Tuesday, April 23, 2019

PTSD for Writers

We just finished up a series on wounds by firearms and touched on the subject of PTSD. Over the next few posts we are going to look closer at PTSD and how it affects the characters we write. This week we will look at some of the most common symptoms of PTSD. And, in the next round, we will see how PTSD manifests in behavior.

Post Traumatic Stress Disorder (PTSD) is a mental disorder that can develop after experiencing a shocking, dangerous or terrifying event. In such events, the body is sent into "fight or flight" and releases a surge of adrenaline. In our previous posts on adrenaline, we looked at how the hormone aids the body in combatting threats as well as its negative aftereffects.

Sometimes the old gray matter gets stuck in fight or flight mode. The brain stays hyper aware, uber sensitive and demands the body to remain ready for another threat. When that happens, PTSD develops. If your character has been through any sort of trauma, these symptoms could easily be a part of their storyline. And, don't assume that trauma is only related to an incident that happens to the character. It could be that your character develops PTSD after witnessing an event.

Some Symptoms of PTSD 

intrusive thoughts or memories 
loss of concentration
outbursts of anger
increased startle
emotional numbness
loss of interest in previously enjoyed activities

PTSD Symptoms in Children and Teens

All of the above can be symptomatic of PTSD in children with the addition of bedwetting, acting out trauma during play time and separation anxiety. In adolescents there can  be destructive behavior and self bodily harm.

Physical Toll on the Body

As you might imagine, all of these mental and emotional states can take a physical toll on the body. PTSD can cause chronic fatigue, vomiting, sensory overload - meaning the lights, sounds, smells and overall physical sensations of an environment overwhelm a person -, distorted vision and hearing, and physical sensations associated with panic attacks.

What is a panic attack? We will look at that a little more closely next week as well as the difference in a panic attack and anxiety disorder. We will also look at film examples of PTSD. Until then, here's a little clip about the rise of PTSD in story telling. 

And speaking of the cinema, here's a video by Martial Club comparing fight scenes in the movies to reality. Enjoy. Until the next round at FightWrite.net, get blood on your pages.

Tuesday, April 2, 2019

Wounds by Firearms Part 3: Sensations and Trauma Video

In our first post in this three part series on firearms, we looked at some statistics regarding gun violence as well as why a bullet does damage. It's not just because it makes a hole. Promise. In part two we looked at what a "caliber" is and looked at some gross pictures. In this, the final post in the series, I spoke with a Justice of the Peace/Coroner, a paramedic and a gunshot wound victim. They all
noted a few things that could add more realism to your work in progress.

Justice of the Peace/Coroner (In the state of Texas, a Justice of the Peace acts as Coroner for a county without a Medical Examiner.)
This judicial officer said that all gunshot wounds can be fatal. There's no "safe place" to shoot a character.  So, don't assume that if your protagonist is shot in the hand that all should be just fine. She also noted that most of what she sees on TV seems fake. And, if a victim is high on drugs, they can keep fighting, even with multiple wounds, for an unbelievable amount of time.

The JoP also pointed out that gunshot wounds can be very bloody. And, the more traumatic the wound, the stronger the smell. If a bullet hits the head, brain matter can go everywhere. The bullet's trajectory is one way to determine if your character's wound to the head, or anywhere else, was self inflicted.

Just as the JoP said that bullet wounds can be very bloody, a paramedic said that sometimes they aren't very bloody at all. This paramedic attended to a victim recently who had five bullet wounds. A few were bandaged with only Tegaderm, a transparent medical dressing that looks like tape. He said that exit wounds were not always the huge, gaping holes as are sometimes portrayed on screen. In fact, the exit wound could be smaller than the bullet. If a bullet doesn't exit the body and is near the surface of the skin, it can be seen through the skin and felt. And, though very injured and with multiple wounds on the body, gunshot victims aren't always screaming in pain.

Gunshot Victim
This victim echoed what the paramedic said, when shot he didn't cry out pain. In fact, he told me that he didn't know he had been shot. The bullet hit him near the knee but he went to the ground from the impact.

In the ambulance he was given IV painkillers. When the painkillers ebbed his leg felt like dead weight. It was over a week before he went in for surgery to remove the bullet. While it was still lodged in his leg, he described the sensation as "screaming pain." After the bullet was removed, the pain was less intense but still excruciating. For weeks the slightest movement in the limb woke him up at night.

