title: Aerial firing and stray bullet injuries: a rising tide.
abstract: BACKGROUND
  Aerial firing is shooting, using fire arm, into the air usually during a celebration.
  
  
  OBJECTIVE
  This observational study aimed to quantify magnitude and impact of stray bullet injuries by aerial firing at surgical emergencies of the Liaquat University Hospital (a university hospital), Hyderabad, Sindh, Pakistan from January 2009 to December 2010 (2 years).
  
  
  METHODS
  During the study period, 144 firearm injuries due to stray bullet reported to the A and E departments of the university hospital. All patients referred to surgical unit providing emergency cover on that day irrespective of the severity of the injury for medico-legal reasons. For this study, the cases were divided into those having trivial injury and do not require any active surgical intervention and those having serious injury mandating surgical intervention. One hundred and two cases of stray bullet injury sustained trivial injury and followed as outpatients after an overnight period of indoor hospitalization; however, 42 patients with stray bullet injuries requiring surgical intervention were hospitalized.
  
  
  RESULTS
  The most common events leading to aerial firing and stray bullet injuries were marriage ceremonies, followed by a political rallies and New Year celebrations. Stray bullet injury also reported after aerial firing on cricket/hockey team victories, Pakistan Independence Day (14th August), cultural day in Sindh and Basant (Kite) festival in Punjab. The most frequent sites with serious stray bullet injury were chest (15), head and neck (10), abdomen (9) and limbs (8), respectively. Surgical interventions performed included chest intubation, exploration of wound tract to retrieve bullet if lodged superficially and was palpable, laparotomy to managed intra-abdominal injury, reduction of fracture site followed by reconstruction, flap reconstruction and graft for nonhealing wound. The mean duration of hospital stay was 19 days. No mortality was observed in this series of patients.
  
  
  CONCLUSIONS
  We conclude that the prevalence of aerial firing resulting in stray bullet injuries is alarmingly on rise in our country. Above all, those doing aerial firing do not considered it as crime, instead taken it as they are privileged to do anything when celebrating. Awareness of the consequences must be propagated by every means to condemn this social crime.
authors.affiliation: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan.
authors.forename: Syed Asad
authors.initials: SA
authors.lastname: Ali
authors.affiliation: Department of Plastic/Burn Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan.
authors.forename: Syed Mohammad
authors.initials: SM
authors.lastname: Tahir
authors.affiliation: Department of Orthopedics, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan.
authors.forename: Asadullah
authors.initials: A
authors.lastname: Makhdoom
authors.affiliation: Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan.
authors.forename: Abdul Razaque
authors.initials: AR
authors.lastname: Shaikh
authors.affiliation: Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan.
authors.forename: Akmal Jamal
authors.initials: AJ
authors.lastname: Siddique
keywords: Management; Pakistan; Wounds and Injuries