Each year in the United States, approximately 30,000 persons with BB and pellet gun * -related injuries are treated in hospital emergency departments (EDs) (1). Most (95%) injuries are BB or pellet gunshot wounds (GSWs); 5% are other types of injuries (e.g., lacerations sustained inadvertently while cleaning or shooting a gun or contusions resulting from being struck with the butt of a gun) (1). Most (81%) persons treated for BB and pellet GSWs are children and teenagers (aged less than or equal to 19 years). To assist in developing strategies for preventing these injuries, CDC analyzed data from an ongoing special study of nonfatal gun-related injuries conducted using the National Electronic Injury Surveillance System (NEISS) of the U.S. Consumer Product Safety Commission; this study has characterized the epidemiology of BB and pellet GSWs among children and teenagers in the United States during June 1992-May 1994 (2). This report summarizes the circumstances of six cases of BB and pellet gun-related injuries identified through NEISS and presents the findings of the analysis of NEISS data.

NEISS includes a probability sample of 91 hospitals selected from all hospitals with at least six beds and that provide 24-hour emergency service (2). Data were weighted to provide national estimates of injuries treated in hospital EDs in the United States and its territories (1).

Case Reports

• A 9-year-old boy was struck by a BB beneath his lower left eyelid after he stepped from behind a board at which other children were shooting. The children had been left unsupervised following a youth club target practice session.

• A 16-year-old boy sustained a severe midbrain injury from a self-inflicted combination BB/pellet gun GSW through the roof of his mouth.

• A 9-year-old girl incurred a pellet injury to the back of her right ankle after four boys fired a pellet gun at her from a passing car while she was walking on a sidewalk.

• A 10-year-old boy sustained injuries to his neck and trachea after being struck by a BB from a gun that had been fired unintentionally by an unspecified person.

• A 13-year-old boy was shot in the neck with a BB gun while he and a friend were playing in a house. The friend, who believed the gun was unloaded, had aimed the gun at the 13-year-old and pulled the trigger.

• A 16-year-old boy sustained a penetrating injury to his right eye after being struck by a BB that ricocheted from a gun fired by a friend.

Summary of NEISS Data

During June 1992-May 1994, a total of 959 BB and pellet GSWs among children and teenagers were reported through NEISS. Based on these reports, an estimated 47,137 (95% confidence interval {CI}=39,746-54,528) children and teenagers were treated for BB or pellet GSWs in hospital EDs during this period (an average of 23,600 per year or 65 per day) (Table_1). The incidence of BB or pellet gun-related injuries was highest for males (53.5 per 100,000 population) and children aged 10-14 years (66.6 per 100,000 population) (Table_1), and the sex- and age group-specific rate was highest for males aged 10-14 years (114.3 per 100,000 population {95% CI=94.1-134.5}).

Although most (64%) persons with GSWs were transported to Eds by private vehicles, 8% of those treated were taken to EDs by emergency medical services (Table_2). Injuries to the eye, face, and head and neck accounted for 31% of all injuries. Hospitalization was required for 5% of cases; of these, 37% were associated with severe injury to the eye.

Data on victim-shooter relationship were complete for 71% of cases (Table_2). Based on these data, 31% of injuries were self-inflicted, and 33% were caused by friends, acquaintances, or relatives. Data on 76% of the incidents indicated the type of injury: although most (66%) resulted from unintentional shootings, approximately 10% were assaults; suicide attempts were rare (0.1%). Locale of the injury incident was known for approximately 55% of cases; approximately 45% of injuries occurred in and around a home, apartment, or condominium.

Reported by: Office of Statistics and Programming, Div of Violence Prevention and Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: An estimated 3.2 million nonpowder guns are sold in the United States each year; 80% of these have muzzle velocities greater than 350 feet per second (fps) and 50% have velocities from 500 fps to 930 fps (AC Homan, US Consumer Product Safety Commission, unpublished data, 1994). Most of these guns are intended for use by persons aged 8-18 years. At close range, projectiles from many BB and pellet guns, especially those with velocities greater than 350 fps, can cause tissue damage similar to that inflicted by powder-charged bullets fired from low-velocity conventional firearms (3). Injuries associated with use of these guns can result in permanent disability or death (4); injuries from BBs or pellets projected from air guns involving the eye particularly are severe (5). For example, based on data from the National Eye Trauma System and the United States Eye Injury Registry -- a system of voluntary reporting by ophthalmologists -- projectiles from air guns account for 63% of reported perforating eye injuries that occur in recreational settings (6).

