Tuesday, March 2, 2021

More on gunshot first aid

Long time reader and some times commenter Tacitus was an ER doc.  I emailed him a link to Divemedic's excellent post on gunshot first aid and asked if he had any thoughts from the perspective of the ER surgeon.  This is his reply, posted with his gracious consent.  It seems entirely sensible.

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Treating gunshot wounds.  A different perspective.


As a regular reader of Borepatch I read with interest the account of the recent “Blogshoot”.  It sounds like a lot of fun.  Afterwards our amiable host asked if I’d comment on the points raised by Divemedic, which were to some extent general First Aid but dealt specifically with what to do if someone gets shot. 


I’ll start by saying that the advice was all good.  EMTs in the field do a lot of little things so that by the time they get to my ER things are hopefully in as good a state as can be.  But here’s my take.


  1. Far and away the most important thing is not to get shot.  This seems obvious, but what part of firearms safety isn’t!  Guns are extremely effective at the job they are designed to do.  If I had any spare neurons left at my age I would not use them debating which clotting agent is best.  Nope, I’d recite the basic rules of firearms safety as a mantra.
  2. OK, let’s say the worst does happen.  There are several very important considerations.  Location, location, location….  There are places where a bullet can hit you where no first aid will help.  Conversely, if you take off the tip of your little toe you will be little the worse for the experience and much the wiser for it.  Tourniquets, heating blankets, dressings…these are with one or two exceptions mostly useful only for the in between things.  Extremity wounds with bleeding for instance.
  3. Location, location, location Part II.  For any given injury the survival rate will vary greatly by where you got shot.  Across the street from Mass General Hospital?  You would have a good chance of surviving anything that was not neurologically devastating.  Going caribou hunting in remote parts of Alaska?  A shovel might be an appropriate addition to your first aid kit.  That’s because…
  4. Time matters.  In trauma there is the concept of a “Golden Hour”.  We have impressive abilities to rapidly, if temporarily, respond to physiological challenges.  Our blood clots.  We mobilize our immune system.  We pick up our heart rate to move around what blood remains faster.  Those systems will eventually fail.  Sooner if you are old and frail.  Later if young and healthy.  I’ll always remember a fit young man who came to the ER with no warning.  He had a gunshot wound that destroyed his femoral artery.  His buddies threw him in the car and drove like hell.  His heart was still beating, but 99% of his blood was on the floor of a Chevy Suburban.  In many cases the most important thing you can do in the face of an obvious serious injury is to call 911 with exact information.  Where you are.  The nature of the injury.  Trust me, if you say the words “gunshot wound, looks bad” and then stand out in a field waving a flag when you hear the helicopter, you’ve done a great deal.
  5. I’d also put in a plug for remembering that there are other far more common medical emergencies that you’ll encounter at the range, and everywhere else.  Take a basic first aid course and learn CPR.  Know your range buddies well enough to pick up on things like low blood sugar…confused people with firearms would seem like a very bad scenario.


And finally I’d say, don’t panic.  Keep your wits about you and do the best job you can.  It’s all you can ask of non professionals.  And it can often make a difference.


In closing I’ll say thanks to all the Borepatchians who offered advice a few months back when I was researching deer rifles after becoming a first time hunter in retirement.  I put your wisdom to good use and am happy with the first firearm I’ve ever owned.  And yes, I do recite the rules of firearms safety as my mantra.


Tacitus MD 

10 comments:

The Freeholder said...

I carry a kit similar to DiveMedic's recommendations. I just have more tourniquets, chest seals and Israeli bandages. I also have added a flashlight (which will soon be a headlight) and a Sharpie.

I'd also recommend to any and everyone to take a Stop The Bleed course if you can find one. I got lucky and had an actual doc teach mine. He had started out as a medic in the Sandbox. He's why I carry multiples of quite a few things, and why I am building a monster version of my normal kit. I figure if I can show the young survivors of the New America that I can be very useful, maybe they'll see to it I get 3 hots and a cot somewhere.

Unknown # 4B, Jr. said...

Q: What's the #1 cause of death at gun clubs and shooting ranges?
A: Heart attack. Not gunshot wounds.

I'm not teaching gun classes much at all anymore but if I were I'd buy an AED to go with the trauma kits (yes, two: a small "stop the bleed" kit from NAR on my belt (plus a second tourniquet in my pocket, just in case) and a larger companion kit that's NEVER more than 5-8 steps away.

You may have the most complete and perfect blowout kit ever made but if it's in your car 60 seconds away those 2 minutes to go get it are a death sentence.

Whenever I walk into a space I look for several things: where are the exits, what sort of people are in this place, and do I see any signs telling me where the AED is (the NAR kit may not be on my belt all the time but the stuff that's inside one is always in my vest or jacket pockets).

Pro Tip: In any class, or gun range gathering, select "The Communicator" - a level-headed person with a fully charged cell phone showing 3 or more bars - this is the person who will call 911 and provide detailed information and directions. They will need a pocket 3X5 card with directions to wherever you are. This person may have to go to the entry gate to meet responders and show them where on the property the injured party is. A second "Communicator" should also be designated as a backup in the the primary Communicator is the person incapacitated.

It's also a good idea at the start of class, or the event, to go over "The Emergency Plan" with the student/attendees - in the event of an emergency who will do what, and how. Having that on a 16X20 poster in large type taped to the classroom wall is a plus.

STxAR said...

I mean no disrespect....

"non professionals" is a term I actually hate. I've never been in an emergency situation where a professional was available onsite at the moment I needed one.

Don't get shot, if you do get shot, get shot where it doesn't matter, or in front of a major trauma unit didn't really help me much.

I may be a weirdo, but if it is interesting, I will study it until I'm comfortable with it. And first aid is one of those interests. The divemedic info was educational.




Pachydermis2 said...

STxAR

No offense taken nor disrespect intended. I of course have been in such situations often.

I was mostly looking to contrast the real world with the unrealistic,
farcical, negligent way gunshots are portrayed in assorted "entertainment".

Scenarios where bystander (better term?) first aid is life and death do happen, but they are uncommon. It is well worth studying first aid. But allergic reactions, heart attacks, and sadly things like overdoses are where field intervention saves many lives.

And while I have no reservations about teaching gun owners - and everyone - about intervention measures the same amount of energy devoted to prevention would be time very well spent.

Be safe.

Tacitus

Old NFO said...

Good adds there! It's always about time, or lack of it...

Aesop said...

Stealing that one!

Murphy's Laws Of Gunshot First Aid:

1. Don't Get Shot.

STxAR said...

@Pachydermis2

I'd like to buy you a meal, and visit for a while. You strike me as a solid individual.

Pachydermis2 said...

STxAR

If you are up Wisconsin way, sounds great!

Tacitus/Pachydermis and several other identities.

Pachydermis2 said...

Oh, I see you are in South Texas. Not down that way often. I do blog regularly on archaeology, robotics, strange fish, current affairs.

https://detritusofempire.blogspot.com/

T

danielbarger said...

All the planning and fancy equipment in the world is useless if you don't have the skills
needed to use the stuff. GET TRAINING. Preferably REAL WORLD training. A real injury is
NOTHING like the fake pretend let's play acting that happens in a First Aid class. And
nobody knows how they will react to an emergency and the sight of real blood spurting or someone in full arrest till they SEE IT. So real world training if at all possible can be the difference between life and death for someone.