What’s the last thing that goes through your mind when you’re shot in the head? Well… apart from the bullet. We’re breaking down what happens in those final moments - how the brain reacts, what you might feel and why Hollywood gets it wrong.This is what really happens when you’re shot in the head. Ok, staring down the business end of a loaded gun is hardly an everyday situation for many of us. Even those who find themselves drawn to more ‘armed and dangerous’ lines of work are statistically unlikely to see a gun fight, let alone be part of one. But the chances are, if there’s a gun pointed at your head, the person holding it might be reckless – or desperate – enough to pull that trigger. Let’s say you’re standing just a few feet from someone with a gun pointed squarely at your head. Maybe it’s a mob hitman. Maybe a bitter ex. Or maybe just a violent psychopath who left their tinfoil hat at home. The reason doesn’t matter. What does matter is that their aim is solid. Their range is close. And there's no chance they’re going to miss. The second that the trigger is squeezed, before the bullet has even left the gun and entered your soft squishy brain, there’s already a whole lot going on. Inside the chamber of that gun sits a cartridge – what most people wrongly call a bullet. The bullet is the projectile at the tip - the rest is the cartridge casing, packed with propellant and sealed with a primer at the base. So, the gun is loaded and cocked. The firing pin is held back under spring tension, resting right behind the cartridge. And now - with one final pull - it’s released. The firing pin snaps forward, punching the primer at the base of the cartridge. That tiny impact causes a spark, igniting the chemical powder inside and creating an instant explosion within the cartridge. The propellant chemicals burn and generate a lot of expanding gas, very quickly, causing a massive build up of pressure. Being bottled up in such a small place means there’s only really one direction all that pressure can travel: outwards. And bullet cartridges are designed to channel the pressure from that mini explosion – and all the kinetic energy it causes – directly behind the bullet. The bullet splits off from the end of the cartridge, and is sent down the barrel at high speeds. Most bullets are tapered into a point, which both helps to reduce air resistance as they come speeding out of a weapon. But that tapered tip is also helpful for allowing the projectile to penetrate wood, metal, or in this case, your head. Now, it’s important to bear in mind, everything we’ve described so far has all occurred within only a few seconds – it’s so fast that your brain likely hasn’t even had a chance to process half of what’s happened. And even more unfortunately for you, that’s not the only problem that your brain is going to have today. Whenever we see gunshots on TV, in movies or even inflict them on other players in video games, deaths often seem to happen instantaneously. Sometimes you might see a character struck by a bullet and suffering a slow and painful death and sometimes characters will shrug off bullet wounds no problem. In real life, these are all possible: instant death, a slow, agonising fatal injury or surviving - although this is in extremely rare cases. But it all comes down to a myriad of factors, and while you might think that a head shot is the fast track to our first instant death option, you’d be surprised – and we’ve found a real world example to prove that too. First among these factors is all down to the specifics; what type of firearm was used, what size and calibre are the bullets it’s firing. Then there’s the trajectory the bullet was travelling and what angle it entered your body. All of these might seem like small details, but they can all mean the difference between life, death and something arguably worse. That’s because being shot, well, it’s all a matter of physics! Assuming we don’t know exactly what kind of load out our shooter is packing, then let’s instead focus on the next majorly important factor: the bullet itself. When a bullet is fired and hits a human body, all that energy behind it is transferred onto you, the unlucky target. Wherever it strikes the body is where the energy is transferred to, and that tapered end means it’s all focused onto a small point. This is what causes direct damage to the body, as that pointed end has enough momentum behind it not just to break the skin, but to penetrate tissue and bone. Now, all that energy, concentrated into pushing the point of that bullet through your head. Let’s say you were directly facing the shooter when they fired. That means the bullet is now spinning through the air with enough kinetic energy to break through the skin of your forehead and into the epicranial aponeurosis – the dense fibrous tissue that covers the upper part of your skull. By now, you might be thinking what kind of damage you’d receive from a gunshot to the head? Or rather, you would be, if you hadn’t just been shot. Well, bullets can damage flesh and organs in a few different ways - the first of which coming as a result of a direct hit. This causes a bullet to leave a permanent cavity in whatever is in its path, which in this case happens to be you and the contents of your head: namely your brain. So, you’d likely be on the receiving end of what's known as a TBI, or a traumatic brain injury. In most urban areas across the U.S., gunshot wounds are a leading cause of TBI’s. Roughly 12% of all TBIs are linked to firearms - whether from violent assaults or accidental discharges. And gunshot wounds to the head account for about 35% of all TBI-related deaths. But, if you’re thinking that means you have a 65% per cent chance of survival, think again. Gunshot wounds to the head are fatal around 90%of the time, with most victims dying on the scene, if not instantly. Though some victims can survive the initial trauma – including one we’ll talk about shortly – around half of these survivors will die in the