Despite the large number of BB and pellet gun-related injuries treated in hospital EDs each year (1), there are no nationally specified safety standards for nonpowder guns. Although voluntary industry standards were established in 1978 and revised in 1992 (7), the effectiveness of these standards for preventing injuries has not been determined. These voluntary standards specify two types of warning labels, including one on the gun itself ("WARNING: Before using read Owner's Manual available free from {company name}"), and one on the packaging ("WARNING: Not a toy. Adult supervision required. Misuse or careless use may cause serious injury or death. May be dangerous up to {specific distance} ** yards ({specific distance} meters).") (7). The voluntary standards also specify that the owner's manual should provide instructions about handling and operating the gun safely, selecting safe and proper targets, caring for and maintaining the gun properly, storing of the gun in an unloaded state and in a safe and proper manner, and always confirming that the gun is unloaded when removed from storage or received from another person (7). However, these standards do not include specifications regarding other important injury-prevention measures pertinent to minors (e.g., limits on maximum velocity and impact force of BBs and pellets or design modifications to clearly indicate when a gun is loaded) (8).

In the United States, 14 states have enacted laws to regulate the sale or possession of nonpowder guns. Although most of these states restrict the purchase, possession, or use of these guns by minors aged less than 16 years or aged less than 18 years, such age restrictions on the purchase of these guns are void in most of these states when a minor has obtained permission from a parent or guardian.

Analysis of the NEISS data indicate that BB and pellet GSWs treated in hospital EDs typically result from an unintentional shooting of a young or adolescent male who either shot himself or was shot by a friend, acquaintance, or relative. Many of these shootings occur when using or playing with a gun in or around the home. These findings suggest that ready access to a BB or pellet gun and ammunition stored in the home and/or the lack of supervision during use of the gun may contribute substantially to the risk for injury among children and adolescents, especially for boys aged 10-14 years. Although most BB and pellet gun injuries are unintentional, the findings from this analysis and from a statewide ED-based surveillance system in Massachusetts (9) also indicate that BB and pellet guns sometimes have been used to purposefully inflict harm.

Unintentional BB and pellet gun-related injuries that occur during unsupervised activities are preventable. Parents considering the purchase of a BB or pellet gun for their children should be aware of the potential hazards of these guns, and should help to ensure the safety of their children in the presence of a BB or pellet gun. Children and teenaged users should recognize that these guns are not toys but are designed and intended specifically for recreational and competitive sport use. Parents or other adults should provide direct supervision at all times for each child who is using or observing the use of these guns. Each user should be educated about the potential danger of these guns, the importance of gun-safety practices, and how to safely handle and fire the gun. The use of protective eyewear should be enforced during shooting activities. When not in use, all guns in the home should be kept locked up and unloaded. Subsequent efforts to reduce the severity and frequency of injuries associated with BB and pellet guns should include determination of the effectiveness of a variety of interventions (e.g., technological, regulatory, environmental, and behavioral).

References

1. McNeill AM, Annest JL. The ongoing hazard of BB and pellet gun-related injuries in the United States. Ann Emerg Med 1995;26:187-94.

2. Annest JL, Mercy JA, Gibson DR, Ryan GW. National estimates of nonfatal firearm-related injuries: beyond the tip of the iceberg. JAMA 1995;273:1749-54.

3. Harris W, Luterman A, Curreri PW. BB and pellet guns: toys or deadly weapons? J Trauma 1983;23:566-9.

4. Wascher RA, Gwinn BC. Air rifle injury to the heart with retrograde caval migration. J Trauma 1995;38:379-81.

5. Schein OD, Enger C, Tielsch JM. The context and consequences of ocular injuries from air guns. Am J Ophthalmol 1994;117: 501-6.

