How to Treat a Gunshot Wound in High Risk or Combat Scenario

This article is to give you an introduction to treated gunshot wounds in emergency situations.

*If you are coming to this page during an emergency, stop and call 911. This does not constitute as emergency medical advice and all casualties should be treated by professionals. Just in case, here is a quick overview:

*Move Patient to a safe location and call 911 (domestic) or a CASEVAC (military)*

1. Inspect the patient. Identify entrance and exit wounds. Apply direct pressure when found.
2. Keep patient flat on their back and elevate legs to prevent shock.
3. For extremity wounds, use pressure bandages first, then a tourniquet if bleeding continues. *For arterial bleeds place direct pressure a couple inches from the promixal side (closest to the heart) of the wound to stop bleeding and apply a tourniquet. Tourniquet should be tight enough to completely pinch closed the affected artery to work.*
4. For chest wounds use caution. Gunshot wounds to either lung area are to be covered with a non breathable dressing. Saran wrap, plastic packaging or even a drivers license can be used. Tape all sides with duct tape.
5. Ensure exit wounds are treated in the appropriate fashion.
6. Monitor heart rate and pulse strength. A fast heart rate and weak pulse indicate possible severe blood loss. Keep patient awake and talking.

Difficulty: Challenging

Instructions

Things You'll Need:

• Bandages (anything CLEAN and absorbent)
• Ace wrap or Kravats (cloth strips)
• Occlusive Dressing with Duct Tape
• Tourniquet
• Optional:
• Tampons (non scented)
• Bungee cord if suitable tourniquet cannot be found

1. Move patient to a safe location and call 911! Medical professionals must be alerted immediately. Ensuring help is on the way is your first responsibility. Do not attempt to treat in a hostile area unless absolutely necessary. A dead or wounded medic becomes a liability, always remember that.
   
   Position the patient flat on their back, with legs elevated to prevent and control shock, if possible. The idea is to keep the blood concentrated in the chest, and gravity assists with this.

2. Don protective gloves if available and perform a rapid full body assessment. Rake your fingers over the patient starting from the head and working down to the shoulders, chest and abdomen. Check each limb individually. Turn patient over on their side and assess for exit wounds starting from the head down. Look for blood, dampness, holes or obvious injury. Exit wounds are sometimes larger, so ensure entrance and exit wounds are properly identified and treated.

3. Treat wounds by severity. Arterial bleeds are the most life threatening and should be treated first. They are identified by a pulsing gush or squirt of bright red blood in time with the patients heart beat. Immediately apply direct pressure to wound.
   
   Extremity Arterial: If bleeding continues on an extremity and direct pressure to the wound is not enough, apply direct pressure to the injured artery two inches up the proximal side of the wound (closest the heart), along the artery. Apply a tourniquet to the pressure point, tighten until bleeding is controlled without direct pressure, and dress wound with a pressure bandage. Hemostats can be used to pinch and hold shut a severed artery. *Use only if properly trained and certified*
   
   Abdominal: With most abdominal injuries direct pressure is the only treatment. I have found non scented tampons to be the easiest and most effective way of treating the external bleeding. NON SCENTED! Mountain Breeze or Vanilla Dreams can lead to Toxic Shock Syndrome and possibly kill your patient. Insert just as far as gentle pressure will let you. Remember it will expand as it absorbs and if pushed too deep can cause complications. Just enough to staunch the bleeding. In case of an abdominal evisceration use a lightly applied, damp bandage in a "taco" shape. Ensure all exposed organs are covered with the moist bandage.
   
   Chest wound: Chest wounds are extremely life threatening if not managed properly. Check for lung sounds or place both hands on either side of the chest and check for bilateral (both sides at the same time) rise and fall. If only one side is rising and falling, or if sounds are found only in one side, the patient potentially has a collapsed lung. Treatment for collapsed lung is an occlusive dressing, made out of a non breathable plastic such as saran wrap or an ID card. For military: MRE packaging work well, or an Ascherman Chest Seal from the Individual First Aid Kit. Place dressing over wound and duct tape all sides. See step 5 for signs and symptoms of complications.
   
   Head and Neck: Direct pressures is the only effect treatment. DO NOT APPLY TOURNIQUET. This may be a no brainer, but trust me when I say people will always surprise you.

4. Monitor blood pressure and heart rate. Check distal pulses (farther away from the heart), pulses will be fast, but hopefully still strong (palpable). Fast, weak pulses indicate hypovolemia (low blood volume) and can lead to shock. If possible, elevate wounded above the heart to slow bleeding. Ensure bandages are not tied unnecessarily tight.

5. Reevaluate the treated wounds. Ensure all bandages are properly dressed, and that the patient is comfortable and awake. Reassurance is very important. Casualties tend to be surprisingly calm, and a good bedside manner goes a long way to keeping them that way.
   
   Chest wounds must be closely monitored for signs of tension pneumo- or hemothorax. This is the buildup of blood or air in the chest cavity, which in turn can put pressure against the heart and aorta effectively pinching off blood flow, leading to death. The main indications are tracheal deviation (throat will be shifted to the side opposite the wounded lung), jugular vein distention (jugular vein will look fat and possibly bluish on the wounded side), and subcutaneous emphysema (air pockets in the skin that pop like rice crispies when palpated). In life threatening cases the treatment is a needle thoracostomy. A large bore needle or canula (IV needle) inserted in the second intercostal space (space between the second and third rib from the top)on the mid-clavicular line (centered between middle of the chest and the side) will release the pressure. After needle or canula are inserted, remove the tip from the syringe barrel to allow pressure or blood to escape. Keep the opening facing away from you in case of squirting.
   
   If no needle is available, and the wound site is open, pressure can be released by removing the tape on one corner of the occlusive dressing. When the patient breaths in, it will be sealed with suction. When the patient breaths out, air should be able to pass through the opening.

6. Stay confident, calm and aware. If you are indeed treating a trauma victim, a calm professional is vastly more effective in controlling shock and patient confidence than a frantic one. Slow down and think about what you are doing; muscle memory and instinct will take over as long as you are in control.

7. When Emergency Personnel arrive, clear the area and turn over the patient to their care. They are trained to take over medical care in these situations and first responders can get impede the evacuation time by trying to keep control of the patient's primary care. Once they are on scene the patient is theirs. Give a pass down report if they ask.

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Tips & Warnings

• The contents of this article are for informational services only. They do are not intended as a substitute to medical advice, diagnosis, or treatment. Never disregard professional medical advice or delay in seeking treatment because of the information in this article.
• If you have an emergency, call 911 immediately.