How to Treat a Bullet Wound

Gunshot wounds are one of the most serious forms of trauma that you can encounter. Gunshots cause three types of trauma: penetration (destruction of flesh by the projective), cavitation (damage from the bullet's shock wave in the body), and fragmentation (caused by pieces of the projectile or bone).[1] If is very difficult to predict the degree of damage done by a gunshot wound, and many of the injuries caused by a gun far exceed what you can reasonably treat. For this reason, the best option for most gunshot wounds is to get the victim to a hospital as soon as possible. Read on to learn what you can do to help stabilize a gunshot victim.

If the victim was shot by accident (e.g., while hunting), make sure that everyone's firearm is secured and pointed away from any other people.

If the victim was shot in a crime, try to make sure that the gunman is no longer on the scene. Wear personal protective equipment if available.

Call for help. Call for emergency medical assistance.

Do not move the victim unless you must do so to keep him safe, or to access care i.e.: in a rural or off-road setting.

General principles of first aid for bullet wounds

Steps, warnings and tips are only for your consideration. Although the specifics of treating a gunshot wound will vary somewhat depending upon the part of the body where it occurs, these steps can be applied to all gunshot wounds.

Act quickly. Time is your enemy in treating the victim. Victims who reach medical facilities during the "Golden Hour" have a much better likelihood of surviving.

Check the A, B, C, D, E's. Assess these five critical factors:

A (Airway) - If the person is unconscious, check to make sure that his airway is not obstructed. The tongue can be a common cause of airway obstruction, and simply turning his head can solve the problem.

B (Breathing) - Is the victim taking regular breaths? Can you see his chest rising and falling? If the patient is not breathing, start rescue breathing immediately.

How to Perform Rescue Breathing

C (Circulation) - Does the victim have a discernible pulse? If the victims does not have a pulse, begin CPR.

How to Administer Adult CPR (Cardiopulmonary Resuscitation)

D (Disability) - This refers to damage to the spinal cord or neck. Check to see if the victim can move hands and feet. If not, there may be an injury to the spinal cord that can be worsened by moving him.

How to Treat a Spinal Injury Victim

E (Exposure) - Make sure that you fully expose the patient so that you do not miss wounds to the armpit, buttocks or other difficult-to-see areas.

Control bleeding. Controlling bleeding is most important thing you can do to save a gunshot victim's life.[1]

Applying direct pressure to most wounds is the best way to control most wounds. Use a pad over the wound and apply pressure directly to the wound. If you have nothing available, even your hand or fingers can be used to control bleeding.

Use pressure points in the arm (between the elbow and armpit), groin (along the bikini line), or behind the knee to control bleeding in the arm, thigh, or lower leg.

There is little that can be done in the field to control serious bleeding from the chest, abdomen, or pelvic region. Your best course of action with these sorts of injuries may be to get the person to an emergency room as soon as possible; however, bleeding of this sort frequently leads to death.

Be prepared to treat the victim for shock. Gunshot wounds frequently lead to shock, a condition caused by trauma or loss of blood that leads to reduced blood flow throughout the body. Expect that a gunshot victim will show signs of shock and treat him accordingly. However, do not elevate the legs if the gunshot wound is to the torso, as this will increase bleeding and make it more difficult for the victim to breathe.

Wait for help to arrive. Stay with the victim until help arrives. Avoid moving the victim unless you must.

Special instructions for regions of the body

Head – Gunshot wounds to the head are frequently fatal. Your best option is to keep the head elevated and get the victim to a trauma center as soon as possible.

Face and neck – These wounds typically bleed severely. Use direct pressure to control bleeding and keep the victim upright. Be careful not to obstruct breathing while controlling bleeding. With injuries to the neck, be careful that blood flow to the carotid arteries isn't disrupted, as this can reduce blood flow to the brain.

Chest and back – Apply direct pressure to control bleeding; understand that it may be difficult to control chest bleeding because the ribs make it difficult to compress the structures that are bleeding. Gunshots to the chest can cause what is known as a "sucking chest wound". These happen when air travels in and out of the wound with each breath. Treat these as follows:

Seal wound with hand or airtight material (e.g., plastic film).

Apply an airtight bandage on three sides of the wound (see image below). Do not close the bandage on the fourth side.

Lift the unsealed side of the bandage as the victim exhales to allow air to escape.

Abdomen – Use direct pressure to the injury site. As with the chest, controlling bleeding in these cases can be quite difficult.

Arm or leg – Use direct pressure to control bleeding. Arm and leg injuries from gunshots can be elevated above the heart to help control bleeding. Use pressure points in the arm, groin, or behind the knee if direct pressure does not control bleeding.

Never use a tourniquet except to:

save a life when excessive bleeding can not be stopped by pressure or to go to get help as when alone, then to
arm or leg only and above bleeding (never on any other part of the body.)!

Never use wire, string or similar narrow material that cause new cut or bursting injury and new bleeding injuries when tightened.

Tips - It is very difficult to accurately assess the severity of a gunshot wound based upon what is visible on the victim; internal damage may be severe even in circumstances where the entrance and exit wounds are small.

Gunshot wounds are a common cause of spinal cord injury. If the victim appears to have a spinal cord injury, do not move him unless you absolutely must. If you must move the victim, be sure to keep the head, neck and back aligned.

When applying bandages to stop bleeding, add new bandages over the old; do not remove bandages when they become soaked.

Warnings - Do not put your own life at risk when treating a gunshot victim.

Even with the best of first aid, gunshot wounds may be fatal.

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