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Clyde

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By: Yanni A., Et Al,
Wiki How
March 2, 2012


Gunshot wounds are one of the most traumatic injuries you can suffer. It's difficult to assess the extent of damage done by a gunshot wound, and most of them far exceed what you can reasonably treat with first aid. For this reason, the best option for most bullet wounds is to get the victim to a hospital as soon as possible. However, this article will provide some guidance on what you can do to stabilize the victim in the meantime.

1. Call for emergency medical assistance.

2. Make sure you are safe.
a. If the victim was shot unintentionally (e.g., while hunting), make sure that everyone's firearm is pointed away from any other person(s), cleared of ammo, safe and secured.
b. If the victim was shot in a crime, try to make sure that the shooter is no longer on the scene and that both you and the victim are safe from further injury. Wear personal protective equipment if available.

3. Do not move the victim unless you must do so to keep him safe or to access care

4. Act quickly. Time is your enemy in treating the victim. Victims who reach medical facilities during the "Golden Hour" have a much better likelihood of surviving. Try to keep your movements swift without making them frenzied.

5. Check the A, B, C, D, E's. Assess these five critical factors

a. A (Airway) – If the person is talking, their airway is probably clear. If the person is unconscious, check to make sure that his airway is not obstructed. Turn the victim's head to the side to facilitate better breathing and get the tongue out of the way. If the victim's mouth is filled with blood, try to help them remove it by coughing or quickly sop it up with a rag or piece of clothing.

b. B (Breathing) – Is the victim taking regular breaths? Can you see his or her chest rising and falling? If the victim is not breathing, sweep his or her mouth for obstructions and start rescue breathing immediately.

c. C (Circulation) – Apply pressure to any bleeding, then check the victim's pulse at the wrist or throat. Does the victim have a discernible pulse? If not, begin CPR. Control any major bleeding.

d. D (Disability/Deformity) – Disability refers to damage to the spinal cord or neck. Check to see if the victim can move hands and feet. If not, there may be an injury to the spinal cord. Deformity refers to things such as compound or obvious fractures, dislocations, or anything that looks out of place or unnatural. These injuries can be worsened by moving the victim.

e. E (Exposure) – Always look for an exit wound. Check the victim as thoroughly as possible for other wounds that you may be unaware of. Pay special attention to the armpit, buttocks or other difficult-to-see areas. Avoid completely undressing the victim before emergency help arrives as this may advance shock.

6. Control bleeding. Controlling bleeding is most important thing you can do to save a gunshot victim's life
a. Applying direct pressure is the best way to control most wounds. Use a pad over the wound and apply pressure directly to the wound. If you have nothing available, even your hand or fingers can be used to control bleeding. Add new bandages over the old; do not remove bandages when they become soaked.

b. Use pressure points in the arm (between the elbow and armpit), groin (along the bikini line), or behind the knee to control bleeding in the arm, thigh, or lower leg, respectively.

c. There is little that can be done with conventional methods if the wound involves the torso, but chemical hemostats (Quickclot, Celox, etc.) have been proven to be very effective on all major bleeds. Ensure that you follow the instructions on the package for application, though it is usually as simple as holding the wound open, pouring in the powder or inserting the powder packet/sponge/applicator, and applying strong pressure for five minutes.


d. Be prepared to treat the victim for shock. Gunshot wounds frequently lead to shock, a condition caused by trauma or loss of blood that leads to reduced blood flow throughout the body[1]. Expect that a gunshot victim will show signs of shock and treat it accordingly by making sure the victim's body temperature is as normal as possible – cover him up if his skin feels cold, or remove clothing and fan him if he's burning up. However, do not elevate the legs if the gunshot wound is to the torso, as this will increase bleeding and make it more difficult for the victim to breathe.

Special instructions for regions of the body
Head – Gunshot wounds to the head are frequently fatal. Keep the head elevated and get the victim to a trauma center as soon as possible.

Face and neck – These wounds typically bleed severely. Use direct pressure to control bleeding and keep the victim upright. Be careful not to obstruct breathing while controlling bleeding. With injuries to the neck, be careful that blood flow to the carotid arteries isn't disrupted, as this can reduce blood flow to the brain.

