Why is it so important to remove the bullet?

October 4, 2007 9:35 PM

In umpteen movies and TV shows that we have all seen, when someone is shot, the first thing that anyone giving them aid is concerned with is "getting the bullet out" - usually followed by a painful extraction of the projectile before any other first aid is applied. Why is this?

You often hear about people who survived gunshot wounds who still have slugs inside them, right? So in the movies, is this done sheerly for dramatic effect, or is there any basis in reality for the urgency of removing the bullet? Is there any pressing need to remove the bullet from a shooting victim that trumps the need to stop bleeding, disinfect the wound, et. c?

posted by GriffX to grab bag (12 comments total)

Sheer dramatic effect. Field surgery, in which a bullet is removed, sans anesthetic, usually with alcohol poured on the wound, and then the deformed bullet is dropped into a handy bowl, is just good drama, even if it is nothing like how wounds are actually tended to in the real world.

In Westerns, they often pulled the arrows out of themselves after getting shot with them. Never mind that this could cause the cowboy to bleed out.
posted by Astro Zombie at 9:43 PM on October 4, 2007

Gunshot wounds generally kill by causing the victim to bleed to death. There is no urgent need to remove the projectile... You want to minimize bleeding and do everything you can to ensure the victim can still breathe, and get to a real hospital asap.
posted by knave at 10:08 PM on October 4, 2007

Why is it so important to remove the bullet?

It's not. In fact, every first aid/EMT course I've taken says to leave the bullet - or any other deeply embedded object - in. Here's a cite from a military First Aid text: "Never attempt to remove bullets."
posted by mediareport at 10:27 PM on October 4, 2007

It's just one of those movie tropes, like cars that explode, or glass windows that can be shattered with physical force without anyone getting horribly cut.
posted by mek at 11:06 PM on October 4, 2007

I agree it's a movie trope -- but the trope comes from old movies set in the past -- when, apparently doctors did think it was important to remove the bullet.

For instance, some doctors believe President William McKinley was actually killed by the probing for the bullet and not by the bullet itself:

"In Garfield’s day doctors would probe gunshot wounds in the belief that if they could remove the bullet everything would be fine. Today we know a hot bullet is self-sterilizing. Garfield’s real problem was the ill-advised, ill-directed poking with nonsterile instruments by every doctor who entered the sickroom... All that meddling introduced more bacteria into Garfield’s body.

"When the doctors finally located the bullet during an autopsy on Garfield’s body, they found it lodged in the back muscle—a far less dangerous place than they had thought. During his trial Charles Guiteau claimed he hadn’t killed the President, the doctors had. He was probably right.

"Today we would put a sterile dressing over President Garfield’s wound, make sure nobody touched it, and immediately administer antibiotics to treat any infectious bacteria that might have been carried into the wound, either by bits of fabric from his clothes or by debris from the bullet itself. ... We’d use an X ray to locate the bullet, but once we found it we might decide to leave it alone, since removing it would require anesthesia and surgery—procedures that could create more problems than the bullet itself."

See: http://www.americanheritage.com/articles/magazine/ah/1992/5/1992_5_104.shtml (scroll down)
posted by Jahaza at 11:26 PM on October 4, 2007 [3 favorites has favorites]

Another fun one is the shooting victim flying backwards from the impact, while the shooter isn't shaken by the kickback from the gun (both should impart the same force).
posted by lostburner at 1:07 AM on October 5, 2007

I've always assumed that the need to remove bullets in old movies, cowboy movies in particular, came from the slugs themselves being made of lead. Leave a hunk of lead in your body and bad things can happen. Then again, they weren't so worried about the ill effects of lead back then (lead water pipes, lead paint, &c.). Just a guess, anyway.

Now there's only depleted uranium to worry about. Pft.
posted by Pecinpah at 3:34 AM on October 5, 2007

It's true that lead does cause heavy metal poisoning---it's really damaging to the centreal nervous system in particular. However, metallic lead is not the chemical form which is directly dangerous (unlike, say, the lead in paint), nor is it very soluble in the body's fluids. The lead has to oxidize to become bioavailable, which can take some time. this is especially true in the low-oxygen, even slightly-reducing, and neutral pH environment of the body. Metallic lead is fairly inert in living tissue.

In the short term, it's easy to imagine that acute injury considerations are far more important to recovery that worrying about a real, but long-term chronic problem like lead poisoning.
posted by bonehead at 4:22 AM on October 5, 2007 [1 favorite has favorites]

Another fun one is the shooting victim flying backwards from the impact, while the shooter isn't shaken by the kickback from the gun (both should impart the same force).

Not that I know from guns, but small arms frequently have recoil absorbers, no? And shooters presumably brace themselves for kickback as shootees do not.

How much difference this makes I have no idea, having never been on the giving or receiving end, but this picture has no doubt embedded in a lot of filmic minds.
posted by IndigoJones at 6:07 AM on October 5, 2007

I've always thought it had to do with the likelihood that the bullet brought something into the wound with it. In the movie version of Master and Commander of the Far Side of the World, there's a whole to-do about whether the bullet tore through the victims shirt and went into him alone (safe) or brought a chunk of shirt in with it (necessitating removal, more of the shirt than the bullet). Now, that's a movie, and IANAD, but from a common-sense point of view it seemed to work.
posted by sarahkeebs at 6:25 AM on October 5, 2007

Civil War era field medicine included instruments for bullet extraction. They included the surgeon's finger, and they weren't antiseptic.

Of course, that war introduced the Minié ball to US battlefields, which basically resulted in amputation as the primary treatment.
posted by dhartung at 7:04 AM on October 5, 2007 [1 favorite has favorites]

What Jahaza said is the best answer. There was a time when this was standard practice, and that time is called "Before Antibiotics."
posted by Miko at 10:27 AM on October 5, 2007