Sensations Noted by Other Gunshot Victims
Many victims say that upon being shot, they felt no pain. More than the breech of the bullet they felt its impact and describe it like being hit by a bat. Some looked at the wound with confusion and shock, not quite believing what they were seeing.

When the sensations of pain set it, they are noted as a deep numbness that gives way to burning. Sharp pain may follow similar to a bee sting or as intense, stabbing pain. If shot in the abdomen, internal bleeding will put pressure on internal organs and cause intense pain. The flow of blood causes a warm sensation as well as one that is cold and wet. Cleaning the wound is noted as sometimes being far more painful than the wound itself.

 What many victims reported most about their injury is something seldom seen on pages or screens: the emotional aftereffects. A friend of mine was shot during a fight. What he endured physically paled in comparison to what he suffered mentally. If your character is shot in an assault, or even in an accident, it is reasonable for them to suffer symptoms of PTSD which far exceeds physical healing time. And, it just so happens, PTSD will be the subject of our next post. Until then, enjoy these videos of  trauma team management of gunshot wounds. The first is a from single bullet that penetrated both legs and the second is gunshot wound to the neck. You will be directed to YouTube to see the first.

Until the next round at FightWrite.net, get blood on your pages. Oh, and, be sure to check out my book with Writer's Digest set to release on June 11.


Wednesday, February 20, 2019

Wounds By Firearms - 2nd Shot: Explanation of Caliber and Wound Pics

In our last post of the Wounds by Firearms series, we looked at some guns statistics in the U.S., watched a video on gun safety and saw a dead pig and live watermelon take a few slugs. This week we are going to look at bit closer at why different bullets do different damage and some examples of damage. WARNING: This post has graphic photos.

BUT FIRST,  let's look at an illustration of what's going on inside the body with different caliber bullets.  As we saw in last week's post, a bullet doesn't simply puncture the body cleanly. The energy causes a gross distortion of the skin and tissue and creates a cavity. If you didn't watch that video from last week, here ya go.

This illustration (1) shows how different bullets penetrate. Sorry it's a bit fuzzy. The number beside the bullet refers to its caliber. A caliber is the internal diameter, or bore, of gun barrel. A bullet's caliber corresponds to the gun it is designed to load. Sometimes that diameter, of both gun and ammo, is measured metrically. Sometimes it is measured by the Imperial System using inches. How do you know which measurement is used? The metric will have mm and the Imperial will start with a decimal. Even though a metric caliber and an Imperial caliber are very similar, they are not the exact same diameter. You shouldn't use metric measured ammo in Imperial measured guns and vice versa. So, a 9mm gun should hold 9mm bullets not .38 bullets even though the caliber of the two are quite similar.  

Don't assume that guns with the same caliber will do the same amount of internal damage. The bore of a gun doesn't tell you how long the case of the bullet will be. A bigger, heavier case does not always equate to greater damage. Bullets work best by transferring kinetic energy to the target and that energy rippling out as a shock wave. (We saw that in our last post.) If a bullet passes directly through the body without delivering a shockwave, you won't create an internal blast effect. But, if that hole created by the bullet is in the right place and causes the target to bleed out, then lack of shock wave isn't an issue. 

For a better understanding of ballistics, read this. It's, like, a whole science and stuff. And a hole science! Get it? Hole science..bullet hole...never mind. Any who, I am not smart enough to explain it. (I don't even understand how microwaves work other than magic.) What you need to know is that to kill a character, you don't have to have a big honking gun! Also, as you can see from the illustration, the design of the bullet can lend itself to tumbling or yawing which equals more damage. If shot in the head with a .22 hand gun, there may not be enough energy created to pass the bullet all the way through the skull. But that little bullet may clang around in there and make a real mess of things.

Ok, now we come to the part of the show that you've all been waiting for: the gross pictures.  These are all very tame pictures. I will not show you a head that's been blown to bits. I'm showing you a few just to give you some ideas. I reached out to two professionals on the subject of bullet wounds. The paramedic said all bullet wounds are different. They are like snowflakes in that respect. Unlike snowflakes, they can be shockingly bloody. That's what the medical examiner said anyway. She also said that brains go everywhere! 

Before the pics, I will provide a space buffer with two videos. The first is one of my favorite people, Hickok45, showing the difference between bullets of the same caliber. The second is some awesome awful martial arts movies.

