Suicide by nail gun more common, less successful, than you might guess

Vaughn Bell pointed out this case study of a patient who tried to commit suicide via nail gun, and how medical personnel decided to treat the injury. The case study is impressive, but so is the addendum: Nail gun wounds—specifically, intentionally self-inflicted nail gun wounds—are a lot more common than you might expect.

As with any tool, some people will use a power tool for something other than its intended use, causing unusual injuries. And with the advent of the ˙weekend warrior,Ó more injuries have been caused by power tools. Specifically, the Centers for Disease Control and Prevention reports a dramaticincrease in nail gun injuries. From 2001Ï2005,there were 37,000 injuries caused by nail guns. Of those, 40% were to non-construction workers.

Care for these injuries is usually the same as for any patient with an impaled object. If possible, and if the object is still visible, secure the object. If the projectile isn_t visible and is lodged in the skull, there_s no way to secure the object, and the injury is likely more severe. In this case, because of the unknown location of the projectile, preventing head movement was the primary goal.

Multiple reports of self-inflicted intracranial foreign bodies are documented in the literature. The majority of these are reportedly from suicide attempts. Because the entrance wound may be extremely difficult to see, prehospital providers and ED personnel need to be suspicious of a suicide attempt or psychiatric illness when a patient presents with any blood on the head.

Fatality is reported in up to 40% of cases involving penetrating head trauma. Compressed air nail guns, specifically, are reported to fire at up to 425 meters per second and can cause significant brain injury.


  1. 425 m/s Wow! Is that correct? Most normal 9mm x 19mm loads run at 350-390 m/s only a few +P loads go into 400 m/s territory. You have to go to a .357 magnum to start finding those speeds as normal in a handgun (if you discount hose newfangled hyper fast small caliber armor piercing rounds such as the 4.6x30mm HK and the 5.7x28mm FN)

    Of course handgun energies are higher as bullet weights are higher but still… WOW! Serious brain injury by firing a nail gun into your head… No kidding!!

    1. The author did sloppy research into nail gun velocities.  Only powder charge nail guns (Ramset, Hilti gun, meant to shoot hardened nails into concrete) can approach such velocities.  The largest pneumatic guns, framing nailers, shoot at about 105 ft/s, about 1/12 the velocity stated in the article.  
      See paragraph 8 of this medical journal article on nail gun injury:

  2. ewww!  

    Even in something as extreme as ending your own life, I really feel like contingency planning is appropriate.  Anything that has a serious chance to leave you alive but in pain & crippled seems like it should be low on your list of options.

    I remember hearing about someone who tried to commit suicide by overdosing on tylenol; instead of dying they just completely fucked up their liver.  Such a shitty way to not quite go.  And the nail gun thing sounds worse!  Although at least the nailgun users aren’t taking up space on the liver transplant list.

  3. I do have a nit to pick with the original article!  They say “with the advent of the ‘weekend warrior.'”  I would argue that the ‘weekend warrior’ is not new in the least, and in fact the absence of the ‘weekend warrior’ was/is abnormal.  Almost everyone has a grandfather or great grandfather that built his own house – he probably had a job.  So was he a weekend warrior?  Going back into history there always were people that did plenty outside of what would be considered a “day job” nowadays, and it was very unusual for someone to not have a hand in some major renovation / construction / improvement of their living quarters.  Only the really wealthy could afford to just pay someone to come in and build their house.

    Anyway, that’s a side note.  On the original subject:  Nail gun to the head!  OUCH!

    1. Actually, “weekend warrior” carries the implication that the person is *not* skilled at the activity in question (so “weekend warrior” football players who played all afternoon at the picnic are sore hurting units on Monday, etc).  Yes, a lot of us have forebears that managed to do major projects on their weekends – but they were working on that project *every* weekend.  This is in contrast to the guy who does something like this one Saturday a year, runs out to Home Depot and gets a lot of supplies, and goes to it…

  4. Reminds me of a punch line to a long-lost joke: “Shut up, kid, or I’ll nail your other foot to the floor.”

    1. In general embedded bullets do not preclude an MRI examination since they are usually made of non ferrous metals. However, caution is to be exercised if there is suspicion for the presence of any embedded ferrous ammunition or shrapnel. The introduction of steel shot for shotguns due to environmental reasons has created a problem for radiologists in this regard.
      This being said MRI examination at 1.5 Tesla for patients with embedded metallic fragments due to combat or terrorist attack is considered safe as long as the fragments are not near a vital organ, which again is a big caveat. In this case with the nail embedded in the brain an MRI examination would be definitively out of the question but even then one could reasonably expect a maximum migration about 10mm, potentially lethal yes but hardly “a mess”.

