chbare

Island, I do not know where you obtained your numbers but they are inaccurate. The 7.62 x 63 mm is commonly called the thirty-aught six, a hunting round. The classic AK variants typically fire the 7.62 x 39 mm round. I assure you it fires a supersonic bullet. The speed of sound is around 300-400 meters/second. A typical 7.62x39 will be around 600-800 m/s.

However, a typical hunting rifle say a .270 fires a larger bullet at supersonic velocity and produces devastating effects. Feel free to verify me, but a standard 5.56 (.223) round will have a velocity around 900m/s (vector) and a weight of around 63 grains. A number of .270 rounds exist, but ill take something in the middle like a 130 grain bullet with a velocity of around 900 m/sec (vector). Convert grains to grams or kg and use the macroscopic formula for kinetic energy (KE = MV(2)/2) and you will find the .270 is capable of delivering more kinetic energy. I do not reasonably think that the round argument is valid. However the ability to load a 100+ round magazine and shoot it off quickly, perhaps that argument carries less inertia than the one above?

Report your findings and go up your chain and perhaps even speak with your medical director for additional guidance. In addition, you need to chart this incident exquisitely in the event the case progresses. I find it strange that the doc did not treat this as a potential sexual battery. In my area we actually have specially trained providers known as sexual assault nurse examiners (SANE) who are immediately called upon in these kinds of cases.

Actually, since the early 1980's, hand guns were either the most common gun used or used in conjunction with an assault type weapon. Therefore, I believe my original notion of remaining broad continues to be valid. http://www.motherjones.com/politics/2012/07/mass-shootings-map

However, the 5.56mm round used in the AR 15 style rifles is most certainly not a large or heavy caliber round. In fact, it is quite small and virtually all the bullets used to hunt deer, elk and so on are of a larger caliber. In addition, where do we draw the line when it comes to a "large amount." I am not being argumentative or talking semantics, but having a good definition of what we are discussing is probably a good idea.

However, I have neither stated my opinion about gun ownership nor have I stated rather I own a gun in this conversation. My point has been to focus on the subject with a broad lense instead of simply focusing on a single aspect. Should we not appreciate the issue as broadly as possible? For example, why focus only on "assault" weapons when it is known that hand guns are the most commonly used firearm in terms of killing people in the United States. Again, I believe in a broad discussion where hyperbole is minimalised as much as possible. I've put personal bias on the shelf and want to focus on the issue broadly since our country is at a point where dialogue and change is possible.

I think you are making assumptions about me and clearly are missing the point I've been trying to make.

Depends. There are many aftermarket companies that make several types of magazines for several types of guns. I know of some high capacity Glock magazines that hold over 30 rounds. I'd say do some work on Google. Better informed = less hyperbole.

Yes, high capacity magazines exist for handguns however.

It's actually not as new as you'd think. Look up the Taos Red River Project. It was a community health programme that New Mexico developed in the early 1990's. Overall, it was a failure, but the information gained from the experience could be very helpful.

I will continue to point to handguns. Many people continue to believe "assault" type weapons are the problem, when in fact, handguns are used to kill many more people than any other type of gun in the United States. Additionally, when we start talking about other concepts such as suppressors, I have to ask, how often are suppressors used in violent crime and self defense, in spite of them being relatively easy to obtain in the United States? Additionally, suppressors actually have a function as they can cut down on noise and can potentially help prevent hearing loss. Some gun ranges in other countries mandate suppressor use to decrease noise signature.

Point understood DFIB.

I am not sure what you are asking or stating?

To be fair, murder rates are grossly under-reported in countries like Afghanistan. Remember, I not only lived there but had to take call at the university morgue in Kabul. It's grossly myopic to use countries that barely function and have no means of reporting even rough estimates of violent crime.

Another issue as stated is government enforcement and government involvement in our lives. The United States government has a less than stellar record of dealing with guns, so a certain amount of concern about how a new set of laws/restrictions would actually be managed is certainly valid.

No problem, I realised my point wasn't too clear.

Yes, I am well of aware of that; however, gun ownership in those countries is still higher than many other nations and gun related recreational activities are actually quite popular in Norway. Actually, ownership is high in many of the Scandinavian countries; however, the culture is different and the regulations are quite different from the United States.

Perhaps I did not explain my point clearly? I am not buying all the comparisions I see people making to countries such as Norway and Switzerland where gun ownership is high but gun violence is low. Unfortunately, I see people pointing to these countries as justification for the United States to not consider changes. However, what many people fail to appreciate is that the high rates of ownership come with many laws, stipulations and regulations. However, I rarely see people point that side of the coin out. Once again, this makes the situation in the United States unique among other "post-industrial" nations.

This type of event is rare in a country like Norway. In other words an exception or a statistical outlier. However, such events are at a point where I would almost call them common in the United States. Such events have occurred multiple times over the past 15 years. It is not valid to compare isolated incidents in other countries to an event that continues to occur on a regular basis in the United States. Edit: I am aware of the high levels of gun ownership in Norway; however, the stipulations such as mandatory gun safes and so on that go along with said ownership are not an inherent component of ownership requirements in the United States.

However, at least some of Mexico's problem comes from guns smuggled in from the United States. Also, regarding Norway, I'm not keen to use outlier events. Particularly, when said events are not uncommon in the United States.

ERDoc, what are your thoughts on handguns? We can talk about assault type weapons all day long; however, when we take a look at violent crime systemically in the United States, hand guns are used to kill many more people than assault type weapons. This trend goes back at least as far as the 1970's. With that said, I understand we are talking about mass shootings in contemporary time; however, should we not extend the dialogue to include a systemic discussion?

One thing I have learned throughout my world experiences is that making judgements about one culture based on the values of your culture can create many pitfalls. Sometimes, a certain amount of cultural relativism must exist if you want to attemtp to see a point of view from somebody elses eyes. I certainly learned a thing or two when I lived in Afghanistan. The bottom line is that guns have been an integral component of the culture and life of both historic and contemporary United States. The citizens took up arms to overthrow Birtish rule, arms were taken up during the Civil War and guns have seen this country through the industrial revolution to the quantum revolution. Guns are even part of the sports scene in the form of recreational persuits, competitions and contests. Guns have been part of our society for hundreds of years. Therefore, I am not sure it is reasonable or even productive to apply or force a world view onto something that is so well engrained into another society. We see how well that is working when applying "Western" ideals to traditionally non-western nations. However, where real progress may occur is in the form of productive dialogue and reasonable legislation with goals that look at the safety related, constitutional related and logistical aspects of the problem that we face. I simple do not believe berating us and saying you cannot believe or understand our culture is productive or helpful. However, the first and perhaps biggest step is for all parties involved to recognise that a problem exists and that problem has not imporved under our current system of policies and procedures. If we can begin to agree on common ground, we can begin to put the hyperbole away and perhaps once we move on in this productive exchange, begin to look at what other countries are getting right and perhaps how these notions can be integrated into a system that protects the rights of our citizens.

You can make anything a gold standard when you apply the right boundary conditions. I'm simply not willing to say one tool is the best overall "gold standard."

I think the ability to run gasses on intubated patients would be helpful in addition to having the ability to run BMP's to appreciate potentially lethal electrolyte imbalances. I'm not sure I see much use for anything else on a "standard" EMS platform. Even lactate monitoring is not high on the list as many things cause an elevated lactate and many issues such as suspected sepsis complications are going to be managed and identified clinically and I'd still look at fluids and so on regardless of a point of care lactate value.

This is a good discussion. I do not believe a general, gold standard airway exists. Depending on the boundary conditions of the scenario, any number of interventions may be warranted.