Chest and back – Apply direct pressure to control bleeding; understand that it may be difficult to control chest bleeding because the ribs make it difficult to compress the structures that are bleeding. Gunshots to the chest can cause what is known as a "sucking chest wound." These happen when air travels in and out of the wound with each breath. Treat these as follows:
  • Seal wound with hand or airtight material (e.g., plastic film).
  • Apply an airtight bandage on three sides of the wound. Do not close the bandage on the fourth side. This will allow the chest to achieve its usual negative pressure state. Air will escape through the valve during inhalation.
Abdomen – Apply direct pressure to the injury site. As with the chest, controlling bleeding in these cases can be quite difficult.

Arm or legUse direct pressure to control bleeding. If you have a length of fabric or string on hand (or can tear one off clothing), make a tourniquet. Arm and leg injuries from gunshots can be elevated above the heart to help control bleeding. Use pressure points in the arm, groin, or behind the knee if direct pressure does not control bleeding (Yanni A., Et Al, for Wiki How, 2012).
 

survivalist

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They also say, if your out of emergency response, open a bullet and pour the gun powder in the wound. This will clot the bleeding. Also if the wounded victim is conscious let him know....It's gonna burn
 

Krime

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They also say, if your out of emergency response, open a bullet and pour the gun powder in the wound. This will clot the bleeding. Also if the wounded victim is conscious let him know....It's gonna burn
I've heard that that only works if the bullet has gone all the way through and not hit any major arteries. if the bullet is still in, give him/her some whiskey and dig it out before the powder.
as far as arteries, I'm not too sure what to do.
 

Clyde

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They also say, if your out of emergency response, open a bullet and pour the gun powder in the wound. This will clot the bleeding. Also if the wounded victim is conscious let him know....It's gonna burn
I have heard that, but never fully researched its validity.

I've heard that that only works if the bullet has gone all the way through and not hit any major arteries. if the bullet is still in, give him/her some whiskey and dig it out before the powder.
as far as arteries, I'm not too sure what to do.
Well I am sure if it is a seriously major artery you are pretty well screwed.
 

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Clyde, awesome post! Spot on! Only thing that could be added is if a clotting agent is used, ''SEND THE PACKAGE'' as alot of ER docs don't see this very often.
 

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as far as arteries, I'm not too sure what to do.
#1....Direct pressure. Put pressure on the wound area. If possible use an absorbent material, towel, shirt, etc. Once the absorbing material is applied DO NOT remove it. The material will aid in clotting and removing it will also remove the forming clot and cause bleeding to return. If the bleeding is soaking through the towel place another one OVER it and continue with direct pressure. You may need to squeeze hard to get the bleeding to stop.

#2....If possible elevate the injured part above the level of the heart. Gravity is your friend. This is usually only beneficial in extremity injuries. If there is a head wound, only elevate to 45 degrees.

#3....Use pressure points. A pressure point is where a pulse can be found. A pressure point is where an artery is close to the surface and is found by placing light pressure and pinching the artery against a bone. The hardest one to locate is the femoral artery. It is located on the inside of the thigh in the groin region. It will take SIGNIFICANT
 

medicken

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#1....Direct pressure. Put pressure on the wound area. If possible use an absorbent material, towel, shirt, etc. Once the absorbing material is applied DO NOT remove it. The material will aid in clotting and removing it will also remove the forming clot and cause bleeding to return. If the bleeding is soaking through the towel place another one OVER it and continue with direct pressure. You may need to squeeze hard to get the bleeding to stop.

#2....If possible elevate the injured part above the level of the heart. Gravity is your friend. This is usually only beneficial in extremity injuries. If there is a head wound, only elevate to 45 degrees.

#3....Use pressure points. A pressure point is where a pulse can be found. A pressure point is where an artery is close to the surface and is found by placing light pressure and pinching the artery against a bone. The hardest one to locate is the femoral artery. It is located on the inside of the thigh in the groin region. It will take SIGNIFICANT
pressure to stop blood flow.

