Ballistic Trauma in Finland : An Epidemiologic and Clinical Study of Firearm and Explosion Injuries

The occurrence and nature of civilian firearm- and explosion-injuries in Finland, and the nature of severe gunshot injuries of the extremities were described in seven original articles. The main data sources used were the National Hospital Discharge Register, the Cause-of-Death Register, and the Archive of Death Certificates at Statistics Finland. The present study was population based. Epidemiologic methods were used in six and clinical analyses in five papers. In these clinical studies, every original hospital record and death certificate was critically analyzed. The trend of hospitalized firearm injuries has slightly declined in Finland from the late 1980s to the early 2000s. The occurrence decreased from 5.1 per 100 000 person-years in 1990 to 2.6 in 2003. The decline was found in the unintentional firearm injuries. A high incidence of unintentional injuries by firearms was characteristic of the country, while violence and homicides by firearms represented a minor problem. The incidence of fatal non-suicidal firearm injuries has been stable, 1.8 cases per 100 000 person-years. Suicides using firearms were eight times more common during the period studied. This is contrary to corresponding reports from many other countries. However, the use of alcohol and illegal drugs or substances was detected in as many as one-third of the injuries studied. The median length of hospitalization was three days and it was significantly associated (p<0.001) with the type of injury. The mean length of hospital stay has decreased from the 1980s to the early 2000s. In this study, there was a special interest in gunshot injuries of the extremities. From a clinical point of view, the nature of severe extremital gunshot wounds, as well as the primary operative approach in their management, varied. The patients with severe injuries of this kind were managed at university and central hospital emergency departments, by general surgeons in smaller hospitals and by cardiothoracic or vascular surgeons in larger hospitals. Injuries were rarities and as such challenges for surgeons on call. Some noteworthy aspects of the management were noticed and these should be focused on in the future. On the other hand, the small population density and the relatively large geographic area of Finland do not favor high volume, centralized trauma management systems. However, experimental war surgery has been increasingly taught in the country from the 1990s, and excellent results could be expected during the present decade. Epidemiologically, explosion injuries can be considered a minor problem in Finland at present, but their significance should not be underestimated. Fatal explosion injuries showed up sporadically. An increase occurred from 2002 to 2004 for no obvius reason. However, in view of the historical facts, a possibility for another rare major explosion involving several people might become likely within the next decade. The national control system of firearms is mainly based on the new legislations from 1998 and 2002. However, as shown in this study, there is no reason to assume that the national hospitalization policies, or the political climate, or the legislation might have changed over the study period and influenced the declining development, at least not directly. Indeed, the reason for the decline to appear in the incidence of unintentional injuries only remains unclear. It may derive from many practical steps, e.g. locked firearm cases, or from the stability of the community itself. For effective reduction of firearm-related injuries, preventive measures, such as education and counseling, should be targeted at recreational firearm users. To sum up, this study showed that the often reported increasing trend in firearm as well as explosion-related injuries has not manifested in Finland. Consequently, it can be recognized that, overall, the Finnish legislation together with the various strategies have succeeded in preventing firearm- and explosion-related injuries in the country.

Tässä väitöskirjatutkimuksessa, joka koostui seitsemästä osajulkaisusta, selvitettiin ampuma- ja räjähdysvammojen epidemiologiaa Suomessa kahdenkymmenen vuoden ajalta, vuodesta 1985 vuoteen 2004. Lisäksi arvioitiin kliinisemmin raajojen vakavia ampumavammoja. Sairaalahoitoa vaativat ampumavammat ovat Suomessa vähentyneet tarkastelujakson aikana. 1980-luvun lopussa sairaalassa hoidettujen ampumavammapotilaiden insidenssi oli 5.1 tapausta 100 000 henkilövuotta kohden (254 kpl), mutta vuonna 2003 enää vain 2,6 tapausta 100 000 henkilövuotta kohden (133 kpl). Tämä väheneminen perustui ensisijassa tapaturmaisten vammojen vähenemiseen, kun sen sijaan väkivaltaisissa ampumavammautumisissa ei selvää pysyvämpää muutosta havaittu. Kuolemaan johtaneissa ampumavammoissa havaittiin pieni väheneminen viimevuosina. Ylivoimaisesti merkitävin riskitekijä ampumiselle on itsemurhayritys. Sairaalahoitoa vaatineita räjähdysvammautumisia esiintyi 1990-luvulla vain 2 tapausta 100 000 henkilövuotta kohden (100 kpl). Hyvin harvinaisissa kuolemaan johtaneissa räjähdysvammoissa havaittiin pieni lisääntyminen 2000-luvun alussa. Tutkimuksen merkittävin löydös oli, että toisin kuin monissa muissa maissa, ampumavammojen määrä on Suomessa laskussa. Tärkeä löydös on vammautumiseen liittyvä merkittävä ( kolmanneksessa tapauksista) samanaikainen alkoholin ja huumeiden käyttö. Tämä on haaste tulevaisuudelle mikäli alkoholin käyttö Suomessa kasvaa. Kolmas löydös oli, että raajojen vaikeiden ampumavammojen hoidossa esiintyi yllättäen yksittäisiä komplikaatioita. Näiden taustalla on ensisijassa vammojen harvinaisuus ja laajat etäisyydet jotka eivät suosi suuria tapaturmien hoitokeskuksia. Harvinaisissa räjähdyskuolemissa on esiintynyt hienoinen nousu viimevuosina ilman selvää osoitettavaa taustasyytä. Yhteenvetona tutkimus osoitti, että ampuma- ja räjähdysvammautuminen on Suomessa kokonaisuutena vakaa ja pääosin hallinnassa. Ampumalainsäädännön uudistuksien ja erilaisten preventiivisten ohjelmien voidaan katsoa onnistuneen tehtävässään.