Stopping blood loss is the single most important thing a bystander can do for a gunshot victim before paramedics arrive. Roughly a quarter of people who die from gunshot wounds have injuries that are survivable if bleeding is controlled close to the time of injury. The steps are straightforward and can be learned by anyone: make the scene safe, call emergency services, apply direct pressure or a tourniquet to stop hemorrhage, seal any chest wound, and keep the person warm. Every minute you spend on those basics shifts the odds.
Make the Scene Safe and Call for Help
Before you touch anyone, look around. If a shooting just happened, the threat that caused it may still be present. You cannot help a victim if you become one yourself. Move to cover, scan for the shooter, and only approach the injured person when you are reasonably sure the danger has passed or you can reach them without crossing into the line of fire. If the person is in an exposed location and can move, help them get to a sheltered spot before you begin first aid.
Call 911 (or your local emergency number) immediately, or have someone else call while you begin care. Tell the dispatcher that someone has been shot, give the location as precisely as you can, and describe what you see: how many people are hurt, whether bleeding is visible, and whether the person is conscious. Stay on the line if possible, since the dispatcher can walk you through steps in real time. If you are alone and must choose between calling and stopping a catastrophic bleed, controlling the bleeding comes first. A person can bleed to death in minutes from a major vessel injury.
Stop the Bleeding with Direct Pressure
Most gunshot deaths that a bystander can prevent involve uncontrolled hemorrhage. Your first tool is your hands. Place a clean cloth, gauze, or even a bunched-up T-shirt directly over the wound and press hard. Do not lift the dressing to peek at the wound; if blood soaks through, add more material on top and keep pressing. The goal is to push hard enough to compress the damaged blood vessels against underlying tissue or bone.
How much pressure matters. Research comparing different techniques found that manual compression generates roughly five times more pressure than a standard field dressing alone, making hands-on force far more effective at stopping flow from a wound.1Injury. Evaluation of techniques for treating the bleeding wound That said, sustained manual pressure is exhausting, and you may need to push for ten minutes or more until help arrives. If you tire, have another person take over without releasing pressure.
For wounds in areas where a tourniquet cannot be applied, such as the groin, armpit, or neck, direct pressure and wound packing are your main options. Wound packing means stuffing gauze or clean fabric directly into the wound cavity and then pressing on top. It sounds aggressive, but it works by filling the space so that external pressure can reach the damaged vessels. Specialized hemostatic gauze impregnated with clotting agents is even more effective if available, but plain cloth packed tightly will still help.
When and How to Use a Tourniquet
If a gunshot wound is on an arm or leg and the bleeding is severe, a tourniquet is the fastest and most reliable way to stop it. Place the tourniquet high on the limb, between the wound and the heart, and tighten it until the bleeding stops. It will hurt. That is normal and expected. If blood is still flowing, tighten further or place a second tourniquet just above the first.
The most widely studied commercial tourniquet is the Combat Application Tourniquet, or CAT. In one crossover study, every participant who used a CAT achieved successful arterial occlusion on the lower extremity, with a median application time of about 29 seconds.2PubMed. Efficacy of the Military Tactical Emergency Tourniquet for Lower Extremity Arterial Occlusion Compared with the Combat Application Tourniquet: A Randomized Crossover Study Other commercially available designs, including the SWAT-T, RATS, and Tourni-Key, have also performed well in testing, with application times under 30 seconds and arterial flow cessation rates comparable to the CAT.3Prehospital and Disaster Medicine. The Efficacy of Novel Commercial Tourniquet Designs for Extremity Hemorrhage Control: Implications for Spontaneous Responder Every Day Carry Some of these compact designs are small enough to carry in a pocket or purse, which makes them practical for everyday carry if you live or work in a high-risk setting.
Once a tourniquet is on and the bleeding has stopped, note the time. Write it on the tourniquet itself, on the person’s skin, or on a piece of tape. This information is critical for the surgical team that will eventually take over care. For a limb that still appears viable below the tourniquet, evidence supports a safe window of about two hours before the risk of serious complications like nerve damage and tissue death rises sharply.4PubMed. Hypothermia in trauma Data from the conflict in Ukraine underscore why timing matters: reports indicate that many tourniquets remain in place well beyond that two-hour window, compounding the risk of limb loss and kidney failure.5BMJ Military Health. A01 From application to conversion: the development of a tourniquet reassessment algorithm for nonmedical military personnel by a NATO specialist team In a civilian setting where paramedics are likely to arrive within minutes, the two-hour window is rarely a concern, but recording the application time is a habit worth building.
