Gunshot wounds happen, sometimes accidentally, sometimes maliciously. When someone sustains a gunshot wound, knowing standard first aid can give them the best shot at recovery.
To treat a gunshot wound, you should remember some standard first aid principles about patient assessment and situational awareness. A gunshot wound is a complicated injury, with many victims sustaining blunt trauma, penetrating trauma, and even burns. The good news is, when you learn to treat a gunshot wound, you'll also be ready to treat many other types of injuries.
To properly treat a gunshot wound, there are several key steps to follow; however, it all starts with understanding how a gunshot wound impacts the body.
Understanding How to Treat a Bullet Wound
Before we can talk about the process for treating a gunshot wound (commonly known as a GSW), we need to understand a little bit about what happens to someone when they're hit with a bullet. Some people might assume that the bullet only pokes a hole, but there's a lot more happening.
Here are several things that happen with a GSW:
Let’s talk more about the dangers associated with gunshot wounds.
Bleeding Associated with Gunshot Wounds
First, gunshot wounds cause bleeding. When the bullet passes into (or through) the body, it will tear open blood vessels, including veins and arteries. This can lead to significant bleeding. In some cases, when a bullet passes through the chest or abdomen, you won't see as much external bleeding.
Don't be deceived. There can still be life-threatening bleeding on the inside of the abdomen or chest cavity.
Bullet Fragmentation and Gunshot Wounds
Another danger of gunshot wounds is the fragmentation of the bullet. You might think the bullet just went through the shoulder area, but there could be shards of metal down in the chest or up into the neck.
It's very important to consider fragmentation, as there can be more to the injury than meets the eye.
Note: Also, know that with gunshot wounds there is often an entrance and an exit wound, which means there are two areas that need treatment.
Wound Cavity Formed by Gunshot Wounds
If you've ever seen a bullet fired into a ballistic gel, then you'll know about the wound cavity. Essentially, when the bullet passes through a person, there's a massive energy dumped into the surrounding tissue - almost like an explosion.
The wound cavity is yet another way that gunshot wounds are deceptive. There can be "just a small hole," when in reality there was significant internal tissue damage.
Let's talk about one last thing before we discuss treatment.
Multiple Victims and Gunshot Wounds
Another hazard with gunshot wounds - there is often more than one victim. If you hear gunshots, or you're responding to a shooting, you should keep in mind that there might be more than one person hurt.
In these cases, you'll need to perform triage on the scene, ensuring the most serious patient receives help first. These situations are known as mass casualty incidents (MCIs). While we aren't talking about mass casualty incidents in detail here, you can review this article on mass casualty triage.
Okay, now let's talk about treatment.
How to Treat a Person Who Was Shot in Seven Steps
Now, on to the treatment of gunshot wounds. Keep in mind that, although this is a "basic" overview, it's not easy to operate during an emergency, and there isn't anything "basic" about first aid. If you want to help, you'll need to spend some time practicing these steps in real life, and in real time.
Here are the steps to treat a gunshot injury:
- Remain safe (but understand the risks)
- Call 911
- Have the right tools
- Assess the injury (entrance and exit and priority)
- Stop the bleeding
- Special consideration: chest injury
- Special consideration: Abdominal injury
Now we'll cover each of these tips in more depth. Know that this is a general overview. However, we will provide links to learn specific skills.
GSW First Aid: Assess the Scene
The first step is to assess the situation. If someone has been shot, you want to figure out what happened. Was it an accident? Have the police caught the perpetrator? Whenever someone is injured by a gunshot, it's important to understand the inherent risk involved.
Yes, you want to help the victims, but you also don't want to become a victim yourself. Consider your training, whether you have any body armor, and the status of the police when helping a victim of a GSW.
Call 911 After a GSW
Make sure someone has called 911 with any gunshot wound. If you're not sure if someone has, just make the call. The worst that can happen is people calling multiple times, and this happens all the time. You don't want to waste any time asking people whether they've called 911 or not.
If someone has a bad bleed, do your best to stop the bleeding as you call 911. Unfortunately, if it's a bad bleed, the 30 seconds it takes you to call 911 might be too long. There's no hard rule here but use your judgment. If someone is bleeding out, try to hold direct pressure while dialing 911.
Have the Right Tools to Treat a GSW
If you can, have the right tools on hand. Ideally, you would have gloves, trauma dressings, tourniquets, hemostatic gauze, chest seals, airway supplies, an emergency blanket, trauma shears, and more.
There are many helpful items. If you're new to first aid, consider starting with something like the civilian medical trauma kit. This thing will have the essentials to get you started. Of course, don't just buy tools and hide them in your closet. Train with them, and store them in your kitchen, car, and backpack.
GSW Injury: Find All Injuries
When treating someone with a gunshot wound, ensure that you find all the injuries. Traditionally, you would start from the head and work your way down the body, looking for injuries everywhere. If you can, use a good pair of trauma shears to remove clothing so that there's no chance you miss something.
Look at the front and back of the patient. Don't just go off what the patient says, because they will be focused on the injury that's the most painful - and that's not always the deadliest.
GSW Care: Stop the Bleeding
The next step is to stop the bleeding. For the arms and legs, you should hold firm direct pressure - you need to push pretty hard. Too many people just lay their hands on the patient, not placing enough pressure to stop the bleeding. After you start holding pressure, never remove the gauze to look at the injury, as this potentially busts up the clot.
Placing a tourniquet is often necessary on the arms and legs. To learn how, watch this video on how to place a tourniquet. If the wound is to the groin or armpit/neck area, then you might pack the injury with gauze and then hold direct pressure over that.
If you're not trained, look for some stop-the-bleed classes in your area.
GSW Special Considerations: Chest Injury
Direct pressure works for the arms, legs, and junctions (neck, groin, armpits), but what about the chest? When a bullet passes through the chest, it often creates a sucking chest wound. Essentially, since there's a hole in the chest, when the person takes a breath the air will try to come in through the wound.
To treat this initially, cover the wound with your hand. Then, if you're trained you can place a chest seal over the wound. You can also use something like a plastic bag taped on three sides so air can escape (potentially preventing a tension pneumothorax). Make sure you don't forget about the victim's back!
For more on chest seals and treating chest injuries, read this guide to using chest seals.
GSW Special Considerations: Abdominal Injury
The abdomen is similar to the chest. One thing to remember is that the lungs come down further than you might think, so even if it looks like a wound to the abdomen, it might also affect the lungs.
Packing the chest and abdomen isn't optimal, if you want to see why you can watch this video on why we don't pack the chest.
Conclusion: How to Care for a Gunshot Wound the Right Way
Hopefully, you've learned something about first aid for a gunshot wound. However, know that there is a lot to learn to become proficient at stopping a serious bleed. The best thing you could do is read more on the topic, take classes, get your hands on some gear (tourniquets, trauma dressings, gauze), and practice.
To treat a gunshot wound, make sure you consider your safety. Call 911 and stop any major bleeds with firm and direct pressure. Do your best to carry some first aid gear so that you're prepared. For injuries to the chest or abdomen, you'll want to seal them with some sort of occlusive dressing.
If you'd like, watch this video on how to treat gun and knife wounds.