Trap guns pose severe survival threat to rural agricultural community: Local study

• Notes need for local population, especially young male farmers, to be educated on avoiding hotspots 
• Suggests law enforcement authorities address victims on legal aspects of firearm possession/usage

BY Ruwan Laknath Jayakody 

Since trap guns and associated morbidity and mortality are among the worst survival threats faced by the rural agricultural community of Sri Lanka, it is therefore vital to take a collaborative effort concerning this health hazard to safeguard the wildlife as well as human beings who live in the vicinity of forests, academics note.

This observation was made in a scientific article on “Trap gun: An unusual firearm injury pattern and injury severity score”, which was authored by M.F. Afdhaal, M.U.F. Zumra, I. Ijaz, M.M.N.S. Madhubhashana and M. Pathirana (all attached to the Anuradhapura Teaching Hospital) and published in the Sri Lanka Journal of Surgery 40 (1) in March 2022.

A trap gun is an illegally manufactured, unusual firearm that causes significant insecurity among the residents of rural areas in Sri Lanka. As described in H. Jayawardhena’s “Forensic medicine and medical law”, it has a long-barrelled, smooth-bore muzzle, resting on a wooden stabiliser, which fires low velocity projectiles (of explosives and pellets), and as mentioned in S.R.N. Benton’s “Trap guns in Sri Lanka”, has a basic trip system (with a trigger cord) as a trigger mechanism, and is triggered by the movement of an animal or a human, which in turn fires the gun.

Though it is uncommon in many parts of Sri Lanka, Afdhaal et al. have observed an unusual number of victims admitted to the Surgical Units of the Anuradhapura Teaching Hospital from the North Central Province, particularly from rural areas.

There are instances, per an Indian study, where approximately 200 admissions were reported annually to the Anuradhapura Teaching Hospital following trap gun injuries.

Afdhaal et al. conducted a retrospective, descriptive, cross-sectional study in the Surgical Units of the Anuradhapura Teaching Hospital. Patients who presented with trap gun injuries as surgical casualty admissions were selected for the study.

The study population consisted of 53 patients. The bed head tickets (BHTs) of the patients from January 2020 to December 2020, were traced.

Patient demographics, the time of occurrence and admission, the body region involved, the type of anatomical structure involved, the injury description, the number of surgeries done, the days of hospital stay, the amount of blood, and the blood component transfusions were included as the study variables.

Afdhaal et al. used the injury severity score as a simplified indicator for anatomical injury severity and defined the injury severity score as minor injuries, moderate injuries, serious injuries (not life threatening), severe injuries (life threatening where survival is probable) and non-survivable injuries. 

The ages of the victims ranged from 20 to 70 years. The mean (average) age was 41.2 years. The majority of the victims were between the ages of 41 to 50 years (26.4%). A total of 51/96.2% were males. The firings had occurred round the clock, but a peak of during dusk (6 p.m.) was observed (54.7%).

According to the injury severity score, 22/41.5% of the victims suffered a score of three, which is severe injury, 12/22.6% of the victims suffered very severe injuries (four), 17/32.1% had suffered moderate injuries (two) and only a small percentage (3.8%) had suffered minor injuries (one). The most common body region affected was the lower limbs in 47/88.7% and among those cases, 39/73.6% were injuries below the knees. Other anatomical regions that were involved were the upper limb (5.7%) and the abdomen (3.8%), however, in most of those cases (60%), the lower limbs were also involved simultaneously. A total of 12/22.7% of the victims had suffered vascular injuries, and three/5.7% of them had suffered from nerve injuries and 62.3% from open fractures. No death or amputations were reported within the particular year. 

The number of surgeries done in each of the cases varied from one to 10 where 42/43.1% of them had undergone only one surgery, commonly under spinal anaesthesia, while the median (the middle number in a sorted, ascending or descending, list of numbers of a data set) number of surgeries was two, whereas out of these cases, four/7.9% of them had undergone more than five surgeries. A total of 17/32.1% of the victims had undergone resuscitation with blood products. The days of hospital stays ranged from one to 97 and the mean hospital stay was seven days.

A total of 46/86.8% of the victims were admitted to peripheral Hospitals initially. Most victims were transferred from the Huruluwewa District Hospital and the Medawachchiya Base Hospital.

Discussing the findings, Afdhaal et al. opined that the reduction in the incidence of trap gun injuries might reflect the at the time prevailing Covid-19 pandemic situation where in this particular year, the people’s mobility was restricted with several months of lockdown imposed by the law enforcement authorities.

Young males who are capable of active occupation are mostly (96.2%) at risk. Similar data has been reported in S. Parathan, J. Arudchelvam and A. Marasinghe’s “Outcome of popliteal arterial (the continuation of the femoral artery [the main blood vessel supplying blood to the lower body and which starts in the upper thigh, near the groin and runs down to the back of the knee] that begins at the level of the adductor hiatus [a gap between the adductor magnus (the largest, most powerful and complex muscle of the adductor group) muscle and the femur that allows the passage of the femoral vessels from the anterior thigh to the posterior thigh and then the popliteal fossa [a diamond shaped space behind the knee joint]) in the adductor magnus muscle of the thigh) injuries presenting to the Anuradhapura Teaching Hospital”. Thus, the trap gun injuries are, Afdhaal et al. observed, likely to have a major economic impact on their families. 

Most of the patients suffered moderate to severe injuries. Such injuries, Afdhaal et al. pointed out, are likely to result in permanent disability. Therefore, they result in an enormous health burden, which includes the costs involved in the hospital stay, operative treatment, drugs and rehabilitation, and which in turn creates a huge socio economic burden to the universal health care policy of Sri Lanka, Afdhaal et al. elaborated.

Though the exact geographical location of the injury is not available in the BHTs, Afdhaal et al. considered the local Hospitals from where they were transferred as the vulnerable geographical area, and therefore noticed a triangular geographical area of distribution as the most vulnerable region which is a loosely defined region in the North Central Province, giving its vertices as Medawachchiya, Huruluwewa and Nochchiyagama. D.M.S. Handagala, W.D.M. Gunasekara and R. Arulkumaran’s “Trap gun injuries – A menace in rural agricultural areas” pointed out that not only in the North Central Province, but that it exists in several other regions.

Preventive measures such as educating the local population, especially farmers on avoiding these hotspots, needs emphasis, Afdhaal et al. added. C.J. Babapulle’s “Medico legal aspects of injuries” noted that the possession and usage of firearms are illegal according to the Firearms Ordinance. Therefore, Afdhaal et al. explained that the victims are also addressed by the law enforcement authorities on the legal aspects.