262, MK255, or the 70gr hollowpoints that JSOC if 5.56 has issues.

  8. The first part of this article, reiterating that blast injuries are far more damaging, externally & internally, than almost any gunshot wound (barring at contact range to the ‘ol nugget), digs up something that still burns me to this day.

    The fact is that for every horrific blast injury, there are many more that show no signs of external bleeding. Many of us have had our bells rung by proximity to detonations caused by hostile mines/IEDs/rockets/etc, and a bad concussion from one of those is just as debilitating as one from falling from an M35; yet why are(were?) Purple Hearts denied for guys (and women) who definitely had such injuries resulting from enemy action?

    We now also know that concussions are cumulative, so even consecutive small ones, which often aren’t even noticable amongst the daily aches & pains of a high op-tempo, can (and do) end up scarring grey matter as bad (or worse) than having a headful of loose teeth after a big badaboom.

    But back on topic; one thing I did notice with smaller calibers, was that hits by almost-spent rounds without any exit wounds, can be extremely hard to find. They sometimes don’t bleed, and if they do, the blood can easily be missed due to clothing/gear, and or blood & dirt from other sources. So outside of a sucking chest wound or fractured bones, the injured (and first-responder) may not even know they’ve been shot until internal bleeding causes shock.

    The good medics I knew told me not to just look, but cop some serious feels to be sure. A small-caliber puncture will still be slightly raised, often firm, and hot to the touch… and sudden cursing in pain is a good sign too.

  9. Yawn…..everyone knows fmj bullets suck. I guarantee you if I shot anyone in the face from bad breath distances with a 9mm hst it will be a one shot instantaneous stop/kill. Or with a soft point or bonded hunting round in 5.56 at conventional combat distances. Funny how the article neglected to mention any .308 instant one shot kills. It’s the same thing..

    • Are you absolutely sure. I personally , I shit you not,shot a human in the side of the head with a 115 gr. Corbon +p. It was terrible, it blew out his eye and a big chunk of skull but he was still walking in circles and firing his gun, he couldn’t lift his arm but he was pulling the trigger. It was terrible. And just like everything else I’ve shot with a nine it took another shot. I do not want to ever have to do that again. it was terrible.

        • So we can assume this took place in a combat zone where he was actively fighting, and you’re still willing to call a headshot “bad shot placement”? In case you ever get accused of not knowing what the fuck you’re talking about and somehow wonder why, it’s because you say shit like this.

  10. I was never shot or blown up in Vietnam, but a USMC colleague and I were on a daytime OP one day and an enemy sniper shot my buddy with a 7.62 round (not sure if it was 7.62x39mm or the older 7.62x54mm), but the round penetrated his left arm at the crook of the elbow and made only a black hole rimmed by blue flesh – no bleeding. I was told that the 7.62mm NATO round (M-14, M-60) would drill a neat little hole through anything/anybody it hit. I did see the result of the the 5.56mm round as fired from the M-16A1, and it could be spectacular. My buds and I figured this was due to the 55-grain bullet’s core weight being located mostly at the rear of the bullet, thus causing tumbling in anything it hit. I saw one enemy who was shot between the eyes and the entire rear of his skull was gone. I saw guys get shot in the forearm and the bullet travelled up the arm, around the rib cage and out the hip. What the effect of today’s ball 5.56mm rounds is I couldn’t say, but the rounds used in Vietnam were effective when they hit, although the light bullet could be deflected by a twig or heavy grass (which was why I preferred the 7.62 NATO round – it went through everything). All that being said, I do not doubt the validity of a combat medic’s observations, although I would be interested in his observations with regard to modern self-defense ammunition.

      • I wonder if the physical size of the individual enemies was considered when choosing the 5.56 ? Also, since the twist of the barrels was changed during the war I would like to now if it was a ‘early Vietnam’ or ‘late Vietnam’ rifle used.

    • “I would be interested in his observations with regard to modern self-defense ammunition.”
      That’s in the last paragraphs. The soft point rounds I’m using on deer do far more damage than any of the issued rounds I saw ever did.

  11. Will be interesting to see what people will be saying about m855a1, mk318 mod1 is a bonded bullet, im sure it works fine too, ive heard good things about mk262. Andrew at the chopping block did a way reduced velocity gel test with m855a1 and it still destroyed the gel block, super nasty

    • “Wonder how Tom in Oregon is doing?”

      As of last evening, he has reported he has fully regained the use of his arm.

