Gunshot wounds (GSW) sustained in remote or wilderness environments present a severe challenge because immediate access to surgical care is impossible. Uncontrolled bleeding from a GSW is the leading cause of preventable death in trauma, making swift intervention paramount. This guidance is intended only for emergency situations without professional medical care and is not a substitute for certified trauma training. The goal in any wilderness GSW scenario is to stabilize the individual to facilitate rapid evacuation to a facility capable of providing definitive surgical treatment.
Prioritizing Scene Safety and Initial Assessment
The first step is ensuring the safety of the rescuer, as a second casualty compounds the disaster. Before approaching the injured person, quickly assess the environment for ongoing threats, such as an active shooter, unstable terrain, or environmental hazards. Once the scene is secure, immediately initiate the process of calling for professional help, using any available means like a satellite phone or personal locator beacon.
The initial patient assessment should follow a logical sequence, prioritizing life-threatening issues. Determining the victim’s level of responsiveness provides a baseline for neurological function and guides subsequent actions. The primary physical assessment involves rapidly locating all wounds to understand the path of the projectile and the potential for internal damage.
Gunshot wounds often have both an entry and an exit wound; identifying both is necessary to gauge the extent of the injury. The most immediate concern is locating the source of the most severe bleeding, as massive external hemorrhage can lead to death in minutes. Once significant bleeding is found, attention must shift immediately to controlling that hemorrhage.
Immediate Techniques for Stopping Severe Bleeding
Uncontrolled hemorrhage is the most common cause of death following traumatic injury, necessitating immediate control measures. Direct pressure is the fastest initial response, involving using a clean cloth, sterile gauze, or gloved hands pressed firmly onto the wound site. If the initial dressing becomes soaked with blood, do not remove it; instead, layer additional material on top to maintain continuous pressure.
For deep wounds, such as those in the groin, shoulder, or torso where a tourniquet cannot be applied, wound packing is the preferred technique. This involves forcefully pushing material, ideally hemostatic gauze or a clean improvised fabric, directly into the wound cavity and against the source of bleeding. The wound must be packed tightly until the material completely fills the space and the blood flow ceases.
A tourniquet is the definitive tool for controlling severe, life-threatening bleeding from an extremity. It should be applied high on the limb, directly over clothing if necessary, and tightened until all bleeding stops and the pulse below the device is no longer palpable. Once applied, the tourniquet must be secured using a windlass mechanism or its locking system. The exact time of application must be prominently marked on the device or the patient’s skin.
Tourniquets are highly effective in saving lives. In the wilderness setting, where evacuation times are prolonged, the device should not be removed by an untrained person once applied. If the initial tourniquet fails to stop the bleeding, a second tourniquet should be applied immediately above the first one.
Managing Airway Compromise and Traumatic Shock
After catastrophic external bleeding is controlled, attention must shift to securing the airway and managing breathing problems, such as those caused by a chest wound. A penetrating injury to the chest wall can create a “sucking chest wound,” allowing air to enter the pleural space. This can cause the lung to collapse (pneumothorax) by disrupting the negative pressure needed for normal breathing.
If air is audibly entering and exiting a chest wound, an occlusive dressing (chest seal) must be created immediately to prevent further air entry. This can be improvised using any clean, non-porous material, such as plastic packaging or a piece of duct tape. The material should be secured over the wound with tape, ideally on three sides. This creates a flutter valve that allows air to escape upon exhalation while preventing air from being sucked in during inhalation.
The systemic consequence of blood loss is traumatic or hypovolemic shock, a state where the body’s tissues do not receive enough oxygen. Signs of shock include a rapid, weak heart rate, pale and clammy skin, confusion, or a decreased level of consciousness. This condition is compounded by hypothermia, as cold temperatures impair the body’s ability to clot blood, worsening the bleeding.
Interventions for shock focus on maintaining the patient’s core body temperature and optimizing circulation. The injured person must be insulated immediately by removing wet clothing and wrapping them in blankets, sleeping bags, or an improvised shelter to prevent further heat loss. If no spinal injury is suspected, elevating the legs slightly can help shunt blood back toward the core organs. No oral fluids should be given to a person in shock, as this increases the risk of aspiration or complicates later surgery.
Wound Dressing and Preparation for Evacuation
Once the immediate threats of hemorrhage and airway compromise are stabilized, all wounds must be dressed securely to protect against contamination. Aggressive wound cleaning should be avoided, as scrubbing or irrigating the site can dislodge clots and restart bleeding. Focus on covering the packed or sealed wounds with sterile or clean bandages and securing them firmly with tape or a wrap.
Continuous monitoring of the patient’s condition is necessary, as stabilization is often fragile in a remote environment. Regularly check the patient’s level of consciousness, breathing rate, and radial pulse to identify deterioration. If a tourniquet was applied, periodically check the dressing to ensure bleeding is not creeping around the edges, which indicates a need for further tightening or a second device.
The final stage involves preparing the individual for transport until professional help arrives or self-extraction is completed. If the patient is unconscious but breathing independently, they should be placed in the recovery position to protect the airway. A conscious patient should be positioned for comfort, avoiding any posture that causes pain or impairs breathing. All necessary gear, including insulation and communication devices, must be secured for transport, prioritizing the movement of the stabilized patient.