#4......Tourniquets.....If all of the above methods have failed to stop the bleeding you MAY consider a tourniquet. I say MAY because once it is applied it is not to be removed. The decision should be made only if the person is going to die without it. I have been in EMS, EMT and paramedic for 30 yrs, and have NEVER had to use one. The tourniquet will stop ALL blood flow and the extremity will die. IF you must use one, out in the backcountry, no medical personnel available for an extended period, there are numerous ways to apply one. Place the tourniquet ABOVE the injury, between the injury and the heart. Use a WIDE item, such as a belt. Do not use a rope, shoestring as it can cause further damage and may not work. Place a bulky item over the pressure point, see #3 above, and use the tourniquet to hold it in place. Get the tourniquet as tight as possible or until the bleeding stops. Once it is applied do not remove it. By removing the tourniquet you will be releasing enzymes into the blood stream that can be fatal. The lack of blood flow below the tourniquet will cause the muscles to start dying. The resulting enzymes from the lack of blood can be very dangerous to the kidneys, heart, brain, liver etc.
 

doc pops

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Medicken,
I too was trained under that school of thought. #2,4, That's what I was trained in also, and in ems world that is still the school of thought. And the six inch thing, wrong answer! An femoral/breakeal artery can with draw over six(6) inches of completely severed.
Now to a more aggressive school of thought, US MILITARY, Federal LE medics, and Doctors use TKs often. Let's start with doctors from toes/fingers, knee/elbow surgery TKs are used the device looks like a super BP cuff , the device is pumped up to (x) number of pounds to stop arteral blood flow to extremity. Timer starts!
Moving on to Federal LE medics. The doctor/medical director is a ferm believer in TKs, and after 4-6 hrs has saved limb and repaired limb from GSWs/IEDs.
Military S.F. guys commonly use TKs, on an extremity that gets hit in a fire fight the TK is put as high on the extremity as possible.
In a grid down/ balloon up world with limited medical, you, we, I may have to be more creative. And the box may have to be thrown away. In extreme times, extreme measures may have to be taken.
There is a school of thought that if in a 6 plus hour situation, that medical help is not coming or extended time that a TK may be applied and released to let blood flow to save extremity till damage can be repaired. And you, we, I may at some time in our future have to use all of our anatomy knowledge to affect repair. There will be no lawyers, courts, or medical directors or bright lights and cold steel to have as back up. The FD, or med units are not coming. You are it!!
#2 I do agree with all, I would like to add that the 18D use a divide called a donut this to put presher around wound to stop bleeding and does not put internal pressure.

Now is the time to learn the skills that we would never use in every day life. These skills will be needed when there is no medical help BUT you, we, I




#2
 

Roninsensei

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Gazrok

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Those books look fantastic! Definitely going on the wishlist (my birthday and christmas coming up you know...)
 

Warriorhealer22

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If I may add a few things to this forum. I was a flight Medic in the Army for 22 years so my experience is real. In situations where EMS is not forthcoming or delayed, you must reassess your patient regularly. The main subject here is gunshot wounds and since most of us here have them and plan in using them should we be put in situations we know. Immediately after a shooting incident occurs, adrenaline will be flowing. This will lower pain thresh holds and allow the body to overcome its affects. Muscles will be tightened, possible clamping off some bleeding. Organs will be affected. When the body loses blood, it sends signals to the heart to send more blood- it pumps harder and the vessels open up- this leads to shock. As the adrenaline is burnt off, the body weakens. Tight muscles relax so unconscious people who were breathing may find their airway blocked by their tongue. Wounds may start bleeding again. Bandages you tied tightly will loosen due to muscle relaxation. Patients WILL lose bodyheat. If it's already cold out then assume hypothermia as well.

Headshots- there are more nonfatal headshots than people believe. round objects striking round objects (bullets striking the skull) tend to graze. This of course can lead to closed head injuries which are just as bad. Just because the skull wasn't penetrated doesn't mean its a nonissue.