      His wife is the most pleased, as his chores have been stacking up at home, while he has been on ‘vacation’… 🙂

  12. This is actually highly interesting. I appreciate all the fine commentary from servicemen. I wonder, though, why articles like these on this and other websites seem to constantly rediscover what hunters have known for a long time. Almost all our bullet “technology” that we possess now was developed through trial and error by hunting bullet manufacturers. These rounds were put through countless varieties of live flesh, and what that experience has OVERWHELMINGLY shown, is that FMJ and even many “soft point” rounds have marginal success rates. Bigger, with more energy, (almost) always equals better, less scouting, less distance cleared by the kill, all sorts of things, and can be demonstrated to you very effectively on any successful hunting trip. All kinds of deer, all over America, have withstood handgun rounds even in hollow point varieties. If you’ve ever shot a wild animal with even a bonded, hollow point handgun round (not counting the big bores), you know that there is often a lot that animal can still do. There is a reason fish and game departments specify minimum caliber and energy requirements. Yet the self-defense crowd continues to debate this with “there is no such thing as stopping power” comments (even though these kinds of statement go through trends, in and out). There are MANY rifle calibers that WILL and have STOPPED game right in its tracks. Yet we constantly hear “the 9mm is all that is needed given modern technology” – even though technology available to the 9mm is available to every other caliber. It seems like the self-defense crowd goes through trends and tends to rediscover things it once knew well every once in a while.

    • I routinely shoot deer through the heart with a .30-06 or .308 that run over 100 yards. I recently shot a fairly pig in the heart with a 150gr soft point at just under 100 yards. The heart was so destroyed it was difficult to find. And yet, the pig probably ran 50 yards.

  13. I had a patient in a level 1 trauma center that was shot in the lower end of his femur, shattering the bone. I called the injury an open fracture. My co-workers disagreed. The surgeon when asked said that pistol rounds are low velocity and do not leave permanent sound channels. Therefore a pistol round sound is too weak to create an open fracture. A similar rifle sound would have been considered more serious. Even surgeons do not respect pistol rounds.

  14. If I recall correctly some bunch of idiots in Geneva mandated some countries use FMJ ammo because ball ammo was “humane”.

    • The actual agreement in the 1899 Hague convention. There is an interesting history behind it. Remember that this was near the dawning of the age of smokeless ammunition, and the relatively large increases in velocity resulting from the use of these powders. When using an unjacketed soft lead projectile, the impact caused a massive mushrooming of the round, and thus a huge exit wound. What is most strange about the agreement is that the increased velocities made unjacketed rounds obsolete–the high velocities cause the eternal layer of the projectile to strip off, not only making it so that there was no contact with the rifling and little if any spin stabilization of the round, but the barrels would lead up very quickly. Jacketed rounds were the only solution for high velocity projectiles. The irony is that a .30 caliber projectile still does a large amount of damage, and a .50 cal machine gun round even more.

      • Okay, so how come the fmj and not a soft point. I think it’s because with a soft point blood and guts would be splattered all over the country side and some might get on the Colonels BDU’s. God forbid

  15. So you are saying we need to stop being PC with our military and load rounds that are meant to stop and kill? I’d suspect the 9mm and 5.56 would work much better with some good projectiles that were meant to do damage to tissue. Pretty sad when the police have better pistol rounds than the military. Not sure what that says about the average citizen compared to our enemies.

    • Not only that but hollowpoints would be advantageous to the US military in many of its current engagements. The enemies it faces rarely wears body armor or cares about the Geneva convention.

  16. Hey J. W. Taylor, Thank You for your service. I appreciate you protecting my sorry ass from the godless hordes. I was just a LEO until cancer put an end to that fun. I was privileged to serve on our Honor Guard, and had the sad honor to play Taps for some real heroes. I wish I had better words to express my gratitude to you and your brothers-in-arms.
    PS it was a good article, too!

  17. I’m not going to argue with JWT about anything he’s said here. I will however point out a few things.

    First, shot placement counts a lot. It’s often hard to place shots though because people, generally, try to avoid being shot. Their movement/shooting back makes target/hunting style shots extremely difficult (unless perhaps you ambush someone).

    Second, the rounds used by many police and military units are not the same as those we might use for self defense here in the US.

