A wave of mass shootings has shaken the country in recent weeks. One in particular — the elementary school shooting in Uvalde, Texas, which left 19 children and two teachers dead — became one of the deadliest school shootings in U.S. history and has sparked an increase in calls for stricter gun control measures across the country.
As was the case in many other high-profile mass shootings in recent U.S. history, such as the 2012 Sandy Hook Elementary School shooting in Newtown, Conn., the 2017 Las Vegas shooting, the 2017 Sutherland Springs, Texas, church shooting and the 2018 school shooting in Parkland, Fla., the Uvalde gunman used an AR-15-style rifle to carry out the crime.
An AR-15 or similar rifles are semiautomatic, military-style weapons that can fire at least 30 rounds, the number of bullets a magazine typically carries, according to NPR. The term semiautomatic means that the shooter must pull the trigger to fire each shot, as opposed to an automatic weapon, which continues to fire for as long as the shooter holds down the trigger. Fully automatic weapons were heavily restricted for civilians in the United States in 1986, when Congress passed the Firearm Owners’ Protection Act.
But AR-15-style rifles, which are easily accessible in many parts of the country, can be just as destructive. “This is a gun whose purpose it is to shoot a lot of high-caliber bullets very, very quickly and do a lot of damage," Joyce Vance, former U.S. Attorney for the Northern District of Alabama, said on MSNBC earlier this month.
Dr. Bindi Naik-Mathuria, a pediatric trauma surgeon at Baylor College of Medicine, told Yahoo News that injuries from this type of weapon are “almost unsurvivable, essentially,” because of the significant damage the bullets cause to the victims.
How wounds from an AR-15-style rifle compare to wounds from handguns
Naik-Mathuria, who is also a fellow at the Baker Institute for Public Policy at Rice University, told Yahoo News that some of her colleagues treated patients of the Uvalde school shooting, but that few of the victims survived. “They received very few patients, because unfortunately, this is what happens with assault weapons,” she said.
She explained that “the blast effect, or the cavitation effect” that a handgun shot causes is not as wide and devastating to internal organs as the one inflicted by high-velocity weapons such as the AR-15 and similar rifles. “When you see handguns, you often just see a little hole on the outside on both sides; shotguns, which are a little bit higher velocity, a little bit bigger. But assault weapons, it's much bigger,” she said, adding that as a bullet from this type of weapon penetrates the body, it typically creates a large cavity that can cause significant bleeding from vessels and completely destroy soft tissue, as well as organs.
“The organs, for example, like the liver or the spleen, that aren't very elastic, they can't handle that. They would basically rupture,” Naik-Mathuria said.
She added that the reason the AR-15 is so deadly is that victims are hit by more than one bullet, with multiple injuries at a time.
Children are less likely to survive AR-15 wounds
The leading cause of death in children between the ages of 1 and 19 in the U.S. is gun violence, according to a recent New England Journal of Medicine report, which analyzed data from the Centers for Disease Control and Prevention.
Naik-Mathuria says that treating and saving anyone from AR-15 wounds is difficult, but that for children, the chance of surviving these injuries is slim. One reason is that victims of AR-15-style rifles lose large amounts of blood very quickly, and children, she says, don't have as much blood in their bodies as adults.
“Children have half the blood volume that adults do,” the Baylor surgeon told Yahoo News. “So you can imagine that the amount of blood that they lose, for that to stop their hearts, is a lot faster than it would be for an adult.”
Chances of survival for both adults and children also depend on the location of the wounds. Naik-Mathuria says that if the bullets hit extremities like the arms or the legs, there’s a higher chance of survival. Again, she says the blood loss children would experience from these injuries, regardless of their location, could be enough to kill them.
Why minutes and location matter for injuries from an AR-15 rifle
Another challenge in the race to save children from AR-15 rifle injuries is that they require immediate, specialized medical attention. “It can't just be any person who sees them. They have to be in a trauma center, a Level I trauma center, where there's massive amounts of blood available and all the equipment that you need, and many surgeons and different techniques that you might need,” Naik-Mathuria explained.
The U.S. has fewer than 50 pediatric trauma centers, she added, mostly located in urban areas. The time it takes to transport victims of these injuries to the hospital can make the difference between life and death.
“I wish as surgeons, we could just wave a magic wand, and those injuries would just be solved, but it's very, very complicated. They have to be in the right place at the right time and be injured in the right location, essentially in order [for us] to save them,” Naik-Mathuria said.
What recovery looks like for those who survive AR-15 injuries
The road to recovery for those who survive injuries from an AR-15-style weapon is long, and many survivors spend several months in intensive care, according to the surgeon.
“I had a child, a 4-year-old with a handgun injury that was in the hospital for seven months recovering. So imagine something five times the size,” Naik-Mathuria said.
Quite apart from the physical injuries, these patients and their families have to face the psychological trauma. Many U.S. hospitals have teams of crisis counselors and social workers available to help gunshot victims the moment they are out of the intensive care unit.
Doctors call for action to reduce gun violence
Naik-Mathuria is one of many doctors in the nation taking part in a social media movement that uses the hashtag #ThisIsOurLane to demand action to reduce gun violence. The hashtag was created in 2018 in response to an NRA tweet that read, “Someone should tell self-important anti-gun doctors to stay in their lane,” after several reports on gun violence were published in the journal Annals of Internal Medicine. Most of the articles called for policies to reduce the rate of firearm injuries and deaths in the country.
The social media campaign was also created in the wake of two mass shootings: one at a California bar that year that ended in 12 deaths and another at a Pittsburgh synagogue, where 11 people were killed. It recently resurfaced after the mass shooting at Robb Elementary School in Uvalde.
“We take care of these patients. We operate on them. We have a very close bond with them. We take care of their families,” Naik-Mathuria said, adding that doctors feel responsible for these patients. She also said that gun violence is a public health problem that needs to be addressed immediately.
“There is no place for assault-style weapons, high-velocity weapons, in civilian life. I really believe that and think most people in my society and most surgeons believe that — trauma surgeons especially, because we just know how destructive they are,” she said.