Gunshot wounds are severe traumatic injuries requiring immediate intervention. The initial minutes following the injury, often termed the “platinum 10 minutes,” are crucial, as the body is at risk from major complications like airway obstruction, tension pneumothorax, and severe blood loss. Remaining calm and acting swiftly can bridge the gap until professional medical help arrives. Bystander care focuses on managing the most rapidly fatal threats until emergency medical services (EMS) can take over.
Ensuring Scene Safety and Calling for Help
The first action is to ensure that the environment is safe for both the victim and the responder. If a threat, such as an active shooter, remains present, do not render aid, as this risks creating more casualties. Once the area is secure, immediate activation of the emergency medical system is necessary to get professional help en route.
The priority is to call 911 or the local emergency number immediately, providing a clear and concise location and describing the nature of the emergency. Inform the dispatcher of the number of victims and the injured person’s status, such as consciousness or heavy bleeding. Time is a factor in all trauma, and prompt coordination is essential.
Prioritizing Life-Threatening Hemorrhage Control
Uncontrolled bleeding is the leading preventable cause of death in ballistic trauma. Addressing hemorrhage is the first step in hands-on care, often taking precedence over airway management in the initial trauma response. The goal is to stop blood loss by applying firm, consistent pressure directly to the wound site.
For external wounds on the limbs, apply a commercial tourniquet immediately if the bleeding is severe, spurting, or if direct pressure is ineffective. Place the tourniquet high and tight on the limb, two to three inches above the wound, avoiding joints, and tighten it until bleeding stops completely. Note the exact time the tourniquet was applied, as medical professionals need this information to manage potential complications.
If the wound is deep, narrow, or located in a junctional area like the groin or armpit where a tourniquet cannot be placed, wound packing is the appropriate technique. Forcefully stuff the wound cavity with gauze, clean cloth, or clothing to fill the space and apply pressure directly to the bleeding vessel. Push the material deeply until the cavity is packed tightly, and then apply continuous, firm pressure over the packed material.
The pressure applied during direct compression and wound packing mechanically stops the flow of blood and encourages clotting. Once pressure is applied, do not release it to check the wound, as this risks dislodging any forming clot. If the dressing or packing material becomes soaked with blood, place additional layers on top without removing the original material.
Managing Airway and Breathing Issues
Once life-threatening external bleeding is controlled, attention shifts to the airway and respiration. If the victim is unconscious, assess the airway for obstruction and clear it if necessary, using a head-tilt/chin-lift maneuver only if a spinal injury is not suspected.
A gunshot wound to the chest can cause an open pneumothorax, known as a “sucking chest wound,” where air enters the chest cavity through the defect instead of the trachea. This can lead to a collapsed lung and the buildup of pressure called tension pneumothorax. A sucking chest wound is recognizable by a coin-sized opening in the chest wall, sometimes accompanied by a hissing sound during breathing.
To manage this, an occlusive dressing is needed to seal the wound and prevent air entry. If a commercial chest seal is unavailable, improvise one using plastic wrap or any airtight material. Tape the material securely over the wound: cover all four sides if using a commercial seal, or tape down three sides if improvising. This three-sided seal creates a flutter valve, allowing trapped air to escape during exhalation while preventing new air from being sucked in during inhalation.
Ongoing Care Until Medical Professionals Arrive
After managing immediate threats from hemorrhage and breathing compromise, the focus turns to stabilizing the patient and mitigating the effects of shock while awaiting EMS. Severe blood loss often leads to hypovolemic shock, characterized by inadequate blood flow to the body’s tissues.
To manage shock, keep the victim warm by covering them with a blanket or coat, as preventing heat loss can slow physiological deterioration. Position the victim comfortably, usually lying down, and loosen any tight clothing. While leg elevation is sometimes suggested for shock, it is generally discouraged in gunshot victims, as it can worsen bleeding from torso or abdominal wounds.
Continuous monitoring of the patient’s level of consciousness and breathing rate is necessary until medical personnel arrive. Check interventions, such as the tourniquet or occlusive dressing, frequently to ensure they remain effective and have not shifted. Providing reassurance and communication helps keep the patient calm, which may slow their heart rate and reduce oxygen consumption.