Gunshot holes

Bullet holes in the wall of an old, rundown cabin near woods in Alaska.

by James Hubbard, M.D., M.P.H.

Many readers have asked that I write about gunshot-wound treatment. After the terrible shootings at the Aurora theater, I thought this might be an appropriate time. If there’s a lesson to be learned from that, it’s you’ll never really know what you might come up against.

And actually, there are new methods for gunshot-wound treatment now. During this war, we’ve changed how we treat gunshot victims on the battlefield. Used to be, the first thing we did was make sure the person had a clear airway and was breathing. But experts have realized that if you’re bleeding badly, that’ll kill you even if you have a clear airway.

Remember that CPR acronym “ABC”? Airway, breathing, circulation? For gunshot victims in war scenarios or other survival situations when you have no access to blood products, it’s now “CAB.” You deal with circulation problems first. Then you can move on to your airway and breathing checks.


First Steps in Gunshot Treatment

1. Stop the bleeding. Direct pressure, elevation, and a pressure bandage (in that order) usually works for most extremities. This might be the time for that fancy Israeli bandage you’ve got in your bag. (If you have one, you hopefully know how to use it. If you don’t have one, there’s no need for me waste your time explaining.) Find more about stopping bleeding, including the proper use of tourniquets, in The Survival Doctor’s Guide to Wounds.

2. Treat for shock. You should be doing this as you’re doing the other steps.

Cover the victim for warmth. Keep covered unless there’s a reason not to, such as you’re checking for wounds. Use medical-grade oxygen if you have it.

3. Strip the person and look over the whole body for wounds. You can’t just depend on looking for an entry and exit wound, thinking you know where the bullet has traveled. Sometimes the bullet can hit a bone, break into fragments, and stray anywhere in the body. And some types of bullets can cause multiple injuries.

What About an IV?

You may have noticed I didn’t mention anything about IVs. Before this war, it was standard practice to start IV fluids on a gunshot victim in the field. But that’s actually controversial now. If you give too much fluid too fast, you may cause the blood pressure to rise enough to blast out blood clots that are keeping the person from bleeding to death. So, unless you’re going to transfer to a medical facility soon, forget the IV, and concentrate on the other things.

Look everywhere. I read of one instance where there were two wounds to a leg—supposedly the entrance and exit wounds. After further exam and X-rays, two bullets were found in the chest, with multiple areas of damage in the intestinal tract. Although you don’t have X-rays in the field, check for difficulty breathing or abdominal pain.

Remember to cover the person back up as soon as you can. Death from hypothermia is a real risk.


Beyond the Basics

Get the victim to medical treatment ASAP. There are all sort of things that can go wrong. For one thing, if the bleeding won’t stop, surgery may be the only treatment that helps. Also, they may need blood transfusions. Neither of these is an option outside a medical facility.

In this post, I’ve talked about the basics of initial gunshot-wound treatment when you can’t get expert help right away. In my next post, I’ll go over more in-depth treatment for specific types of gunshot wounds.

Thanks to my daughter Beth. She’s a paramedic who has trained the military, and knows much more about this than I.

Please, everyone, share your experiences. It could help other readers save a life.

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