      TL;DR: Combat radiology is a bitch.

  5. Did anybody else read this article while clutching their head as if their brain was going to spill out? 

  6. Nail guns don’t work as a suicide method, because the nails don’t deform or break-apart at impact. They simply slice a clean, narrow hole through the brain. It might cut a major artery, in which case, the person might bleed-out. But it would be relatively slow.

    Guns work due to the deformation of the bullet as it impacts the skull. The classic “small hole going in, big hole going out” scenario. Even if it doesn’t exit the head, the bullet will have greatly deformed (usually flattened/expanded) and, thus, caused a shit-load of interior damage as it shreds-through brain matter, arteries, and the like.

    So, remember kids…Nailguns are for losers.

    1. Actually bullet deformation only really happens if you use a fragmenting bullet like a Glazer or hollow point. Or maybe an un-jacketed “wad cutter”. But the average copper jacketed “ball ammo” will go right though. A 9mm hole just above each ear, one going in and one going out, is very “incompatible with life” as the state medical protocols say. You will bleed out, and rather quickly. But even if you did this in an ER, with immediate medical attention, I’m pretty sure you are now an organ donor. 

      When I was a newbie construction laborer I was angle-nailing through those sheet-metal lumber ties (’cause my boss told me to) using an air nailer. I was up in a scissor lift, about 30 feet off the ground working on the ceiling of a church. Little did I know that a nail could curl and reflect right off the metal, shooting off across the room. Thankfully this happened when the nail gun was angled AWAY from me, not the hundred or so time it was held an an angle where the deflected nail would have wound up in my face. Never did THAT again. =:-o

    1. Remember to bless your nails before use. Do not target fast-moving winged fae in an urban environment. Always leave a saucer of oil out for your tool repair gnome.

      1. And what do the Fae have to fear from blessings? It is the cold iron they cannot abide. Hence I have always done my Fae slaying with bow and sword. Nail guns?? .. Are you sure they work in Tír na nÓg??

  7. Am I the only one bothered by the X-ray image shown on this post (from the linked jems .com case study)? It shows the head of the nail at the rear of the skull, indicating a shot from the patient’s “6 o’clock position” (directly behind). That’s pretty unexpected for a supposed suicide as described in the case study.

    (Must go now to watch more episodes of C.S.I.)

  8. It doesn’t exactly surprise me.  Bullet-firing guns are a restricted purchase, nail guns are not.  Anyone who has used one knows they pack quite a punch.  For someone in a suicidal mindset I can see them trying that route despite the drawbacks.  Suicidal people often don’t realize that a route may be quite unpleasant (like the previously-mentioned Tylenol.  It fries your liver, you die of a lack of liver function.) or prone to leaving you damaged but not dead (brain penetration that doesn’t hit anything vital.)

  9. It’s especially bad if you try to do it with one of those “palm nailers” that takes about a hundred rapidly repeated blows to drive a nail…  Just sayin’…

  10. I will corroborate that nailguns are not all that effective as a suicide tool and offer an anecdote.

    While interning at the coroner’s office, I went to pick up a body of a man who killed himself with a nailgun. Oldboy got two in the chest and four in the right temple before he gave it up. And these were eight-penny framing nails. Autopsy showed that it wasn’t likely the ones in the head that actually killed him. The nails through the skull didn’t actually deform much brain tissue. Hard to say exactly what deficit it would have left him with, but there’s a decent chance he could have survived it.

    However, one of the nails in his chest pierced a pulmonary artery and he bled out into his pleural cavity. Possibly suffocated to death before he lost consciousness from blood loss.

    So don’t do that, kids. It’s not a happy way to go. And don’t just run your car in the garage, either. You’d be really surprised at the mess that leaves behind.

  11. My 2 cents as an owner/user of many nail/staple guns; pneumatic-gas-.22 charge is that they are all dangerous and marked as such.  The manufacturers of these devices mark them with serial numbers, explicit safety markings, AND most give you safety glasses with the purchase (unlike firearms manufacturers).  Most can be easily defeated to fire from an unsafe position, but unlike firearms they don’t work so well for anything other than their intended use.  I am sure that anyone who has been using these things for a while can tell you the fasteners don’t go too far and tend to tumble upon release.  

    My point? I wonder if attempted suicide by nail gun is any more or less interesting, shocking, or successful than any other attempt? I know that it hurts to even fully depress the safety tip against your head on some of these – you would think that would give you that one last chance to think it over..but that’s not how one is thinking, I assume.

    Hey Andy as you probably now know they have special guns for that- with an exposed nail tip to place in the tie hole before firing.

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