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Hydrostatic shock
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==Arguments against== [[Dr. Martin Fackler|Martin Fackler]], a [[Vietnam Era|Vietnam-era]] trauma surgeon, wound ballistics researcher, a colonel in the U.S. Army and the head of the Wound Ballistics Laboratory for the U.S. Army's Medical Training Center, Letterman Institute, claimed that hydrostatic shock had been disproved and that the assertion that a pressure wave plays a role in injury or incapacitation is a myth.<ref name="fn_(9)"/> Others expressed similar views.<ref name="fn_(50)">Patrick UW: Handgun Wounding Factors and Effectiveness. FBI Firearms training Unit, Quantico, VA. 1989.</ref><ref name="fn_(51)">MacPherson D: Bullet Penetration—Modeling the Dynamics and the Incapacitation Resulting From Wound Trauma. Ballistics Publications, El Segundo, CA, 1994. </ref> Fackler based his argument on the [[lithotriptor]], a tool commonly used to break up kidney stones. A lithotriptor uses sonic pressure waves which are stronger than those caused by most handgun bullets,<ref name="fn_(9)" /> yet it produces no damage to soft tissues whatsoever. Hence, Fackler argued, ballistic pressure waves cannot damage tissue either.<ref name="fn_(3)">Fackler ML, Gunshot Wound Review, Annals of Emergency Medicine 28:2; 1996.</ref> Fackler claimed that a study of rifle bullet wounds in Vietnam (Wound Data and Munitions Effectiveness Team) found "no cases of bones being broken, or major vessels torn, that were not hit by the penetrating bullet. In only two cases, an organ that was not hit (but was within a few cm of the projectile path), suffered some disruption." Fackler cited a personal communication with R. F. Bellamy.<ref name="fn_(9)"/> However, Bellamy's published findings the following year<ref name="fn_(900)">Bellamy RF, Zajtchuk R. The physics and biophysics of wound ballistics. In: Zajtchuk R, ed. Textbook of Military Medicine, Part I: Warfare, Weaponry, and the Casualty, Vol. 5, Conventional Warfare: Ballistic, Blast, and Burn Injuries. Washington, DC: Office of the Surgeon General, Department of the Army, United States of America; 1990: 107–162. available for download: http://www.bordeninstitute.army.mil/published_volumes/conventional_warfare/conventional_warfare.html {{Webarchive|url=https://web.archive.org/web/20091124065919/http://www.bordeninstitute.army.mil/published_volumes/conventional_warfare/conventional_warfare.html |date=2009-11-24 }}</ref> estimated that 10% of fractures in the data set might be due to indirect injuries, and one specific case is described in detail (pp. 153–154). In addition, the published analysis documents five instances of abdominal wounding in cases where the bullet did not penetrate the abdominal cavity (pp. 149–152), a case of lung contusion resulting from a hit to the shoulder (pp. 146–149), and a case of indirect effects on the central nervous system (p. 155). Fackler's critics argue that his evidence does not contradict distant injuries, as Fackler claimed, but the WDMET data from Vietnam actually provides supporting evidence for it.<ref name="fn_(900)"/><ref name="fn_(99)">{{Cite arXiv |eprint = 0812.4927|last1 = Courtney|first1 = Michael|last2 = Courtney|first2 = Amy|title = Misleading reference to unpublished wound ballistics data regarding distant injuries|year = 2008|class = physics.med-ph}}</ref> A summary of the debate was published in 2009 as part of a ''Historical Overview of Wound Ballistics Research.'' {{blockquote| Fackler [10, 13] however, disputed the shock wave hypothesis, claiming there is no physical evidence to support it, although some support for this hypothesis had already been provided by Harvey [20, 21], Kolsky [31], Suneson et. al. [42, 43], and Crucq [5]. Since that time, other authors suggest there is increasing evidence to support the hypothesis that shock waves from high velocity bullets can cause tissue related damage and damage to the nervous system. This has been shown in various experiments using simulant models [24, 48]. One of the most interesting is a study by Courtney and Courtney [4] who showed a link between traumatic brain injury and pressure waves originating in the thoracic cavity and extremities.|Historical Overview of Wound Ballistics Research<ref>{{cite journal |url=https://www.researchgate.net/publication/26238151 |doi=10.1007/s12024-009-9090-z |title=Historical overview of wound ballistics research |year=2009 |last1=Maiden |first1=Nick |s2cid=19066708 |journal=Forensic Science, Medicine, and Pathology |volume=5 |issue=2 |pages=85–89 |pmid=19466590 }}</ref>}}
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