This patient is no stranger to physical violence, as evidenced by the titanium plating that repaired a mandible fracture. But now, rendered blind by the shotgun blast, life will look much different.

In my profession, I see lots of people who have been shot in the face. Rarely, do these people die immediately. They sometimes succumb to an infection, or other complication, but rarely do they die in the immediate aftermath of the gunshot wound. This mostly applies to pistol caliber rounds and I’ve seen all manner of them ranging from .22’s all the way up to the mighty .45 hit someone, somewhere in the maxilla or mandible, and the wounds, while often horrific and ultimately disfiguring, don’t always render the recipient unconscious even. In many cases though, the recipient DOES stop doing whatever they were doing BEFORE they were shot in the face.

Case in point…this person was the recipient of two blasts from a 12 gauge shotgun loaded with shot and there are twenty five plus pieces lodged in their face and neck, all resulting in superficial injuries, EXCEPT FOR the injuries he sustained to the eyes, which resulted in immediate blindness due to the ocular damage. Eyes are a superficial structure…it doesn’t take MUCH to render them inoperable.

But, like in so many cases I’ve seen before, the, “psychological stop,” that occurs with a significant facial injury isn’t to be overlooked. People get into a mindset of singular purpose (retreat and seek medical care) when they’ve taken a round of any kind to the face, and that is safe to say, vocationally generic! Good guy, or bad guy, when people get shot in the face, they most typically break off the attack! A rare exception to that I can think of is superhero Jared Reston. His case is uncommon though. I see a number of these patients come through the surgical service at my work and they most always change their tack, as soon as the round hits!

So something to consider and think about. I am not a fan of birdshot for defensive purposes as I think that the pellets lack the mass to penetrate once they encounter tissue resistance. The hollow bones of the face don’t resist ballistic attack well; they most always perforate or fracture and let whatever is coming in, come in! In this case, nearly all the wounds were superficial, and except for the few that were removed with digital pressure or a small forcep (think popping a BIG zit) the rest were left in place, as many are adjacent to vital neurovascular structures that would be potentially hazardous or further debilitating to remove.

So, in summary, small shot…leave it for smaller animals. Use time tested buckshot in a shotgun that you’ve patterned with said buckshot. The shot placement here was good, and in a civilian context, it was a win, because the actions of the recipient ceased immediately. Remember, we’re not trying to assassinate anyone as responsible Civilian Defenders…we’re just trying to get home. If you fire a shot and get a good hit, and the attacker breaks off, mission accomplished! Top off, check yourself for injuries, grab some cover if you haven’t already, keep your head up and get on the phone to the police. So next time someone tells you that a headshot with a shotgun is invariably fatal, well, you can argue that it isn’t EVERYTIME!

Thanks for reading! -Dr. House

Don’t discount the value of a Remington 870 loaded with quality 00 buckshot. It’s my choice and many other far more learned people for good reason! You don’t need the latest AR to have an effective civilian long gun.