    Third, in civilian terms the effectiveness at killing, or “lethality” if you prefer, of a round is not much of an issue in terms of self-defense. If the bad guy is stopped, that is incapacitated, convinced to surrender/retreat, or whatever by the dose of copper jacketed lead he/she receives then the round was sufficient to stop them which is what matters. Whether or not that BG dies now, later or dies many years from now due to something unrelated to the shooting is immaterial to civilian self-defense shooters. In fact, whether or not the BG is even shot at, never mind hit, is at best a secondary consideration to whether or not their threatening behavior stops.

    As such, a round that takes the BG out of the fight but doesn’t kill them is just as effective as one that does kill them. Once the threat has been stopped there is no reason to keep shooting and, generally speaking, it’s illegal to keep shooting at that point. Further, in many cases, the laws governing a civilian shooting are not as “loose” as the ROE in another country where assumptions about continued threats can be made and not have to be justified to a suspicious LEA or DA. (In other words you don’t have to justify every round fired in a war zone the way you might have to back here in the good ol’ US.)

    Again, I’m not arguing about the rounds in question. I’m simply pointing out some stuff the article didn’t cover.

    • Strych9 , I suppose unless you make a habit out of shooting humans , most people mag dump, that’s why I do not fault cops for that. Another comparison, one your probably familiar with would be, your in a fight with someone whom is as fast or faster then you, can kill you with one good placed punch or kick, he can do this even though he has been knocked down and may die. Now how many times and how fast are you going to punch / kick that guy. ? I know my answer is down and out and then some.

      • possum:

        “…down and out and then some”

        In terms of physical blows you will probably get away with that legally as long as, after they’re down and out, you don’t beat the person so badly they are permanently injured or beat them to death in a manner that it’s obvious you kept kicking the shit out of them after they couldn’t fight back any more. You can probably convince people (a jury if need be) fairly easily that in a fisticuffs match for your life you didn’t even realize the other person was unconscious and that you had no desire to seriously harm them but that the point where they became non-threatening was blurry.

        Shooting someone who is “down and out” to get to “and then some” is quite a bit different. Understandable in many situations but also illegal and much, much harder to legally defend than a few extra punches, kicks or an extra second with a choke or strangle.

        Shooting someone who is no longer a threat like this is basically the equivalent of using martial arts to knock someone out or beat them up so badly they can’t fight back and then pulling a knife and stabbing them. While I totally get the idea of being as safe as possible in terms of making sure they really are no longer a threat the law really doesn’t allow us to use battlefield tactics against a mugger and do something like putting an “anchor shot” into them when to the average observer they’re out of the fight.

        Remember that “reasonable man” test they use in court? When it comes to violence your average juror is going to be your average Joe/Jane. They probably have never been in a serious fight and never even considered a gun fight or shooting someone who comes at them with a knife etc. They don’t think about things like you do and they probably will often be far from “reasonable” in judging your actions after the fact.

        • once you start swingin’… you’re so pissed off by that time that those couple freebies after the eyes roll back are regret eliminators.
          but your hands will still hurt two years later.

    • All good points, but this is one of the two points I wanted people to come away with:

      “If the bad guy is stopped..”

      In my experience, the bad guy is rarely stopped outright. The fight will continue. Be prepared to continue to fight.

      • I definitely appreciate that sentiment. It’s funny people do what they are trained. I remember retraining a bunch of Infantry guys to shoot more then the double tap, even dead people can be dangerous.

  18. Blah blah blah.

    Yup – FMJ bullets poke clean little holes.

    Big flat soft lead bullets make big fat bleeding craters complete with shock and awe…

    Aw shucks.

  19. As a trauma surgeon, I have seen quite a few people survive everything from .22 through .38, 9mm, .45, full automatic fire and even mortar shells. I have seen some amazing wounds, such as several entering under one orbit, passing through the sinuses and nasal cavity and exiting exactly between the zygomatic arch and mandible without hitting anything of value. Most of my patients weren’t so lucky, but the overwhelming majority have survived. One day I ran into the medical examiner over lunch at the hospital and I commented on this. He said, “of course, you never see the ones who did not make it to the ER.” Any bullet in any caliber could be survivable, but do you see (and count) the ones who did not make it to triage?

    • The difference between you and me is that I was often the one doing the shooting, or right next to the people doing it. Also, there often were no other medical services, and I lived in the communities I served. If there was a firefight, I knew about it, either directly or immediately indirectly.

      • I recognize that. Even though I’m not shooting at work, I can’t say we weren’t sometimes being shot at. And I recognize that we are in what you would call a tertiary care setting, but at at least one hospital, some of our gunshots have been inflicted in house. At least one patient I recall had not even started bleeding when I got to him.

