MLC of Firearm injury

MLC of Firearm injury

Patient is mostly serious if bullet hits chest or abdomen/head/neck, you dont have time to wait and keep the victim, In that case :

1.  Vitally stable the victim,dont stitch or remove the bullets ,only apply pressure bandage.

2.  Write 2 marks of identification by yourself ,you see with your eyes(its important).

3.  Color of clothes and note down number/size of holes u see at entry and exit sites. Roughly write at a rough paper what u think bullets corresponds to respective holes in the clothings.

Note any soot/ blacking / burning at cloth fibers at site of entry of bullet. You write it all as your record to further copy it on MLC page .

4.Now examine the wounds,

Make a drawing on rough paper,this drawing you will draw on the mlc paper later on. 1stly you make sure its a bullet or not/superficial /deep/single entry wound in chest, blacking/ sooting /hair burn.

Is there exit? Make trajectory of path and if u dont see any exit write no exit but there can be swelling redness on opposite side which you will mention.

5.If there are multiple bullets fired, see through-through, does two superficial entry-exit point has a

connection? Do it with a pencil or ✂ but do not open any closed wound .Also note and scratch the clotted blood at wounds, sometimes they are just scratches and no bullets with no depths.Dont listen to attendents they will force you to believe its a firearm.

6.  You keep the docket of police in MlC which you will fill after patient is refferred to tertiary care but On your emergency slip you will write MlC NUMBER /identity marks/clothings which will be saved in tertiary hospital.

7.  After all this, you refer victim and advised x ray/ct/ ultrasound on slip.

8.  Make 2 separate slips ,write please give expert surgical and radiological opinion with procedural/operational Notes or findings.

You send the patient ,keep an attendent with you to fill in the MLC register, you write all you wrote on rough paper.

You hand over the mlc/docket to police. Your work is done.

9.  For rare cases where you suspect its fabricated or not a firearm wound or where you want to linger on bad attendants..... Foran insaaf ki farahmi na krain, take clothing of patient and scrap the area/swabs or take pieces of shrepnal ,seal them and send them to firearm and ballistics PFSA lahore for kind of weapon and does the Gun powder matches on cloth and scraps. It will take a month for report to come back to you.

Beacuse mlc katwany sb milky aty hain, ap pe pressure hota, after 2'3 weeks vict akela ata hy, do what you please.

#Result # after some days patient will come back for result. They will force you to declare it as firearm without tertiary notes ,dont do it ,if you declare it ,opponent party will challenge it as you will not have any proof of what happened in tertiary care.Have an emergency slip and ask the tertiary hospitals 1=radiologist 2= surgery for operational/ surgical/procedural notes.

And do write ATTESTED COPIES of everything, MS /AMS/Professor/AP can attest the procedural files.

Without it they are useless in court and you cannot declare result unless you have them as proof.

Radilogical report of fracture/bones/ribs etc

Surgical notes/visceral damage or not/depth of wounds.

*You will declare bone injury like you do in normal MLCs .

*You will write USG/x ray/ct/ surgical notes for visera/intubation/hemothorax in detail on mlc paper. After all this you will write from all investigations and surgical and radiological opinions [ it is likely a firearm injury]. There are special sections of firearm that only police puts.

Sometimes fake firearm cases come, people forces you to declare small cuts/abraisons/minor wounds as firearm. Your job is to access the clothing/wounds/history and then declare it as firearm or not. If you think its not firearm , declare it as F1lA1 and as blunt or sharp weapon.

Remember,blackning,soot,burning may not be present ,entry and exit wounds can be mixed as 'Fankaar Qoum' Wet Towel/cloth rakh ke self inflicted fire marti hy so that doctor can be dodged about range of fire.When you dont see signs of close contact you write distance may be more than 3 feet, in this way self inflicted fires get away. So you write its firearm injury and subject it to I.O (investigating officer) to further investigate. Thats all