Ping Ping Ping Goes the Bullet—or Should It?

By Ralph J. Riviello, MD, MS, FACEP, and Heather V. Rozzi, MD, FACEP | on February 5, 2023 | 0 Comment

How we handle bullets in the ED can affect the ballistic analysis. Because bullets are soft and malleable, use of metallic surgical instruments like forceps to grasp the bullet can impart marks from the instrument into the bullet (Figure A). These marks can disrupt the ballistic markings and make comparisons and weapon matching impossible. Furthermore, dropping the bullet into a metal basin can also alter these ballistic markings and have similar consequences. There have been reports of physicians using a metallic instrument to mark the bullet with their initials or a symbol so they can identify it if asked in court. This can also ruin, obscure, or alter ballistic markings and should not be used.

FIGURE B(LEFT): If metallic instruments are to be used, they can be modified with rubber or silicone tubing over the tips (red-rubber catheters or Suture Booties) to prevent them from damaging the bullet.

So, what should be done to remove and handle bullet evidence?⁴ First of all, whenever possible use instruments made of plastic to retrieve and handle bullets. Often these may not be available or as useful as metallic instruments. If metallic instruments are to be used, they can be modified with rubber or silicone tubing over the tips (red-rubber catheters or Suture Booties) to prevent them from damaging the bullet (Figure B). Use minimal pressure when handling the bullet and if able, do not engage the clamping mechanism of the instrument. Next, never drop the bullet into a metal basin; use a plastic basin. If only a metal basin is available, line it with surgical towels and create a divot to gently place the bullet into until it can be packaged. And of course, do not place your own marks on the bullet and minimize any handling of it. You do not need clean the bullet, but you can gently remove any large pieces of tissue.

Key Points

Gun violence is increasing; and emergency and trauma physicians should understand the forensic needs of patients.
Hospitals should have policies in place on how to handle forensic evidence.
When handling ammunition-related evidence (bullets/casings), metal instruments and basins should NOT be used.
Bullets should be protected and packaged in envelopes or specimen containers.
All forensic evidence should be properly labeled with patient name, date of birth, date and time of collection, and collector’s name.
A well-documented chain of custody ensures the integrity of the evidence.

The bullet then should be packaged for transfer to law enforcement. The best way to do that is to place it a coin envelope. You can wrap it in gauze first for added protection. As an alternative, a sterile plastic specimen cup can be used. It should be lined with gauze as well in order to protect the bullet and prevent it from moving around. Whichever packaging is used, it should then be labeled with the patient’s name, date and time, and the name of the person who collected and/or packaged the evidence. Next, a chain of custody form should be used or chart notation should be made detailing what was done with the evidence. At a minimum, the name of the accepting officer and their badge number, law enforcement agency, name of the person turning over the evidence, date and time, and the signatures of both persons should be documented. A copy should remain in the chart and another copy should be sent with the evidence.