If You Only Have Improvised Materials
Not everyone has a commercial tourniquet on hand. You can improvise one using a strip of fabric (a belt, a scarf, a torn shirt) and a rigid stick or pen as a windlass. Wrap the fabric around the limb, tie the stick in place, and twist until the bleeding stops, then secure it so it does not unwind. The band-and-windlass design performs the most consistently among improvised options.6PubMed. The safety and efficacy of improvised tourniquets in life-threatening hemorrhage: a systematic review
Improvised tourniquets do have real limitations. In one simulation study, only about a third of untrained participants managed to stop hemorrhage with an improvised tourniquet on their first attempt, compared to 94% who succeeded with a CAT.7Annals of Emergency Medicine. Just in Time to Stop Bleeding: Comparing an Improvised Tourniquet Out of Common Items to a Commercial Tourniquet Using Simulation-Based Training Another study found that improvised tourniquets made from an emergency space blanket took over three times longer to apply and failed to fully stop arterial flow in nearly half of applications.8PubMed. Arterial Occlusion Effectiveness of Space Blanket‒Improvised Tourniquets for the Remote Setting Narrow materials like belts can also cause a ligature effect, concentrating pressure on a small area, which raises the risk of nerve and tissue injury.9Military Medicine. A Comparison of Improvised and Commercially Available Point-of-Wounding Tourniquets in Simulated Traumatic Amputation with Catastrophic Hemorrhage Use the widest material you can find, ideally at least an inch and a half across.
An improvised tourniquet is always better than no tourniquet when someone is bleeding to death from a limb wound. But the data make a strong case for keeping a commercial tourniquet in your car, backpack, or workplace first-aid kit if this is a scenario you want to be prepared for.
Dealing with a Chest Wound
A gunshot to the chest creates a unique and dangerous problem. If the bullet penetrates the chest wall, air can be sucked into the space around the lungs with each breath, preventing the lung from expanding normally. You may hear a sucking or gurgling sound from the wound, or see bubbles forming in the blood around it.
The standard first-aid response is to seal the wound. A commercial chest seal is ideal: it is a large adhesive patch designed to stick to skin even when wet with blood. Vented chest seals, which have a one-way valve, perform better than unvented ones in animal studies because they allow trapped air to escape without letting new air in, reducing the risk of a dangerous buildup of pressure inside the chest.10PubMed. The Use of Chest Seals in Treating Sucking Chest Wounds: A Comparison of Existing Evidence and Guideline Recommendations If you do not have a commercial chest seal, any non-porous material can work in a pinch: a credit card, a piece of plastic packaging, or even a gloved hand held flat over the hole. The improvised seal should be taped on three sides, leaving the bottom open so trapped air can vent out. If the person’s breathing worsens after you seal the wound, peel up one edge briefly to let pressure escape.
Remember that bullets often create both an entry wound and an exit wound. Check the person’s back and sides for a second hole. If you find one, it needs to be sealed too.
Abdominal and Groin Wounds
Gunshot wounds to the abdomen and groin are especially tricky for bystanders because the major blood vessels in these areas cannot easily be compressed with a standard limb tourniquet. For groin wounds, specialized junctional tourniquets exist that are designed to press against the pelvis or armpit, but these are mostly carried by military medics and are unlikely to be in a civilian first-aid kit.11PubMed. Abdominal aortic and junctional tourniquet controls hemorrhage from a gunshot wound of the left groin Your best option as a bystander is wound packing: stuff clean material directly into the wound and apply firm, sustained pressure.
If a bullet to the abdomen has caused organs to protrude from the wound, do not try to push them back in. Military tactical guidelines advise covering exposed bowel with a moist, sterile dressing or a clean water-impermeable covering like plastic wrap, keeping it moist, and securing it in place.12Journal of special operations medicine : a peer reviewed journal for SOF medical professionals. The Management of Abdominal Evisceration in Tactical Combat Casualty Care TCCC Guideline Change 20-02 In a trained medical context, a brief attempt at reduction may be considered, but for a bystander with no surgical experience, the safest course is to cover, keep moist, and wait for paramedics. Death in these cases usually comes from associated internal bleeding rather than the exposed tissue itself.
Preventing Shock and Hypothermia
A person who has been shot and is losing blood will go into shock. Their body shunts blood away from the skin and extremities to protect the brain and heart, which makes them pale, clammy, confused, and cold. Hypothermia accelerates a dangerous feedback loop sometimes called the lethal triad: blood loss drives hypothermia, hypothermia worsens the blood’s ability to clot, and poor clotting increases blood loss.4PubMed. Hypothermia in trauma Breaking that cycle is part of your job as a bystander.
Keeping the person warm is simple but makes a real difference. Lay them on a blanket, coat, or anything that insulates them from the ground. Cover them with additional layers. If you have a space blanket (the crinkly mylar sheets that come in many first-aid kits), wrap it around them. Minimize unnecessary movement but do not let them lie on cold concrete if you can avoid it. If they are conscious and there is no abdominal wound, letting them lie with their legs slightly elevated can help maintain blood flow to the brain.