emergency room. So, safe to say, your odds of sustaining a traumatic brain injury? Pretty high. Odds of you surviving it? Not so much. But what exactly causes someone to die from a gunshot wound? A wound where a bullet enters the body – or in your case, the cranium – but does not travel far enough to exit is referred to as a ‘penetrating wound’. If a bullet is able to travel fast and far enough through to exit the body, this is called a ‘perforating wound’ - also known as a ‘through and through’. In either instance, you’ve still got a high velocity metal projectile penetrating and travelling through your brain tissue. But what an impact like this also causes is a wave of pressure to be transmitted through that brain tissue. The resultant damage from this pressure wave – as well as the bleeding – can cause the brain to swell, leading to a TBI and death. There’s another type of injury that can also occur when being shot, and that’s caused by the shock waves of the bullet’s impact. Any tissue surrounding the bullet as it travels on its path can become caught up in a temporary vacuum, created by the high speed and velocity of the projectile. This vacuum can be forty times the size of the actual bullet itself, warping and stretching any tissue caught in its path. As the bullet burrows deep - or passes clean through - it rips apart tissue, bursts blood vessels, and unleashes a surge of pressure inside your skull. But there’s also shockwaves that are coming off the bullet. They ripple outward from the bullet’s path like waves across a pond, distorting and stretching brain matter in every direction. And if that wasn’t bad enough, some bullets can fragment on impact. This causes small, sharp pieces of metal to become lodged throughout any tissue the bullet passes through. The severity of an injury and the extent of the damage left by a gunshot wound to the head can vary depending on the location. If the bullet passes through the tip of your right frontal lobe - just behind the forehead - and avoids the base of the skull, you might actually be “lucky.” That’s because this area doesn’t house as many vital brain functions or major blood vessels as deeper regions. But that still doesn’t guarantee you’d survive the injury inflicted though. If a bullet enters through the tip of your left frontal lobe and travels downward toward the temporal lobe and brainstem - then that’s a different story. It would be travelling through some of the most vital tissue inside your head. That’s more likely to be lights out, permanently. The same goes for if a bullet’s trajectory went through any of the key blood vessels in your brain. This could result in a blood clot, which would rapidly expand, compressing the vital tissues of your brain. If that happens, you’re either dead on the scene, or battling against more of that rapidly increasing pressure inside your skull. Whichever way you slice it, it’s not looking good. If the bullet doesn’t directly penetrate your vital brain tissue shortly after impact, then any one of the resultant injuries will likely finish you off… unless you happen to be extremely lucky. Remember how we mentioned some gunshot victims survive their initial wound? Well, one of those was 14-year-old Ahad Israfil, who was shot in the head as the result of a freak accident. In 1987 while at work, Ahad’s employer allegedly knocked a firearm onto the floor, which caused the weapon to discharge. The bullet struck Ahad in the head, destroying much of his brain tissue - in particular his right cerebral hemisphere, along with the right half of his skull. He was immediately rushed to hospital, where intensive care surgeons tried to save his life. To their amazement, after five hours, Ahad regained consciousness and tried to speak. The skin covering Ahad’s scalp actually survived the injury, and plastic surgeons were able to use a silicon implant to fill the resultant hole in his skull - where the right half of his brain had been. The skin was then stretched over this implant to give Ahad more of a natural appearance - the repairs to his scalp meant he could even regrow his hair. But if you’re thinking that Ahad lived a difficult life missing half of his brain, think again. When a bullet damages someone’s right hemisphere, this can leave the victim with motor and sensory impairments on the left side of their body, and vice versa. Functions like thought, memory, speech and vision are controlled by both sides of the brain working in tandem. So, damaging one hemisphere can mean that someone is still able to perform some of these functions, more often in a limited capacity. Incredibly though, Ahad Israfil not only regained most of his mental faculties and is able to speak, he even successfully obtained an honours degree from his local university. He lived a long life afterwards, eventually passing away in an Ohio nursing home back in 2019, over 30 years after surviving his traumatic brain injury. His is a pretty remarkable story and a great example of the human brain’s capacity to recover even from severe injuries. But if we were in your shoes, we wouldn’t exactly put all our chips on miraculously getting better after being shot in the head. You need a lot of things on the bingo card in order to survive a wound like that, but hey, maybe you get lucky. So long as the bullet entry point and exit wounds aren’t too severe, and the bullet misses the critical areas of the brain. It also needs to be a low-caliber round, fired from a lower-velocity weapon and the shooter can’t be too close. You’d need immediate, high-quality medical treatment, be in good health - not too old, no major medical conditions - and your blood pressure should be stable. And you don’t end up with one of the several possible resultant internal injuries from the gunshot… then maybe survival would be on the cards for you. Think you'd survive a shot to the head? What surprised you the most? Drop your thoughts below. No go check out What Happens When You Die? or click on this video instead.