A bullet wound is a severe, life-threatening medical emergency requiring immediate professional intervention due to the high risk of rapid blood loss and internal organ damage. Ballistic trauma creates widespread damage, often far from the entrance site, due to the projectile’s path and the transfer of kinetic energy to surrounding tissues. This guide provides immediate first aid stabilization and temporary life support measures until Emergency Medical Services (EMS) personnel arrive. The priority is to bridge the time gap between injury and definitive medical treatment at a trauma center.
Prioritizing Safety and Calling for Help
The first step in any trauma situation is ensuring the scene is safe for both the rescuer and the injured person. Do not enter a situation where you could become a casualty, as this increases the number of people requiring rescue. Only after confirming the environment poses no immediate threat should you approach the patient to begin administering aid.
Simultaneously, or as soon as safety is confirmed, immediately activate the emergency response system by calling 911 or the local emergency number. Provide the dispatcher with a clear description of the location and the nature of the emergency, specifically stating that a person has a gunshot wound. Relay information about the patient’s condition, such as whether they are conscious or breathing, to help the dispatcher prepare the responding medical team.
A quick assessment is necessary to identify the source of the bleeding and locate all wounds. Gunshot wounds can be penetrating (bullet remains inside) or perforating (an exit wound is present). Expose the injury by carefully removing or cutting away clothing to find both the entry and exit points, as both locations may require immediate bleeding control.
Stopping Severe Blood Loss
Hemorrhage, or severe uncontrolled bleeding, is the leading cause of preventable death in trauma cases, making immediate bleeding control the most time-sensitive intervention. The initial and most effective technique is to apply firm, direct pressure to the wound using a clean cloth, sterile gauze, or any available material. This pressure must be constant and strong enough to compress the blood vessels and allow a clot to form.
If the wound is deep and cannot be easily compressed (such as the torso or groin), the next step is wound packing. This involves tightly shoving gauze or clean fabric deep into the wound cavity until the cavity is full. After packing, maintain continuous, firm direct pressure over the packed material to maximize the compressive force against the bleeding vessels. Do not remove any material once it is placed, even if blood soaks through, as this can disrupt the forming clot; simply add more layers on top and continue pressure.
A tourniquet should be applied only if life-threatening bleeding originates from an arm or leg and cannot be controlled with direct pressure or wound packing. The device must be placed high on the injured limb, approximately two to four inches above the wound, but never directly over a joint. Tighten the tourniquet until the bleeding stops completely, which will likely be painful for the patient.
Once applied, the tourniquet must not be loosened or removed by first aid personnel, as this action can restart the hemorrhage. Note the exact time the tourniquet was applied, writing it directly on the device or the patient, as this information is needed by the medical team. Never attempt to remove any impaled objects, including a bullet or bullet fragments, as they may be providing a tamponade effect that controls the bleeding. Removal of such objects should only be performed by a surgeon in a controlled operating room environment.
Recognizing and Managing Traumatic Shock
Traumatic shock, specifically hypovolemic shock, is a systemic response to massive blood loss and inadequate oxygen delivery to the body’s tissues. Signs of shock include a rapid heart rate, pale or cool and clammy skin, and an altered mental status (confusion, restlessness, or anxiety). These symptoms are the body’s attempt to compensate for reduced blood volume by shunting blood away from non-essential organs toward the brain and heart.
Immediate management involves keeping the patient warm by covering them with a blanket, coat, or whatever is available, as hypothermia can worsen shock and compromise clotting ability. The patient should be kept lying down to maximize blood flow to the brain. Avoid elevating the feet in trauma patients with suspected head, neck, or chest injuries, as this can increase bleeding or impair breathing.
Continuous monitoring of the patient’s responsiveness and breathing is necessary while waiting for EMS. If the patient becomes unresponsive, the rescuer should be prepared to open the airway and monitor breathing. The goal of this pre-hospital management is to stabilize the patient and prevent further deterioration until they can receive definitive care.
Subsequent Medical Procedures and Long-Term Care
Once the patient arrives at the trauma center, medical personnel begin a comprehensive assessment, often utilizing rapid imaging techniques like X-rays and computed tomography (CT) scans. These scans map the bullet’s trajectory and identify damaged organs or internal bleeding. The immediate focus is stabilization through blood transfusions and fluid resuscitation to combat hypovolemic shock and prepare the patient for surgery.
Surgical intervention is frequently required to perform damage control, which prioritizes stopping internal hemorrhage and controlling contamination before definitive repair. Surgeons debride the wound, removing devitalized tissue and foreign material necessary to prevent severe infection. Repair of damaged blood vessels, intestines, or other organs follows, sometimes requiring multiple staged operations.
Infection prevention is addressed immediately through the administration of broad-spectrum antibiotics and tetanus prophylaxis, as the wound tract carries debris and bacteria deep into the tissues. Long-term recovery is often complex, involving physical rehabilitation to address muscle and nerve damage and restore lost function. Patients with chest or abdomen injuries are more likely to require readmission for complications, highlighting that the effects of a bullet wound can last for years.