  20. Bullshit. Every head shot i’ve seen with 5. 56 was devastating and instantly fatal. Also seen several one shot kills with 9mm. And .22 for that matter.

  21. Yeah, 9mm might not be the best but for the average civilian, you get two hollow point 9mms into someone’s chest and they are most likely going down, especially since the average self defense shooting happens at around 3 feet distance. Easy to shoot, high capacity, and they get the job done.

    Now for trained soldiers, yes, I think there can be a debate for them carrying bigger bullets but I am not a soldier so I won’t be getting into that debate.

    • “especially since the average self defense shooting happens at around 3 feet distance”

      Total myth. There’s no actual data to back that up.

      But I still buy your basic premise. Note that your premise includes 2 center mass shots, which is a lot harder to do when someone is shooting back at you.

  22. This is certainly a treatise on the limits of convention-approved ammunition and the current NATO rounds available.

    Take note and don’t make the same mistake.

  23. Sobe,
    Your M E is right. It is called “survivor bias” it’s like looking at the holes in damaged spitfire fighters that made it back to base and add armor to those places. That has no effect on future missions until they examined wrecks that never got back to base. They had holes in different places where the armor was needed.
    In self defense shootings where the shooter survives, we look for lessons. It might be better to examine shootings where the good guy dies to look for lessons.

    • Survivor bias is more appropriate for the ER doc, not for the guys doing the actual shooting. I counted the dying and the dead.

  24. An interesting article but a couple of points:-

    1- As a medic, do you only see the ‘live’ cases? I assume that you don’t see the dead so it would be hard to get an accurate fatal/non-fatal ratio
    2- Have you actually seen ‘hundreds’ of people being shot (as it happens), or hundreds who have already been shot and are laying on your doctor table? The former would allow for a valid opinion on the ‘surviveability’ of varying weapon types

    Thank you!

    • 1. No, I see the living, some of whom I’m shooting at, the dying who got shot, and the dead we shot, and a whole lot more. We also tried to put every person we could into the biometric database, so a big part of my job was putting the dead into the system.
      2. Both. I’ve seen hundreds of people during or immediately after high energy penetrating trauma. I don’t have a doctor’s table. I’m a medic. I worked on trauma mostly in the field.

      • Thanks for your service Sir and good reading.
        I always walk away a little smarter after reading articles or listening to people like you.

  25. That was the first every article I wrote for TTAG, years ago. It was upon request, so I just posted the data, with few conclusions.

    Here’s the conclusions I want people to get out of the article. Most are obvious to experienced shooters, but I have certainly learned there are a lot of on new shooters reading this site.

    1. Pistol rounds really suck compared to rifle rounds.
    2. The standard NATO rifle rounds we carried really sucked compared to soft points.

    And here’s the big ones that I hoped everyone would get.

    1. If you are shot, you aren’t out of the fight. Keep fighting.
    2. If you shoot someone, they aren’t out of the fight. They can still kill you. Keep fighting.

    That’s not gym wall slogan shit. That’s from my own experience and real data. You aren’t out of the fight just because you are shot. Neither is your opponent.

  26. I like JW Taylor’s articles, even the reruns.

    There is a difference, though, between cops, soldiers and joe CCW permit holder, that I didn’t see mentioned in the comments:

    Cops are trying to apprehend people suspected of a crime, or to use force to stop a crime in progress. Soldiers are trying to capture or kill people.

    Joe CCW permit holder is not trying to kill or capture people, and generally not trying to apprehend people. Joe CCW permit holder is generally trying to stop someone from victimizing him (or her).

    if left with an avenue of escape, most common bad guys (not all, but most) will flee when facing armed resistance. Many mass shooters either committed suicide or gave up when faced with armed resistance. Most bad guys are not dedicated to achieving a military objective, as opposed to the ordinary criminal. What most bad guys want is an easy victim, and the threshold for them retreating is therefore lower. There are lots of examples of bad guys GTFO of dodge when a good guy shoots at them with a pocket pistol, or even just pulls a pocket pistol.

    In the 1986 Miami shootout in which wounded bad guys killed or wounded a bunch of FBI agents, note that the Platt and Matix were trying to flee, and engaged in the infamous gun fight after their car was forced into a tree and they were surrounded.

    The point is that having a relatively weak gun (.380 or 38 special or whatever) might make sense for Joe CCW permit holder or Joe homeowner even though it clearly doesn’t make sense as duty weapons for cops or Soldiers.