Talk to them. Reassurance is not just kindness; it helps slow the panic response that raises heart rate and accelerates blood loss. Tell them help is on the way. Keep them as still and calm as possible.
What Not to Do
Some well-meaning instincts can make things worse:
- Do not remove the bullet. Leave it in place. Digging for a projectile causes more tissue damage and can restart bleeding that has clotted. Bullet removal is a surgical task.
- Do not apply a tourniquet to the neck, chest, or abdomen. Tourniquets work only on limbs. Applying one to the neck would strangle the person; applying one to the trunk is anatomically impossible and would not stop internal bleeding.
- Do not give them food or water. If surgery is needed, a full stomach increases the risk of aspiration under anesthesia. A sip of water to wet the lips is fine, but do not let them drink freely.
- Do not loosen a tourniquet once it is working. Releasing pressure can dislodge clots and restart hemorrhage. Leave the tourniquet in place for medical professionals to manage.
- Do not move the person unnecessarily. If there is any chance of a spinal injury, such as a gunshot to the back or neck, moving them improperly can worsen the damage. For unconscious patients with a potential spinal cord injury, research supports positioning them in a lateral trauma position that protects the spine rather than the standard recovery position.13PubMed. Evaluating prehospital care of patients with potential traumatic spinal cord injury: scoping review
What to Tell Paramedics When They Arrive
When emergency medical services reach the scene, the information you give them can shape early treatment decisions. Research on EMS handoffs shows that the history of what happened and the patient’s chief complaint are reported in the vast majority of transfers, but vital details like tourniquet application time or interventions performed sometimes get lost in the chaos.14Journal of Collegiate Emergency Medical Services (JCEMS). Evaluating the Content and Quality of Emergency Medical Services Oral Patient Handoff Reports Be ready to tell them:
- What happened: “They were shot in the left thigh” is more useful than “they got hurt.”
- What you did: “I applied a tourniquet at 2:15 PM” or “I packed the wound and applied pressure for about ten minutes.”
- What you observed: “The bleeding slowed after the tourniquet went on,” or “they were talking at first but stopped responding a few minutes ago.”
- Number of wounds: If you found both an entry and exit wound, say so.
Keep it short and specific. Paramedics are trained to ask follow-up questions for anything they need clarified. The most valuable thing you can offer is a clear timeline and a description of what interventions you performed.
Why Bleeding Control Training Matters
Knowing the theory is helpful. Having actually practiced the skills is much better. The “Stop the Bleed” campaign, launched by the American College of Surgeons, offers free or low-cost courses that teach wound packing, tourniquet application, and direct pressure techniques. A systematic review of these training programs found that the vast majority of studies reported significant improvements in both knowledge and tourniquet skills after training, along with greater willingness and confidence to help a bleeding patient.15PubMed Central. Can “Stop The Bleed” training courses for laypersons improve hemorrhage control knowledge, skills, and attitudes? A systematic review
The benefits are real, but they fade. Multiple studies show that bleeding control knowledge and skills drop off within a few months after training, with noticeable declines appearing as early as one to three months out.16PubMed Central. The effect of external bleeding control training courses on lay first-person responders’ knowledge, skills, and attitudes in low- and middle-income countries: a systematic review That means a one-time course is not enough. Refreshers, even brief ones, help keep the muscle memory intact. The simulation training data on improvised tourniquets tell the same story: participants who got hands-on practice roughly doubled their success rate compared to their initial untrained attempts.7Annals of Emergency Medicine. Just in Time to Stop Bleeding: Comparing an Improvised Tourniquet Out of Common Items to a Commercial Tourniquet Using Simulation-Based Training
How Gunshot Wounds Differ from Other Injuries
A gunshot wound is not just a puncture. Bullets transfer kinetic energy to tissue as they pass through the body, creating two kinds of damage: a permanent cavity where tissue is directly crushed and destroyed by the bullet’s path, and a temporary cavity where surrounding tissue is violently stretched outward by the shockwave of energy.17PubMed. Ballistics reviews: mechanisms of bullet wound trauma That temporary stretch can damage blood vessels, nerves, and organs well beyond the visible wound track. This is why a gunshot wound that looks small on the surface can involve catastrophic internal bleeding.
Higher-velocity rounds, like those from rifles, create much larger temporary cavities than handgun rounds, which means more extensive tissue damage and a greater likelihood of injury to structures far from the bullet’s path. For bystanders, the practical takeaway is that the severity of a gunshot wound is almost impossible to judge from the outside. A small entry wound does not mean a small injury. Treat every gunshot wound as potentially life-threatening, control what you can see, and let the trauma surgeons figure out what happened inside.