A bullet wound is a severe form of penetrating trauma where a projectile tears through skin, muscle, and potentially bone or internal organs. The high velocity of a bullet causes extensive damage far beyond the visible entry and exit points due to the transfer of kinetic energy into surrounding tissue. Any bullet wound is a medical emergency requiring immediate professional intervention because of the immediate threat to life posed by blood loss and internal injury. The actions described here are strictly first-aid measures intended only to preserve life and stabilize the patient until emergency medical services (EMS) arrive. Always contact local emergency services immediately, such as by calling 911.
Prioritizing Emergency Medical Response and Bleeding Control
The immediate priority upon encountering a gunshot wound victim is to control severe bleeding (hemorrhage), as rapid blood loss is the leading cause of death. While waiting for EMS, rapidly assess the patient’s airway, breathing, and circulation (A-B-C) to ensure they remain conscious and are breathing adequately. If the patient is unresponsive or breathing is compromised, focus on maintaining an open airway and preparing to administer cardiopulmonary resuscitation (CPR) if breathing ceases.
To control external bleeding, immediately apply direct, firm pressure to the wound site using a clean cloth, sterile gauze, or any available material. The pressure must be consistent and strong enough to compress the damaged blood vessels, slowing the flow of blood. If the initial dressing becomes saturated, place an additional layer directly on top and maintain pressure without removing the soaked material, which could disrupt clotting.
If the wound is on an arm or a leg and severe hemorrhage cannot be stopped by direct pressure alone, a tourniquet application is necessary. A properly placed tourniquet should be positioned high on the limb, at least two to three inches above the injury, but never directly over a joint. The device must be tightened until the bleeding completely stops, not just slows down, indicating arterial blood flow has been occluded.
Note the exact time the tourniquet was applied, as medical professionals require this information to manage potential complications from prolonged use. Tourniquets are intended for life-threatening extremity bleeding and must remain in place until hospital staff can take over. For wounds in the torso, neck, or head, a tourniquet is not an option; continuous, unrelenting direct pressure is the only first-aid measure.
Managing shock is a significant concern, as it results from severe blood loss and inadequate tissue perfusion. Signs of shock include a rapid, weak pulse, rapid breathing, and pale, cool, or clammy skin. To help manage shock, keep the patient warm using blankets, coats, or emergency thermal coverings, as maintaining body temperature is important.
Keep the patient flat, but if the injury is in the chest or abdomen, avoid elevating the legs, as this can increase internal bleeding or impair breathing. The rescuer should quickly check for both an entry and an exit wound, as a bullet passing completely through the body (perforating trauma) creates two distinct injury sites. However, under no circumstances should the rescuer probe or explore the wound tract to search for the projectile or an exit point.
Initial Cleaning and Debris Removal
Once life-threatening bleeding is controlled and EMS has been contacted, attention can turn to the superficial cleanliness of the wound, though this remains secondary to hemorrhage control. The rescuer should wash their hands thoroughly or use hand sanitizer before touching the wound to minimize the risk of introducing bacteria. This is a basic measure of infection prevention for both the patient and the provider.
For initial cleaning, gently irrigate the wound site using sterile water or a sterile saline solution to flush away surface contaminants. The goal is to remove visible dirt, debris, or foreign matter pushed into the outermost layer of the wound. Perform this irrigation with low pressure to avoid forcing contaminants deeper into the tissue.
Strictly avoid certain common household or first-aid agents, as they can cause further tissue damage and slow healing. These contraindicated substances include hydrogen peroxide, rubbing alcohol, povidone-iodine, or any strong antibacterial chemicals. These agents are cytotoxic, meaning they harm healthy cells, which is counterproductive in severe trauma.
Only remove easily accessible foreign objects that are loose and visible on the surface of the skin, such as small pieces of clothing or surface dirt. This can be done carefully using sterile gauze or a clean pair of tweezers. Any object that is embedded or requires manipulation of the wound to extract must be left in place for professional medical staff.
Attempting to probe the wound, reach inside, or enlarge the opening to retrieve a projectile or deep fragment is highly dangerous. Such actions risk causing catastrophic secondary injury, including severe bleeding from a damaged vessel or further contamination of the deep tissue. The only acceptable action is covering the wound with a clean, non-adherent dressing once superficial cleaning is complete, then awaiting medical transport.
Recognizing Internal Injury and Infection Risks
The greatest danger from a bullet wound often lies beneath the surface, where internal bleeding and organ compromise can occur despite controlled external bleeding. Signs of internal hemorrhage can be subtle but include a rapid heart rate (tachycardia) and a drop in blood pressure, leading to dizziness or lightheadedness. The patient may also exhibit signs of shock, such as pale, cool, and clammy skin.
If the injury is to the torso, specific signs may indicate internal organ damage. Abdominal injury may present with swelling, rigidity, or tenderness, sometimes accompanied by nausea or vomiting. If the lungs are involved, the patient may have difficulty breathing, chest pain, or cough up blood, signaling pulmonary damage.
Penetrating trauma carries a high risk of infection because the projectile can carry foreign material, like clothing fragments and bacteria, deep into the tissue. While immediate first aid focuses on life support, the risk of infection remains high following the injury. Early signs of localized infection include increasing redness, swelling, and pain around the wound site.
Systemic infection, which can lead to sepsis, is indicated by a fever above 100.4°F (38°C) or the presence of pus (thick, discolored drainage) from the wound. The potential for tetanus is also a serious concern with any deep, contaminated wound, emphasizing the need for prophylactic treatment upon hospital arrival. Any signs suggesting internal complications or developing infection necessitate immediate transfer to a trauma center.
Necessary Professional Medical Care
Seeking professional medical care is mandatory, regardless of how minor a bullet wound appears, because the extent of internal damage is often impossible to assess externally. Upon arrival at the hospital, medical staff immediately stabilize the patient and employ imaging techniques to visualize the projectile’s path. This often includes X-rays and computed tomography (CT) scans to track the bullet, locate fragments, and assess damage to bone and soft tissues.
Surgical intervention is frequently required for penetrating trauma, even if the patient appears stable. Surgeons perform debridement, which involves thoroughly cleaning the wound tract deep inside the body to remove contamination, dead tissue, and foreign debris. Surgical exploration may also be necessary to repair damaged organs, blood vessels, or bone fractures caused by the bullet’s passage.
Standard medical treatment includes the administration of broad-spectrum antibiotics to prevent or treat potential bacterial infections introduced by the trauma. Pain management is also a significant part of the immediate and ongoing care plan. The decision to remove a retained bullet or fragment depends on its location; if removal would cause more damage than leaving it, the fragment may be left in place.
Wound closure is typically delayed for several days in penetrating trauma to allow for continued drainage and to monitor for signs of deep infection. First aid is merely a temporary, life-preserving bridge to sophisticated hospital care, which is the only setting where definitive treatment can be safely and effectively provided. Long-term follow-up is necessary to monitor the wound’s healing, manage scar tissue, and ensure no delayed complications arise.