All these pics are post mortem and cleaned up. For information on bleeding out and how to measure how much blood one is seeing, go to this post.

Soot on hand
Direct contact range - muzzle imprint

Direct contact wound - gases released from firing cause charring and stellate pattern. Soot and abrasion ring present.

Powder tattooing

Intermediate wound - entry wound irregular as bullet may have tumbled in flight, powder tattooing

Entry at left, exit at right. Exit wounds can look very different
from entry wounds as the bullet distorts in the body.

That's all I can attach because my blog is acting crazy. If the outcry is loud enough, y'all know I will get more pictures. I love you like that. But, really, this is enough. You get the point: Wounds by firearms aren't quite what you might imagine them being. 

In the next installment we will ask a medical examiner a few questions and get some firsthand accounts of what it's like to take a bullet. Until the next round at FightWrite.net, get blood on your pages!

(1) Gunshot wounds infographic from Medical College of Wisconsin University, Department of Surgery
(2) photos from library.med.utah.edu/WebPath/TUTORIAL/GUNS/GUNINJ.html#1

Wednesday, January 23, 2019

Wounds by Firearms - Pt 1 Stats and How Guns Do Damage

If the setting of your manuscript is the good ole U. S. of A. and it contains a violent crime with a weapon, statistically, that weapon will be a gun. That's why there's a whole chapter on guns as well as gun injuries in my book. Be on the lookout for it June, 2019 with Writer's Digest. 

According to Criminal Justice Information Services Division 2016 report, of the 15,070 murder weapons used in the United States, 11,004 were firearms. What that means for us as writers is that we need to be familiar both with firearms and what they do. (Choose these links for a review of handguns and rifles/shotguns.) 

In this first installment we are going to look at how to NOT handle a gun, some statistics regarding gun injuries and exactly how guns do damage. Hint: It's not just because the bullet makes a hole.

How to NOT Shoot a Gun (In good conscience, I have to include this.)

Guns by the Numbers
Where are our characters most likely to be shot? 
Well that depends on the circumstances of the shooting: assault versus unintentional. But, in both cases, I think the facts will surprise you. According to the Centers for Disease Control and Prevention/National Electronic Injury Surveillance System (yeesh, that's a mouthful) the area most likely to struck by a bullet is the legs and feet. 


Mode of transport to hospital (1):
Ambulance/EMS - 69%
Air Transport - 2
Private Vehicle - 13 
Walk-in/police - 6
Unknown (We all know it was a dragon) - 7

Medical outcome for firearm injuries in the U.S.(1):
ER visit, treatment and release - 31%
Hospitalization and release -  36%
Death - 33%

Fatal injuries by firearm(1): Men - 86%, Women - 14
Nonfatal injuries by firearm (1): Men - 90, Women - 10

Fatal injuries by age (1):
0-14 years   2.4%
15-24          42.7
25-34          27.4
35-44          12.1
45-54           8.0
55-64           3.9
65+              3.2

Approximate number of fatalities by firearm type (2):
handgun - 64%
not stated - 28
rifles - 4
shotguns - 3
other - 2

How Guns Do Damage

When a bullet enters the body, the energy that put it there dissipates and creates a cavity. That cavity stretches, distorts, and compresses the surrounding tissue. This is known as blast effect and the faster the bullet, the greater the blast effect; as well, the greater the bodily damage. If the bullet tumbles or oscillates within the body, the potential for damage increases even more.

Here's a video on exactly what a bullet does to tissue. Notice that even though the entry wound looks like a tidy hole, the skin expanded and contracted greatly with the initial impact. It's pretty shocking. There's also a bit about bullet proof vests.

Damage Done by Different Guns
One way to see the sort of damage a gun can do is to whack a watermelon. 

What if the bullet isn't fired from a gun. Is it still dangerous? For those of you looking for creative ways to kill with a bullet, this video is for you. (I love Hickok45 on YouTube. Fantastic resource and just a charming fella.)

In our next round on FightWrite.net we will look at the sort of wounds created by firearms. Until then, I leave you with a beautiful disarm by Victor Marx and the perfect disarm by Master Ken. OSS and get blood on your pages!

(1) ncbi.nlm.nih.gov/pmc/articles/PMC4700838/
(2) statista.com/statistics/195325/murder-victims-in-the-us-by-weapon-used/