Performing cardiopulmonary resuscitation (CPR) on a gunshot victim is complex because cardiac arrest in a trauma scenario differs significantly from a medical one, such as a heart attack. While CPR may be necessary, the standard sequence of life support must be altered to address the immediate threat of massive blood loss. Gunshot wounds often lead to hypovolemic shock, where the heart stops not from an electrical malfunction but from a critical lack of circulating blood volume. Successful intervention depends on prioritizing stopping the bleeding before attempting to artificially circulate blood.
Ensuring Scene Safety and Activating Emergency Services
The first step in any emergency, especially one involving a weapon, is ensuring the safety of the rescuer. If the threat is still active, such as an ongoing shooting, a bystander must not approach the victim until law enforcement has secured the area. No medical intervention is worth the rescuer becoming another casualty.
Once the scene is safe, or the rescuer can move the victim to a secure location, immediately call 911 or the local emergency number. The dispatcher needs a clear description of the location, the nature of the injury (a gunshot wound), and the number of victims. This information allows emergency medical services (EMS) to dispatch appropriate resources and prepares hospital staff for a trauma patient with severe blood loss.
The Priority Step: Controlling Massive Hemorrhage
For a gunshot victim, the most immediate threat to life is uncontrolled bleeding; cardiac arrest in this context is often a direct result of massive hemorrhage. The body can bleed out in as little as five to eight minutes, a timeframe that typically exceeds the arrival time of professional medical help. Circulation cannot be maintained by compressions if the volume of blood remaining in the body is insufficient. Controlling this massive blood loss is the immediate priority.
Direct Pressure and Tourniquets
The first technique is direct pressure, which involves firmly pressing on the wound with a clean cloth or gauze. Maintain that pressure without checking the wound. For wounds on the limbs, a commercial or improvised tourniquet should be applied high and tight above the injury, squeezing the limb until the bleeding stops completely.
Wound Packing
If the wound is in a junctional area like the shoulder, groin, or torso, where a tourniquet cannot be placed, the technique of wound packing becomes necessary. This involves pushing gauze, ideally hemostatic gauze if available, directly into the wound cavity and then applying sustained, direct pressure. Stopping the leak addresses hypovolemic shock and buys time until the victim can receive definitive surgical care.
Performing Chest Compressions and Rescue Breaths in Trauma
If the victim is unresponsive, not breathing normally, and life-threatening bleeding has been addressed, the rescuer should begin cardiopulmonary resuscitation. Chest compressions are performed at the standard rate of 100 to 120 compressions per minute, pushing down about two inches deep on the center of the chest. This action mechanically attempts to pump the small amount of blood remaining to the brain and other vital organs.
In trauma-induced cardiac arrest, hemorrhage control and managing a collapsed lung take precedence over conventional chest compressions. If the victim is not breathing, compressions should be initiated while maintaining pressure on the wound. Rescue breaths should be given after 30 compressions. The goal of bystander CPR is to maintain minimal circulation until professional help arrives. If the victim is responsive or breathing normally, CPR is not indicated, and the focus remains entirely on bleeding control and monitoring.
Understanding the Limits of Bystander CPR in Gunshot Victims
The success rate of CPR for trauma-induced cardiac arrest is significantly lower compared to cardiac arrest from a primary medical cause. This is because chest compressions cannot generate adequate blood pressure (perfusion) when the victim has lost a substantial amount of circulating blood volume (hypovolemia). External compressions are also ineffective if the lungs are collapsed or punctured, which are common secondary injuries.
CPR does not address the internal damage caused by a bullet, such as internal bleeding or injuries to major blood vessels. These injuries require immediate, advanced medical interventions like surgery, which are only available in a hospital or advanced pre-hospital setting. The primary role of a bystander is to perform the sequential steps of ensuring safety and stopping the bleeding, which offers the greatest chance of survival and buys time for the victim to reach specialized care.