A gunshot wound (GSW) is a severe form of ballistic trauma requiring immediate intervention. The projectile’s immense kinetic energy generates a temporary cavity within the body, causing damage far beyond the immediate wound channel. Such injuries often lead to catastrophic hemorrhage, the leading cause of preventable death in these situations. The first aid steps taken immediately following the injury are profoundly important for survival until professional emergency medical services (EMS) arrive.
Scene Safety and Activating Emergency Services
The first step upon encountering a gunshot wound victim is ensuring the environment is safe for both the injured person and the rescuer. If the threat that caused the injury is still present, providing care places the rescuer at unacceptable risk. Only after the area is confirmed secure should the focus shift to the victim and notifying professional responders.
Activating emergency medical services is the next step. A call to 911 or the local emergency number must be made at once, even if the rescuer is simultaneously applying pressure to the wound. Providing clear and concise information to the dispatcher is paramount for a timely response.
This communication should include the precise location of the incident, the nature of the emergency, and the number of people injured. The dispatcher also needs specific details about the victim’s condition, such as whether they are conscious, breathing, and experiencing massive blood loss. Relay any observations about the potential location of the entry and exit wounds if known.
Controlling Life-Threatening Bleeding
The most immediate threat to life from a GSW is severe bleeding, known as hemorrhage, which can cause death in a matter of minutes. Controlling blood loss is therefore the highest priority for any person providing first aid. The initial action involves exposing the wound by removing or cutting clothing to assess the full extent of the injury.
Look for both an entry wound and a potential exit wound, as both sites must be treated to control blood loss effectively. Direct pressure is the most straightforward and effective method for controlling external bleeding.
Apply firm and steady pressure directly onto the wound using a clean cloth, trauma dressing, or any available material. This pressure must be forceful, often requiring the rescuer to lean their full body weight into the injury site, particularly for large-vessel bleeds. If the initial dressing becomes soaked, place additional layers directly on top of the first, rather than removing the original material, which could dislodge any forming clot.
Wound Packing
For deep wounds in the torso, neck, or groin—junctional sites where a tourniquet cannot be placed—wound packing is necessary if appropriate materials are available. This method involves quickly and firmly stuffing the wound cavity with gauze or clean material to create internal pressure against the bleeding vessel. Once packed, sustained direct pressure must still be applied to the site to maintain the hemostatic effect.
Tourniquet Application
If severe bleeding is from an arm or a leg (extremity) and cannot be controlled by direct pressure or wound packing, a tourniquet must be applied immediately. Place the tourniquet high on the limb, about two to three inches above the wound, but never directly over a joint. It must be tightened until the bright red arterial bleeding completely stops, which often requires significant force.
A commercially made tourniquet is preferred, though improvisation may be necessary. Once applied and bleeding ceases, the time of application should be clearly noted and communicated to medical personnel. The tourniquet remains in place until the victim reaches definitive medical care.
Addressing Systemic Complications and Shock
Even after external bleeding is controlled, the victim remains at high risk of developing hypovolemic shock, a life-threatening condition resulting from insufficient blood volume to circulate oxygen to the body’s tissues. This systemic failure requires careful management until medical professionals arrive. Recognizing the signs of shock is an important part of continuing first aid.
Signs of hypovolemic shock include pale, cool, and clammy skin, reflecting the body shunting blood away from the surface to preserve flow to vital organs. The heart compensates for blood loss by beating rapidly, resulting in a fast, weak pulse. Breathing may become rapid and shallow as the body attempts to increase oxygen intake.
The victim may also exhibit changes in mental status, such as confusion, agitation, or decreased consciousness. To manage shock, keep the victim lying flat and still to help maintain blood flow to the brain. If there are no suspected injuries to the head, neck, or spine, the legs can be slightly elevated to assist venous return.
Thermal regulation is an important aspect of shock management. A trauma victim can quickly lose body heat, leading to hypothermia, which exacerbates the body’s inability to clot blood effectively. Cover the victim with a blanket, coat, or anything available to maintain their body temperature.
Monitoring the victim’s airway and breathing is a continuous process while awaiting EMS. If the victim becomes unconscious, place them in the recovery position (on their side) to prevent aspiration, provided there is no suspected spinal injury. If the victim stops breathing or has no pulse, initiate cardiopulmonary resuscitation (CPR) immediately if trained.
Critical Actions to Avoid
Several actions, though seemingly helpful, can significantly worsen the outcome for a gunshot wound victim and must be avoided. Moving the injured person should be minimized unless they are in immediate danger, such as from an active threat or fire. Unnecessary movement can aggravate internal injuries, dislodge blood clots, or cause further damage if there are bone fractures or spinal trauma.
If an object is impaled in the body, it must not be removed. The object may be acting as a plug, and its removal could trigger massive, uncontrollable hemorrhage. The only exception is if the impaled object is obstructing the airway or interfering with CPR.
Do not give the victim anything to eat or drink, including water. The trauma will likely require immediate surgery, and a full stomach significantly increases the risk of aspiration during anesthesia. Provide reassurance and keep the victim calm until professional help takes over.