6. Parver LM. The National Eye Trauma System. Int Ophthalmol Clin 1988;28:203.

7. Committee on Standards, American Society for Testing and Materials. Standard consumer safety specification for non-powder guns. Conshohocken, Pennsylvania: American Society for Testing and Materials, 1992.

8. Greensher J, Aronow R, Bass JL, et al. Injuries related to "toy" firearms: Committee on Accident and Poison Prevention. Pediatrics 1987;79:473-4.

9. CDC. Emergency department surveillance for weapon-related injuries -- Massachusetts, November 1993-April 1994. MMWR 1995;44:160-3,169.

In this report, the terms BB gun and pellet gun refer to nonpowder guns that use compressed air or gas to propel lead pellets or steel BBs. ** Distance is dependent on the type of gun and muzzle velocity.

TABLE 1. Characteristics of children and teenagers aged <=19 years treated in hospital
emergency departments for BB and pellet gun-related injuries -- United States,
June 1992--May 1994
==================================================================================================
Characteristic      No. *     (%)     Rate +    (95% CI &)
----------------------------------------------------------
Sex
  Male             40,605   ( 86.1)    53.5    (45.1-61.9)
  Female            6,532   ( 13.9)     9.0    ( 6.7-11.3)

Age (yrs)
   0- 4 @           1,040   (  2.2)     --
   5- 9             8,033   ( 17.0)    21.6    (16.5-26.7)
  10-14            24,400   ( 51.8)    66.6    (54.9-78.3)
  15-19            13,664   ( 29.0)    39.6    (31.8-47.4)

Total              47,137   (100.0)    31.8    (26.8-36.8)
----------------------------------------------------------

* Based on weighted data from 959 BB and pellet gunshot injuries reported through the National
  Electronic Injury Surveillance System.
+ Annualized rate per 100,000 population.
& Confidence interval.
@ Rate was not calculated because of the small number (21) of cases in this age group; interpret
  estimate with caution.
==================================================================================================

TABLE 2. BB and pellet gun-related injuries treated in hospital emergency departments
(EDs) for children and teenagers aged <=19 years, by selected characteristics -- United
States, June 1992-May 1994
=================================================================================================================
Characteristic                    No. *      (%)       º     Characteristic                    No. *      (%)
-------------------------------------------------------+-------------------------------------------------------
Mode of transport to ED                                º     Victim-Shooter relationship
  Private vehicle                30,298    ( 64.3)     º       Self                           14,636    ( 31.0)
  Walked in                       7,788    ( 16.5)     º       Friend/Acquaintance             9,280    ( 19.7)
  Emergency medical                                    º       Relative                        6,445    ( 13.7)
    service/Fire rescue/                               º       Stranger                        1,260    (  2.7)
    Ambulance                     3,742    (  8.0)     º       Other/Shooter not seen          1,821    (  3.9)
  Police vehicle                    468    (  1.0)     º       Not Stated                     13,695    ( 29.1)
  Other/Not stated                4,841    ( 10.2)     º
                                                       º     Type of Injury
Primary body part injured                              º       Unintentional                  30,960    ( 65.7)
  Extremity                      25,453    ( 54.0)     º       Assault                         4,903    ( 10.4)
  Trunk                           7,276    ( 15.4)     º       Suicide attempt                    34    (  0.1)
  Face                            6,788    ( 14.4)     º       Not stated                     11,240    ( 23.8)
  Head/Neck                       4,747    ( 10.1)     º
  Eye                             2,839    (  6.0)     º     Locale of injury incident
  Other                              34    (  0.1)     º       Home/Apartment/
                                                       º         Condominium                  21,413    ( 45.4)
ED Discharge Disposition                               º       Street/Highway                  1,821    (  3.9)
  Not hospitalized               44,759    ( 95.0)     º       Other property                  1,389    (  2.9)
  Hospitalized                    2,378    (  5.0)     º       School/Recreation area          1,104    (  2.3)
                                                       º       Farm                               90    (  0.2)
                                                       º       Not stated                     21,320    ( 45.2)
                                                       º
                                                       º     Total                            47,137    (100.0)
-------------------------------------------------------+-------------------------------------------------------
* Based on weighted data from 959 BB and pellet gunshot injuries reported through the National
  Electronic Injury Surveillance System.
=================================================================================================================

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