First Steps in Gunshot Treatment
- Stop the bleeding. Direct pressure, elevation, and a pressure bandage (in that order) usually works for most extremities. This might be the time for that fancy Israeli bandage you’ve got in your bag. (If you have one, you hopefully know how to use it.
- Treat for shock. You should be doing this as you’re doing the other steps. Cover the victim for warmth. Keep covered unless there’s a reason not to, such as you’re checking for wounds. Use medical-grade oxygen if you have it.
- Strip the person and look over the whole body for wounds. You can’t just depend on looking for an entry and exit wound, thinking you know where the bullet has traveled. Sometimes the bullet can hit a bone, break into fragments, and stray anywhere in the body. And some types of bullets can cause multiple injuries. Remember to cover the person back up as soon as you can. Death from hypothermia is a real risk. one bullet can cause multiple injuries—both internal and external. Even if you can’t get expert treatment right away, you need to get it as soon as you can. There are some lifesaving things I don’t cover here that you just can’t do outside a hospital.
Signs of Internal Bleeding Since you can’t see all the bleeding, it’s important to note the initial vital signs. Warning signs of internal bleeding include: Decreasing alertness Nausea/vomiting Weak pulse Lowering blood pressure, or faster and faster pulse. Important Note These treatments for gunshot wounds are complicated and require advanced knowledge. Someone with internal bleeding is probably not going to survive without rapid transfer to a medical facility. For a Gunshot Wound in the Head Think about: the airway.
Tips: Attempt to control the bleeding with direct pressure as best you can (no tourniquets around the neck). Make sure the blood doesn’t choke the person. You can have a conscious person sit up and lean forward, or turn an unconscious person on their side and bend the top knee forward to keep them that way. If you believe a carotid artery (that large artery on either side of the neck that supplies the brain) is nicked, you can apply soft direct pressure, and include an occlusive dressing.
How to Make an Occlusive Dressing out of a Driver’s License For an open, or “sucking,” chest wound, you want to keep air from getting in but also let excess air escape. One makeshift way to do this is to lay a driver’s license or plastic wrap on the wound. When the diaphragm contracts and pulls in air (the same mechanism that makes us breathe), the vaccuum will suck the object onto the wound. But if air needs to escape, it can easily push the object up. The victim needs other treatment, such as a chest tube, right away. The occlusive dressing is just a temporary treatment to keep the situation from getting worse.
For a Gunshot Wound in the Chest Think about: air sucking, spine injury.
Tips: Open chest wounds are also nicknamed sucking chest wounds because they suck air in and can lead to a collapsed lung. You can help stop the sucking by closing the open wound with an occlusive dressing. Remember the spine is also included in the back of the chest. Be very careful about movement of these victims. You want to keep them as still as possible and not damage the spinal cord. If the heart, the lungs, the spine, or a large blood vessel is damaged, there’s not much you can do outside getting immediate expert medical care.
For a Gunshot Wound in the Abdomen Think about: organ protection.
Tips: If the wound is open and you can see the intestines, find a moist, sterile dressing to place on top of the wound (to protect the organs). If the intestines are ripped open, the victim needs immediate medical care. If they don’t bleed to death, they’ll likely die of the coming severe infection. The victim should take nothing at all by mouth until the pain lets up, and then wait a day or two. This is obviously a difficult situation, but this step is very important and a time when a slow drip of IV fluids would be useful.
For a Gunshot Wound in the Arms or Legs Think about: bones.
Tips: Direct pressure, elevation, pressure bandage—in that order. Elevate the wound above the heart, and apply a pressure bandage. Then if it’s still bleeding, take your fingers and apply pressure to the brachial artery for the arm or the femoral artery for the leg. (See the box to the right.) If all else fails in an extremity, go to a tourniquet. (It may come down to “lose a limb or lose a life.” If the area is rapidly swelling, that’s a sign of internal bleeding. Also, consider that a bone might have been injured, even shattered. If you suspect this, the area needs to be splinted. If an arm wound won’t stop bleeding despite direct pressure to the wound and elevation, press on the brachial artery around the place where the arrow in the left picture is pointing (below the armpit). Do this by grabbing underneath the person’s arm, wrapping your fingers to the artery (inner arm), and pressing firmly on it with your fingers. You’ll know you probably have it right when the bleeding slows down. If it’s still not controlled, try pressure nearer to the heart.
Here’s a trick to try it out now: Get a partner, and find the person’s radial pulse (in the wrist on the thumb side). Then grab the upper arm as described above. You should feel the pulse stop. Only do this for a couple of seconds, of course, since you’re stopping blood flow. For a leg wound that won’t stop bleeding, apply pressure to the femoral artery, shown in the picture on the right. The best place to do this is in the middle of the bend between the front of leg and the hip. (This is not the place where the arrow is pointing; it’s above it.) For a Superficial Wound If the gunshot wound is superficial, clean it as much as you can. Start antibiotics when you’re finished taking care of the wounds.