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