No figures could be found for the armies currently fighting wars in developing countries their wounded are unlikely to benefit from recent developments in care of casualties which increase the proportion of wounded people who survive. Military casualty figures come only from armies with a good medical infrastructure. However, the articles we found include large numbers from different situations. The medical literature does not contain statistics on all battles or civilian incidents in which firearms have been used. These incidents were unverified and do not represent all incidents reported by this news service. One of us (RC) tabulated a parallel analysis of some incidents reported on BBC radio’s World Service from January 1996 to the end of 1998. We calculated the ratio of the number of people wounded to the number of people killed. In this study wounded means the number of people who were injured and survived to leave hospital, while killed means the number of people whose injuries were fatal, including those killed where the weapons were used (the military equivalent being killed in action) and those who died after reaching a medical facility (the military equivalent being died of wounds). Some of these publications contained data on incidents that happened earlier this century. We performed a search on Medline for reports published since 1980 that reported mass casualties of firearms outside the context of armed conflict, gave the number of people wounded and killed, and gave the context in which the weapons were used in each event. We also wrote to the chief military medical officers of 89 countries as listed in the International Committee of Military Medicine asking for medical publications in Index Medicus that might contain official statistics on casualties we did not ask for any confidential information. We performed a search on Medline for reports that gave statistics on those wounded and killed in armed conflicts since 1940. We sought data on the number of people wounded and killed in armed conflicts or mass shootings from three sources: Medline searches official military casualty figures quoted in the medical literature and BBC radio’s World Service. We reviewed official figures in the medical literature on mortality from the use of conventional weapons and firearms under various circumstances to see how mortality varies according to the context in which weapons are used. Firearms, particularly automatic weapons, have been used in mass shootings, in which the number of people killed may be more than the number wounded. 14 – 17 Conventional weapons may also be used in urban violence, murders, or terrorism. Weapons have been used by military staff on unarmed civilians or prisoners of war in such cases the number of dead may be known from a body count or from forensic evidence of mass graves, but the number of survivors is either unknown or likely to be none. 2 – 13 However, weapons might be used in armed conflict but outside the international laws of war-for example, against civilians or to execute prisoners. Mortality associated with weapons during war has been recorded in the medical literature. 1 Little attention has been paid to the fact that the mortality associated with a given weapon varies considerably according to the context in which it is used. 1 In this article conventional weapons are legitimate weapons currently used by armies that utilise projectiles or non-nuclear explosions. Conventional weapons are designed to cause injury by transmitting kinetic energy to the body, generally not to a specific part of the body (with the exception of buried antipersonnel mines), and arms and legs make up almost half of the human target. The mortality associated with a particular kind of weapon-that is, the proportion of those injured who die-is a measurable outcome. The effects of weapons on humans resulting from their design are different from those resulting from the context in which the weapons are used.
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