Day: July 18, 2024

Four days after former president Donald Trump was shot in the ear at a rally in Pennsylvania, his medical team has yet to release detailed records of his condition or treatment. And while his campaign has pronounced him to be in good health, numerous experts on gunshot trauma and emergency medicine interviewed by STAT said there could still be outstanding questions.

All emphasized that they could not comment specifically about Trump’s injury, having not examined him themselves, and added that it did appear that the injury was minor. But they also said that in cases like Trump’s, it would be important to rule out any injury to the brain or neck.

“It may appear like only a graze to Trump’s ear, but a ballistic injury that close to the head/brain isn’t trivial,” Baylor University Medical Center emergency physician Amy Faith Ho posted on X shortly after the shooting on July 13.

Here’s how experts said they would respond to injuries like Trump’s — and their thoughts on the lingering questions that have not been publicly addressed.

How emergency doctors approach gunshot wounds like Trump’s

In an interview with STAT, Ho elaborated on how gunshot wounds close to the head are typically treated. “Initially, our concern would be things like brain bleeds, arterial bleeds, or other vascular injuries, like something called a dissection. We would also be concerned about bony injuries, so fractures and specifically a skull fracture or a cervical spine fracture if it hit the neck.”

“Besides the obvious inner and external ear injuries possible, the force of ballistics at that proximity make both skull fractures and head bleeds a very real risk,” Ho said. Injuries of this kind would require CT scans of the head and the neck, allowing evaluation of the arteries in both, Ho said. She said she’d also check for hearing loss, vertigo, and dizziness.

Nicholas Namias, chief of the division of trauma and acute care surgery at the University of Miami Miller School of Medicine, also noted that the biggest concern with gunshot wounds close to the head is always a brain injury.

“These weapons are very high velocity, and you actually can get a brain injury with what looks like a graze, without even a fracture to the skull,” Namias said.

Following initial treatment of the local wound and a CT scan to detect potential brain damage, Namias added that he would refer the patient for psychological testing.

“Most people don’t have it filmed,” Namias said of traumatic events like this. “He can see it over and over and over, so this has got to be harrowing and so you would screen someone like that for post-traumatic stress disorder.”

Any gunshot wound to the head is treated seriously, said Matthew Mostofi, associate chief of emergency medicine at Tufts Medical Center.

Most gunshot victims, he said, are rapidly assessed to make sure their airway is open, their neck is stabilized, and that they are breathing. “A quick way to do this is to ask their name. If they say, ‘My name is Donald,’ you say, ‘Great, you’re breathing.’”

“Then we examine you,” he said. “We’d look at the ear last.”

Mostofi emphasized that he could not diagnose Trump from a distance but said that the information he had heard suggested Trump had only sustained an injury to the pinna, or outer ear. “That’s not a life-threatening injury,” he said.

Ear injuries do have specific potential complications that Trump’s medical team would likely be on the lookout for, according to Mostofi, such as “cauliflower ear” — a malady often seen in wrestlers that occurs when the skin and cartilage of the ear become separated by a hematoma and the cartilage does not receive enough oxygen as the wound heals. One remedy is to use a pressure bandage after the injury to make sure the skin and cartilage stay in contact.

“The ear is an interesting little appendage,” he said. “It’s skin over cartilage and there’s not a lot of blood supply.”

He also said perichondritis — an infection of the ear cartilage — remained a risk and could be more serious than infection of the skin.

Mostofi said patients who had fallen or experienced tenderness in their neck would be sent for further imaging to rule out issues to the head, neck, or spine, especially if they were older, but said “if you hadn’t fallen or had any tenderness we might not do any imaging.” He said he did not think concussion was a potential issue because the bullet had been fired from so far away. While “barotrauma,” or damage to the eardrum by a pressure change when a gun is fired in a closed car, can be a risk, that was not the case here.

Kenji Inaba, a professor and vice chair of surgery at Keck Medicine of USC and chief of trauma and surgical critical care there, also said there was a low likelihood of brain injury or hearing loss from a ballistic injury to the outer ear, but that close examination was important to look for errant bullet fragments or anything that may have hit the ear and continued into the face or brain.

“When we’re talking about ballistic injuries or gunshot injuries, we want to make sure we discuss all the potential injuries,” said Inaba, who is also the medical director for the Los Angeles Police Department.

Inaba said the apparent minimal nature of a gunshot injury that could have been far worse was something he sees often in his own trauma center. “We see this all the time, where the head or the body happens to be in a particular space completely impacts the consequences of that bullet,” he said.

Open questions about Trump’s injury

So far, there has been no release of official medical reports from those who treated Trump and no release of test results or imaging following the shooting. What is known is that after the shooting early Saturday evening, Trump was taken to Butler Memorial Hospital in Pennsylvania, where staff treated his injuries. He was released the same day within a few hours. Trump said Saturday in a post on his social media platform, Truth Social, that he had been “shot with a bullet that pierced the upper part of my right ear.”

The most detailed medical information yet has come from Trump’s former White House doctor, Rep. Ronny Jackson of Texas, who said he examined Trump shortly before the start of the Republican National Convention and said on a podcast that the bullet had taken off a chunk of Trump’s ear.

“He was lucky,” Jackson said on The Benny Show. “I mean, it was far enough away from his head that there was no concussive effect from the bullet, and it just took the top of his ear off.” Jackson said Trump’s wound was initially bleeding heavily but that he “will be OK.”

Jackson told The New York Times he had changed the bandage on Trump’s ear and that it was large “because you need a bit of absorbent” and “you don’t want to be walking around with bloody gauze.”

Trump told Jackson that had he not pulled his head back just a microsecond before the shooting to gesture toward a graphic behind him, “that bullet would have entered his head,” according to Jackson. He added that Trump told him: “That chart that I was going over saved my life.”

Trump’s son Eric told CBS News this morning that his father did not receive stitches but “had a nice flesh wound” and was doing well.

In the aftermath of the attempted assassination, more detailed information from official medical sources has yet to be released — a cause of concern for some observers.

Nick Mark, an intensivist in Seattle, said that he was frustrated more information was not being released or reported by the media.

“Did he have a head CT? What did it show? Did he have stitches? Tetanus shot?,” Mark asked Tuesday in a post on X.

Speaking with STAT, Mark said that he didn’t want to fearmonger and that the wound could be minimal. That said, “I’d want to know as a doctor that the person running for the highest office hasn’t been cognitively impaired by a high velocity bullet.”

“There’s been so much attention rightfully given to President Biden’s health, and almost nothing about this,” Mark said. “It’s frustrating.”

Steven Beschloss, who wrote a book about presidential assassin Lee Harvey Oswald, said he was concerned about the information vacuum surrounding the shooting. “I find it stunning Trump is the only source—did a bullet hit him, graze him, or was it something else,” he posted.

“It’s been three days going on four since this horrific event occurred […] yet we have not received a medical report from the hospital nor have we received a medical report from the campaign or the Trump organization about the damage to his ear,” said former Republican National Committee chair Michael Steele in an interview with MSNBC. “There are a lot of questions about that ear.”

The consensus, however, is that Trump got lucky.

“It certainly would seem former President Trump should make a full recovery,” said Thomas Scalea, the physician-in-chief of the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center. “In terms of his ability to function and recover, it seems it won’t be a problem.”

Scalea said his thoughts went beyond the medical issues involved. “The real story to me is you can’t run for president without someone trying to kill you,” he said.

“It was close — three or four inches away and this is a completely different story,” he said. “It’s a matter of inches.”