  27. I remember reading once in a police tactical textbook that one guy was shot *33 times* with 9mm by responding officers and he managed to run 100 yards before collapsing.

    As they say, a pistol is only useful for being able to fight until you can get to heavier weapons. Carry a pistol on your person – and a .308 AR-10 in your car. Or an M-79 grenade launcher. 🙂

    I don’t think a “mag dump” is ever justified, however. You run out of ammo and the threat might still be a threat while you’re reloading – especially if you missed with most of that mag dump because you were rattled. Better to make several controlled shots to the head rather than mag dump. Most people – JW Taylor can correct me if I’m wrong – won’t be functional after several rounds to the head, especially if you hit them in the upper right quadrant where the motor controls are.

    You shoot until the threat goes down – which immediately makes it harder for him to continue fighting, at least effectively – then you monitor for movement, then scan for additional threats, and if there are none, continue monitoring for movement. If the threat doesn’t move, you disarm him or move to cover and continue monitoring – or finish him with rounds to the head if that doesn’t represent a legal issue.

    By the way, that implies that the immediate “scan for additional threats” which some courses teach almost robotically could be counterproductive in that your attention has been turned from the immediate threat who could remain an immediate threat. Don’t over train something that might be tactically wrong under different circumstances.

  28. So what this whole article should say is, ball ammo is not that great use hollow points for any caliber and shot placement is king. That is all.

    I am Waxman and I approve this message.

  29. I guess I could get one of those big ass .45-70 revolvers, and load ‘er up with hollow points, but how am I gonna carry that thing around under a t-shirt?

  30. The head is surprisingly hard to hit. It moves A LOT and with a quickness.

    In a perfect world, you would ‘anchor’ the head with a controlled pair to the chest. Then, once the head isn’t moving as much, because the body is now trying to figure out what the hell just happened, you shoot for the soft spots of the skull.

    Now, NOTHING in a gunfight is perfect, ever. The skull is pretty damn hard and designed to DEFLECT impacts like that, as opposed to blunt them. Finally, you go to war with what you have, not what you want. DOD mandates hardball ammo. Part of the training JWT and his folks do revolves around the fact that the bullets suck, and their training is quite different.

    Finally, there’s the target. The phrase ‘the enemy has a say’ is much more important here. In general (and very generally), US cops are not dealing with a determined foe, despite numerous examples to the contrary. US troops are generally dealing with a very determined adversary, and that fanaticism makes a difference.

    A man I knew via the internet had a great phrase, ‘Shoot it until it changes shape or catches fire’. That’s a good philosophy to have, and sometimes, you only have the tools in your hands to do that with. JWT had the best training that could be given, with the best tools his group could get, with the best ammo they were allowed. Like he said, just cuz you’re shot, doesn’t mean your dead, and just because you’re shot fatally, it doesn’t mean you’re dead RIGHT NOW.

  31. I remember reading about a police shoot out that happened well over 30 years ago somewhere in Hunterdon county NJ. The bad guy was a BIG fella, somewhere between 300 and 400 pounds and shooting at the police. There were several officers shooting back and they scored multiple hits center mass on the bad guy. He finally surrendered when his gun ran empty and they arrested him took him to the hospital where the docs discovered that none of the center mass hits caused serious damage on the bad guy, because the bullets didn’t penetrate past the massive layer of fat this guy carried in his gut. I wish I remembered the details better, but I believe it was back when cops were still carrying .38 revolvers. I think the bad guy got hit something like 8 or 10 times, maybe more. The bad guy didn’t stop fighting when hit until his gun emptied. The good guys didn’t stop fighting until the bad guy quit and put his hands up.

    I also remember reading a Massad Ayoob story about a worker in a restaurant that was being robbed. He took a bullet in his belt buckle that barely broke his skin. but he died. It was determined later from witness statements that he was mentally programmed that being shot meant that you died. He gave up and surrendered his life because of a survivable wound and a really bad mindset.

    There really is no way to predict accurately what is going to happen in a gun fight.

    • It goes the other way too. We had an officer shot with the bullet penetrating his spine. He was in the hospital, alert and talking. Our chief went to the hospital and talking with him, he told the chief not to worry, he would be back to work soon. Later that day he was told he was paralyzed and would never walk again. That night he told the hospital staff he wanted no more visitors. Later that night he died. The doctors explained he did not die of the bullet wound. He simply willed himself to die. The mind is certainly an all powerful thing.


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