Medical Tropes – How to shoot your characters without killing them

We are all familiar with the standard cop show cliché, a character is shot in the shoulder, but is perfectly fine in time for the next commercial break.

It goes without saying that this isn’t a terribly realistic portrayal of likely event, but as characters getting shot at is a very common situation in certain genres, I think an article discussing the mechanics of this will probably be handy.

Things to keep in mind.


The type of gun.

All guns are not alike.

  • A bullet from a small caliber pistol is obviously going to transfer much less energy into a target than a high velocity rifle bullet.
  • A shotgun fired at long range is liable to cause unpleasant superficial injuries, but less likely to be fatal.
  • Some modern sniper rifles are officially designated as light anti-tank weapons, so use your imagination regarding the likely effect on the human body.

Some bullets are scarier – it’s not rocket (propelled grenade) science


The type of injury

Fatal injuries are likely to result from major damage to a vital organ, infection, or blood loss. Whilst your arms and legs are devoid of vital organs they still contain arteries, they are not free fire zones.

Major organs tend to be very well supplied with blood, and can be difficult locations in which to stop bleeding.

Non fatal bullet wounds to the face and head are possible but are likely to result in severe disfigurement or cognitive impairment.

Wounds to the legs, arms, and hands may severely disrupt the use of those limbs, this may, or may not, be repaired via surgery. Moving an injured limb is not just a matter of willpower.


The degree and type of penetration

A high velocity round that passes straight through its target with striking anything vital often cause less damage than lower velocity bullets that dissipate all of their energy into the target. This will be heavily influenced by the type of ammunition used.

Glancing bullet wounds will be less dangerous, but can still cause life threatening blood loss. Bullets that strike bone can shatter it, making full recovery more difficult and painful, and potentially sending fragments of bone into other tissue.


The possibility of infection

Infection can dramatically influence the severity of an otherwise nonthreatening injury. This can be influenced by environment (e.g. a rat infested warehouse), the geographical location (infection is more likely in tropical locations), the time taken to seek treatment, quality of available medical facilities, and access to antibiotics.

Any wound to the gastrointestinal tract can be expected to result in severe infections due to release of material from the stomach or intestines into the body, as well as chemical inflammation from stomach acids and digestive enzymes. Contrary to popular belief, prognosis for abdominal injuries is actually reasonably good, given access to modern antibiotics and surgical techniques, but would drop considerably without them.



Generally speaking, the closer that you get to the heart, the greater the potential for life threatening bleeding is.  Severing the artery in your thumb is less severe than severing the artery in your shoulder, but is always going to be a big deal.

On a practical basis, severe bleeding is a good choice for dramatic potential, as bleeding is probably the easiest way to threaten a characters life without necessitating long term injury or even extended recovery time. But this isn’t always the case, if blood loss is severe, then organs, including the brain, will be damaged by the loss of oxygen. Damaged arteries or veins can be difficult to repair and prone to re-rupturing.


Hands and limbs

Whilst damage to muscle tissue, is less serious than damage to most other organs, that muscle is still there for a reason.

If a character loses large chunks of muscles, joints, or sustains damage to the tendons that link muscle to bone, a character is likely to suffer some degree of permanent mobility loss, and will often require painful and time consuming reconstructive surgery.

Joints, especially, knees, are very easy to damage, and very difficult to repair, and injuries to the joints may also trigger arthritis.

Severing a tendon effectively means cutting the cords that allow a limb to move, like cutting a puppet’s string. This  is especially important when considering injuries to the hands, which do not actually contain muscle tissue, and are completely reliant on tendons linking to muscles in the arm for movement.

Injuries to the forearm can therefore impair the hand, and it is very easy for damage to the hand to sever tendons and stop movement completely. It is common to see movie characters impaled through the hand, but in reality it’s nearly impossible for this to occur without severing tendons, these tendons are also very prone to injury from knives.