Chest wounds- the ribs do a good job of deflection but open chest wounds need to be treated quickly- this is a breathing issue as well as a circulation issue and may lead to an airway issue. "Sucking chest wounds" occur when the lung is trying to draw air or exhale from the hole. Often entrance wounds will not produce this as the musculature will often act as a seal. it is the exit wounds that will be sucking. It is not wrong to treat any chest wound as a sucking chest wound. Also, remember, anything done in the field will not fix the problem! Surgery will.

Abdominal wounds- if the legs are kept straightened, its best for the patient if the legs are raised a bit to take the pressure off the muscles as this will relieve some pain. Also, the abdominal cavity can hold all the blood in our body. Internal bleeding is not very treatable in the field.

No matter what caused the trauma- if they are conscious, keep them in the fight! The fight for their lives- talk to them get them involved, once they go under, things get worse.

ALWAYS TREAT FOR SHOCK
 

GatherYeAcorns

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By: Yanni A., Et Al,
Wiki How
March 2, 2012



Gunshot wounds are one of the most traumatic injuries you can suffer. It's difficult to assess the extent of damage done by a gunshot wound, and most of them far exceed what you can reasonably treat with first aid. For this reason, the best option for most bullet wounds is to get the victim to a hospital as soon as possible. However, this article will provide some guidance on what you can do to stabilize the victim in the meantime.

1. Call for emergency medical assistance.

2. Make sure you are safe.
a. If the victim was shot unintentionally (e.g., while hunting), make sure that everyone's firearm is pointed away from any other person(s), cleared of ammo, safe and secured.
b. If the victim was shot in a crime, try to make sure that the shooter is no longer on the scene and that both you and the victim are safe from further injury. Wear personal protective equipment if available.


3. Do not move the victim unless you must do so to keep him safe or to access care

4. Act quickly. Time is your enemy in treating the victim. Victims who reach medical facilities during the "Golden Hour" have a much better likelihood of surviving. Try to keep your movements swift without making them frenzied.

5. Check the A, B, C, D, E's. Assess these five critical factors

a. A (Airway) – If the person is talking, their airway is probably clear. If the person is unconscious, check to make sure that his airway is not obstructed. Turn the victim's head to the side to facilitate better breathing and get the tongue out of the way. If the victim's mouth is filled with blood, try to help them remove it by coughing or quickly sop it up with a rag or piece of clothing.

b. B (Breathing) – Is the victim taking regular breaths? Can you see his or her chest rising and falling? If the victim is not breathing, sweep his or her mouth for obstructions and start rescue breathing immediately.

c. C (Circulation) – Apply pressure to any bleeding, then check the victim's pulse at the wrist or throat. Does the victim have a discernible pulse? If not, begin CPR. Control any major bleeding.

d. D (Disability/Deformity) – Disability refers to damage to the spinal cord or neck. Check to see if the victim can move hands and feet. If not, there may be an injury to the spinal cord. Deformity refers to things such as compound or obvious fractures, dislocations, or anything that looks out of place or unnatural. These injuries can be worsened by moving the victim.

e. E (Exposure) – Always look for an exit wound. Check the victim as thoroughly as possible for other wounds that you may be unaware of. Pay special attention to the armpit, buttocks or other difficult-to-see areas. Avoid completely undressing the victim before emergency help arrives as this may advance shock.

6. Control bleeding. Controlling bleeding is most important thing you can do to save a gunshot victim's life
a. Applying direct pressure is the best way to control most wounds. Use a pad over the wound and apply pressure directly to the wound. If you have nothing available, even your hand or fingers can be used to control bleeding. Add new bandages over the old; do not remove bandages when they become soaked.


b. Use pressure points in the arm (between the elbow and armpit), groin (along the bikini line), or behind the knee to control bleeding in the arm, thigh, or lower leg, respectively.

c. There is little that can be done with conventional methods if the wound involves the torso, but chemical hemostats (Quickclot, Celox, etc.) have been proven to be very effective on all major bleeds. Ensure that you follow the instructions on the package for application, though it is usually as simple as holding the wound open, pouring in the powder or inserting the powder packet/sponge/applicator, and applying strong pressure for five minutes.


d. Be prepared to treat the victim for shock. Gunshot wounds frequently lead to shock, a condition caused by trauma or loss of blood that leads to reduced blood flow throughout the body[1]. Expect that a gunshot victim will show signs of shock and treat it accordingly by making sure the victim's body temperature is as normal as possible – cover him up if his skin feels cold, or remove clothing and fan him if he's burning up. However, do not elevate the legs if the gunshot wound is to the torso, as this will increase bleeding and make it more difficult for the victim to breathe.

