Combat Medic’s Advice: “Shoot the heaviest rifle round…shoot at what (you) can hit, and then shoot it again” BY DAN ZIMMERMAN


Reader JWT writes:

RF, a few friends, and I were shooting out on my range at a dueling tree. After having to shoot one steel paddle no less than 4 times with my 9mm service pistol to get the paddle to swing, I commented on how much I hated the 9mm, and the 5.56 NATO as well, and how I had never seen a single shot kill from those rounds, even at close ranges, and even from head shots.

Robert asked, “Seen a few people shot, have you?”

I responded, “hundreds”. Then he asked me to share . . .

I hate sharing, but I’ve been all over the world and I have seen a whole lot of people shot, stabbed, burned, run over, and blown up, and some of you might find this information valuable.

I was an EMT and a trauma tech working on a truck and in a trauma room for about 10 years and I was an army combat medic for eight years. Also — and this is important — when deployed I was almost always part of an “advisor” force. I was technically a “combat advisor” for two tours in Afghanistan, embedded with the Afghan National Army and Afghan National Police force. I’ve done the same thing with host nation National Guard troops in Central America.

I’ve never worked OCONUS on a large US base, and my patients have almost always been local nationals. Few of my patients OCONUS have been American troops, and I am grateful for that. Because of my specific role, and because I was often the closest competent medical provider for an extremely large number of people (sometimes over 20,000), I have treated an inordinant amount of gun shot and blast injuries in places where surgical treatment was often well over an hour away. My average medevac time for an urgent or urgent surgical patient in southern Afghanistan was four hours. That’s a long time to bleed. During my first tour in Afghanistan, I averaged one patient death per day.

I kept mission logs and patient logs. Looking through all my logs, both CONUS and OCONUS, I have recorded 371 gun shot wounds and significant blast injuries. About 20% of my patients were children under the approximate age of 12. About half of the total were blast wounds, primarily from mines and IEDs of all types. But that half represent a much greater number of deaths, and it doesn’t include the dead that didn’t make it to me.

Let me cut to the chase here, if the goal is to live, you would rather be shot close range in the face by a 9X19 or .45ACP round than step on a mine or be in the first 10 yards or so of any significant blast. Blasts cause multiple injuries, and shrapnel from the blast is often travelling far faster than even the fastest modern rifle caliber bullets. Wounding comes from overpressure, penetrating trauma (the vast majority of the injuries) and the body actually being thrown against other objects or the ground. So if the choice is to drive over an Italian anti-tank mine (still a little bitter about that one), or take one in the noggin, I say grin and bear it.

I owe Robert an apology. I did actually record one single-shot kill from a 9X18 (Makarov). It was a contact shot into the center chest on a sleeping target. The victim died immediately. I have also recorded a few single-shot kills from a .45ACP, one from as far out as 60 meters, fired from an HK UMP 45, which one of our team members carried and used with Jedi-like skill. The vast majority of engagements with that weapon, however, were within half that distance and patients usually took several hits. What can I say, he got lucky once.

On the civilian side, I saw only one single-shot kill from a pistol ever, and that was from a .357 magnum, within a living room, probably not more than five yards. The round entered the sternum and exited the spine. In fact, within the US, the vast majority of people that I saw shot lived after receiving medical treatment. That includes attempted suicides. I even had a patient live after a self inflicted shotgun wound to the face. He died of the cancer he was attempting to flee from, months later.

Beyond that, I do have recorded kills with a 9X19, but they all required multiple shots or they all took time to die.  Time enough to return fire or flee far enough to have to search for them. I don’t mean seconds of life, either — I mean minutes or hours. I have seen people shot that had to traverse long distances that still got away. And damn that’s frustrating.

In just about every country I have been in, our host nation counterparts — army and police — used the 9X19 NATO round.  Because so much of what I did was house-to-house police searches, I’ve seen a lot of pistol shootings, much more than US police would ever see, and much more than experienced by most medics deploying solely with US personnel. And yet, I have zero, not one single experience, where a single gunshot wound from a 9X19 NATO round killed someone prior to them being able to return fire or flee. This includes people shot in the chest, back, back of the head (one hit behind the left ear) the neck and the face.  None.

Unfortunately, the same goes for the 5.56 NATO round. I have yet to witness a single shot quick kill with this round. I even recorded a patient shot from less than three feet away, square in the back of the head, who lived. The round did not exit his body. Yes, he was immediately rendered unconscious and required (might I say exceptional) medical treatment. He was comatose for at least six months after that, but he lived.

But more importantly, in every experience, at ranges from zero (negligent discharges) to 35 yards (my closest, and worst-placed, shot on a person) to 400 yards (our average initial engagement distance in Afghanistan) individuals shot with a single 5.56 NATO round had time to fire, maneuver, or both. Did I see single shots that killed eventually? Yes. Does that matter in combat? Not one damn bit if you are the one they are still shooting at.

For those of you who say “just shoot them again,” I would tell you that is actually pretty difficult on a mobile target with cover at 400 meters who is shooting at you. Also, once they get shot they tend to be a little more wary. People are tricky that way. I will never forget the terror of shooting a man, watching the round strike his chest, and then see him lay over a short wall to steady his aim and continue firing at my teammates.

In my experience, the standard NATO combat round pokes 5.56mm holes in both bones and flesh, shattering nothing. It creates minimal bleeding. I know people say it tumbles and yaws, but that isn’t my experience at all. I saw it poke tiny holes in humans and rarely induced hemorrhaging sufficient to cause unconsciousness or uncompensated shock, which is the only result that matters.

On the flip side, having a patient who was shot by a 7.62X51 NATO or larger round was a rarity. Dead people aren’t patients, they are a supply issue. Patients hit with a ZSU aren’t patients either, they are an iron-like odor in the wind.

Take from that what you will. For me, what I learned is, when it comes to combat, shoot the heaviest rifle round I can, shoot at what I can hit, and then shoot it again if I can. I also learned that, in general, multiple organ damage shortens the time a patient is able to compensate for hemorrhagic shock far greater than the effect of a larger wound track in a single organ. And the Ma Deuce is the greatest, most perfect thing ever invented by man.

I have included a photo of a patient shot at close range with the 5.56NATO round (above).  The photo is of the patient’s calf, and is as I received the patient, within minutes after the shooting. Minimal care was necessary, with the primary concern being infection and tendon damage, not blood loss or bone damage. This is typical of the damage I have seen by this round.

As an aside, Chris Kyle (FWFS, brother) was a friend of mine, and while not so patiently listening to one of my Crown-induced rants on the 5.56 NATO, he suggested that it was not caliber I hated, but the bullet. He told me to load up the case as fast as I could, push a 64 grain or heavier soft point round and see what happens. So I had Underground Tactical built me an AR in 5.56 which I swore I would never own, and built rounds ranging from 64 to 75 grains with it. I’ve taken 11 deer with them, and the wound tracks are nothing like I saw with the NATO round. I’ve never had to look for an animal, and a little Underground 5.5lb AR in 5.56 is my go-to hill country deer gun now, which is just crazy.