A word about body armor

The efficacy of body armor is severely overstated in a lot of fiction. A reasonable working assumption is that a civilian or police quality vest (that has been designed to protect against bullets, and not just stab wounds) will provide decent protection against low caliber ammunition and limited protection against higher caliber pistol rounds, but almost no protection against a rifle. Repeated hits, especially in the same location, will degrade the protection.

Military grade armor may be supplemented with (heavy) ceramic plates that provide limited protection against rifle rounds. Helmets provide limited protection against very low caliber bullets, and might deflect a heavier round away from the skull.


Associated injuries

If bullets are being sprayed around, it is  just as likely for people to be hit by flying fragments of glass, stone or metal as the bullets, these injuries should not be discounted.

It would also be very easy for a character, especially an out of shape one, to injure themselves in the mere act of seeking cover during a gunfight.


Summing Up

This has obviously been something of a whistle stop through traumatic medicine, so if there is anything that people would like more detail about, please don’t be afraid to ask in the comments, and, as always, general feedback is appreciated.


  • By Gil, May 22, 2014 @ 12:19 pm

    Thanks for the tips! Just a question, though. In my story my character gets shot in the side and in the thigh. It’s non-fatal, but still pretty nasty that he won’t be able to move for at least a month. How would treatment for this injury be? (not first-response, mind. He is a wanted criminal and they treat him in the basement of another character’s home).

  • By admin, August 25, 2014 @ 9:25 am

    Apologies for the late response & Keeping in mind that I’m not a medical professional…

    I’d imagine the priorities are going to be.

    1) Stopping the bleeding.

    2) Removing fragments of bullet (and possibly bone) from the wound, tricky without an x-ray.

    3) Sewing the patient back together, ideally in such a way that they don’t fall apart again at a later date.

    4) Infection control, Lots of antibiotics.

    Assuming you want your character to recover completely from this, your best bet might be fairly superficial wounds, with a nasty follow up infection.

  • By Summer Griffith-Mook, July 30, 2015 @ 11:27 pm

    You’ve been so helpful when it comes to helping me with my description, but I do have a question or two. So as weird as it may seem, my character is in the middle of the Amazon rainforest and she has just been shot in the left shoulder. However, she also has about nine stab wounds – her murderer wants her to suffer for personal reasons. So I read that being in a tropical climate increases the risk for infection, my first question is: should I have the bullet taken out? Secondly, how long would it take her to die with nine stab wounds, (four in the legs, four in the arms, and one near the hip) and a gun shot wound with a basic pistol? However, the important information you need to know is that she has a special blood type that allows her to survive longer than the average person and heal quicker too. I would really appreciate some help, I’ve been struggling with this for some time:)

  • By Rosie, January 21, 2016 @ 1:04 pm

    I’m writing a scene where a teenager is shot in the abdomen with a small caliber bullet (either ,22 or .25). This bullet would end up piercing the liver, which would cause a lot of bleeding. Would the bleeding be mostly internal? Or would there be a large bloodstain on the ground?

    The this character receives medical attention as fast as they can. But in an ambulance in about 8 minutes en route to a hospital about 15 minutes away (just based off how close I am to a hospital). What are the chances of my character dying before arriving. I’m intent on this character surviving though not without a very, very close brush with death. What would be the most realistic time frame for receiving care at a hospital, but nearly dying. And what would be the estimated recovery time for this type of injury?

    Many Thanks,


  • By Jack, February 1, 2016 @ 5:00 am

    I am writing a scene where a character during the 1960s is shot in the head with a low-caliber handgun. The bullet strikes a glancing blow and does not penetrate the skull. However, a bullet fragment or two penetrates the inner skull, but does not appear to affect his motor skills. Because of the danger in trying to get at the fragments, the doctors (with 1960s technology available) decide to leave them. I want the victim to survive a few years, but deal with after-effects, such as headaches and occasional blurred vision. A few years later, I want a blood vessel to erupt due to the location of the fragment, and have the victim die from a cerebral hemorrhage. Any help you can give me will be deeply appreciated, and acknowledged in my book (this will be my fourth published work!).

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