Special instructions for regions of the body
Head
– Gunshot wounds to the head are frequently fatal. Keep the head elevated and get the victim to a trauma center as soon as possible.

Face and neck – These wounds typically bleed severely. Use direct pressure to control bleeding and keep the victim upright. Be careful not to obstruct breathing while controlling bleeding. With injuries to the neck, be careful that blood flow to the carotid arteries isn't disrupted, as this can reduce blood flow to the brain.

Chest and back – Apply direct pressure to control bleeding; understand that it may be difficult to control chest bleeding because the ribs make it difficult to compress the structures that are bleeding. Gunshots to the chest can cause what is known as a "sucking chest wound." These happen when air travels in and out of the wound with each breath. Treat these as follows:
  • Seal wound with hand or airtight material (e.g., plastic film).
  • Apply an airtight bandage on three sides of the wound. Do not close the bandage on the fourth side. This will allow the chest to achieve its usual negative pressure state. Air will escape through the valve during inhalation.
Abdomen – Apply direct pressure to the injury site. As with the chest, controlling bleeding in these cases can be quite difficult.

Arm or legUse direct pressure to control bleeding. If you have a length of fabric or string on hand (or can tear one off clothing), make a tourniquet. Arm and leg injuries from gunshots can be elevated above the heart to help control bleeding. Use pressure points in the arm, groin, or behind the knee if direct pressure does not control bleeding (Yanni A., Et Al, for Wiki How, 2012).

BSI for you and I. Gloves priors to all the above. BSI = Body Substance Isolation. Protect yourself first.
 

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My wife had worked O.R. I got the field surgery kit. Quick Clot is a must if your moving about. If you have a dollar tree around they have a great selection of gauze bandage and wraps plus paper tape. Lot of other items you'll need in the long run. Surgical masks, gloves , knee braces, elbow, ankle you can't beat the price.
 

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I know it might sound strange for guys to have these items in their BOB but sanitary napkins & tampons will work. Depending on the size of the wound, a tampon can be place right in it to stop the bleeding. The pads can be used as dressings.
Also someone said to give the "patient" some whiskey. I would avoid this until the bleeding has stopped because alcohol thins the blood and makes it harder to stop the bleeding. Always treat for shock. Never met anyone who could take a gunshot and not go into shock. It might not be immediately but they will most likely go into shock after the adreline has subsided.
 

jontte

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just what I have in my med-kit,sanitary napkins and tampons,absorbent and sterile,light weight aswell
 

nubria

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I've got lots of gauze From 2'.5 inches pads & rolls but i can see if its losing blood that it would work. I thought I was finish buy them foolish me. Thanks for the tip gentleman.
 

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This is probably a mute point, however I have seen experienced medics get caught up in the minute and for get and go into harms way to try to help a GSW victim/buddy... Get them to render self aid, crawl, drag, hook a line to them selves. Lay down massive amounts of RDS down range to change the shooters mind and look for a less for aggressive force to shoot at. Above all if you get jacked up then there is two victims. I saw B.S.I., I did not see SEEN SAFE! This is a strong point to remember!!! After this stop bleeding, sucking chest wounds, controls the airway, keep warm, treat for shock. Listen to "Warriorhealer22", he is shooting "NO B.S.", you should pay close attention to what he is saying, or you will get behind the curve.
Good luck, be safe, and God bless!
 

nubria

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Were on the back roads of the less traveled far from cities. Hope I'll be left in peace. when I order from stores they have a hard time finding me. I got 4 people around me I hope won't be a problem. One couple traps hogs which there a lot of. We get along good trading with them is a plus. Hope i don't get shot but if so we do have the field manuals from the Army.
 

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