how to deal with gunshot wound

[divemedic]

If you try direct presure and it don't work then you elevate and try presure point and that ain't working you have wasted a bunch of time and blood that could be saved with the tourniquet.

This is where I was going in criticizing the military model: the military person who does this as a part of his military duties won't get sued when the patient loses a limb. This is NOT the standard for people outside of the military, and lawyers will have a field day with this if you try it on the outside.

and BTW: the same goes for using tampons to plug holes. Do that on a chest wound, and you just took a small puncture and potentially made an open Pneumothorax. Never, never, never stick any object into a puncture.

 

[delta53]

clot syringes

I keep 1-2 celox syringes and wraps with me in my truck and home all the time, if you don't know about them the syringes inject celox med into the wound and the wraps clot the surface enough to maybe get you to help with a full tank

 

[EvanWilliams]

Actually the tourniquet is being moved back up to the second line method to control severe bleeding in the National Registry Paramedic curriculum this year.

b

YES!! Tourniquet. I don't give a damn about nerve damage etc. You gotta keep blood inside the pipes. Heavy bleeding put pressure to the artery above and don't let go. Also apply pressure to the wound site if someone else is available. Some clotting agent in the range bag isn't a bad idea. Lot's of people on Aspirin, plavix and coumadin lately.

I'll take my chances with the lawyers. Good samaritan laws vary by state.

 

[divemedic]

One thing about Good samaritan laws in all 50 states: they do not cover you if you are practicing procedures above your level of training.

Why is it that the mods shut down threads where people are giving legal advice because (in their words) "the OP needs to see a lawyer," but they are OK with amateur Dr House dispensing medical advice?

 

[EvanWilliams]

One thing about Good samaritan laws in all 50 states: they do not cover you if you are practicing procedures above your level of training.

Why is it that the mods shut down threads where people are giving legal advice because (in their words) "the OP needs to see a lawyer," but they are OK with amateur Dr House dispensing medical advice?

Moderating. Hmmm. No comment.
I am no doctor but I have worked in the ER, ICU and OR for 20 years and dealt with alot of trauma. If you can't control bleeding extremity with direct pressure then get a tourniquet on and elevate. If it is arterial and a large one, tourniquet might be first choice. Better to lose a limb than a life. I have never worried about lawyers when it comes to doing the right thing.
I also note that Blackhawk now has that integral tourniquet system in their BDUs.

 

[wgaynor]

I learned to use the tampon method in the Army when I was training as a Combat Medic 91W. While I never had to use it myself, I have heard several success stories. Necessity is the mother of all inventions.

Maxi pads can also work well in applying direct pressure as you elevate the limb.

Don't forget to treat for shock. Lay the injured person down, elevate the legs. Keep the head down. If it is a gut shot, just bend the legs at the knees.

Know the ABC's. Airway, breathing circulation.

When in doubt, ship them out...

 

[usmc1371]

divemedic,

I FULLY AGREE with you that in the civilian world using a Tourniquet when it is not absultly needed is just asking to be sued by some one who is prob lucky to be alive. I should have added to my previous post "for deployed/combat applications".

 

[scythefwd]

All of our medics carried tampons for GSWs. Its basically a perfectly sized bandage to shove in a GSW. I was told that SF in Afghanistan came up with this idea. Also humor value when guys started bitching to the medics about whiney stuff... they could hand them a tampon.

My old man told me about that. He got out in 94ish, so I don't think that is the origin of the idea. I was taught that as a boy scout in wilderness survival class as well (I had already heard it from my old my... retired grunt) which had to have been before 8th grade. I'm 30 now, you can do the math.

As with everyone else - don't shove it IN the wound. Use it to cover the wound (it is sterile until you unpackage it).

 

[divemedic]

As with everyone else - don't shove it IN the wound. Use it to cover the wound (it is sterile until you unpackage it).

Thank you. Shoving it in the wound will take a puncture and turn it into a sucking chest wound. The chest tends to be self sealing, as far as air entrainment goes- until people start poking things into the hole. This is something I have seen experienced medical people screw up.

Listen people, I am not blowing smoke here. I am a 20 year medic and an instructor. The company I teach for is training the Air Force medics before they deploy. I would also point out that the GSWs you see in the military and the medicine you practice are ENTIRELY different from what you will see in the civilian world. Some key differences:

In the military, your patients are handpicked to not have significant medical history, they are in reasonably good physical shape, they are all young, and the combat medic doesn't have to worry about medications affecting treatment, or legal liability.

The weapons used in the civilian world tend to be lower power, vary greatly in caliber and bullet type, and a host of other differences. I have seen GSWs that go from .22 cal all the way to 7.62, shotguns slugs, and everything in between.

Please do not attempt procedures above your training level. The advice on this thread is going to hurt or kill someone. Instead of trying to learn this on an internet forum, get some training.

 

[WalkAbout]

Just for the record, I'm going to state the obvious and say if you aren't professionally trained to do something like a needle decompression, don't do it based on instructions you found on the internet! Even knowing which side to do it on requires a bit of experience in knowing what to look for.

 

[Bix]

Please do not attempt procedures above your training level. The advice on this thread is going to hurt or kill someone. Instead of trying to learn this on an internet forum, get some training.

Worth repeating.

I provided a link to a school that I have experience with in post #9. Several other schools provide this specific type of training. The notion of trying to "learn" this stuff from an errornet forum when these opportunities exist is just absurd.

 

[WalkAbout]

Volunteer?

I've posted more in this single thread than any other since I've joined THR, but I'm going to hit it one more time to suggest something for anyone interested in learning this stuff and a whole lot more for free. Most cities/towns/municipalities have volunteer rescue squads that are usually desperate for people. They'll typically pay for you to get your NREMT-B, which gives you an excellent foundation putting you well ahead of the ordinary citizen in terms of first aid knowledge. Once you've been there a while they'll usually pay to advance your training to EMT-I (basically a few skills shy of Paramedic) or EMT-P (Paramedic) where you can learn the more advanced levels of dealing with a GSW that we've discussed like needle decompression. It's an excellent opportunity to learn and get experience, plus you get to help people from all walks of life. In the event that you're ever unlucky enough to need to know how to deal with a GSW, you'll be far more prepared to deal with it.

</high horse>

b

 

[TYY]

Airway
Breathing
Circulation
Disability
Exposure

Though for battefield trauma it becomes

Situation
Circulation
Airway
Breathing


I run level I traumas for GSWs. Some good and some bad advice in this thread. Read up on ATLS if you are interested in how this stuff is done. Action in the field may be different than what we do in the trauma bay, but the principles and thought process are the same.

 

[JoeSlomo]

Quote:
Actually the tourniquet is being moved back up to the second line method to control severe bleeding

Yup, lots of advancements in being able to save limbs after tourniquet application. Lots of combat experience in Iraq and Afghanistan to back up the results. If in doubt, slap a tourniquet on, they will get to higher medical care fast enough that limb amputation won't be an issue in the vast majority of cases. Bleeding out, however, can happen in minutes.

+3

Direct pressure, preferably from the individual shot and bleeding if at all possible.

Elevation of the wound site above heart level, if at all possible.

Slap a tourney on just in case. Two schools of thought on this, 1.) Tighten it and evacuate ASAP. As mentioned, a tourney can be applied for quite some time without ill effects if you can get them to higher treatment. 2.) Leave it loose and tighten ONLY if bandaging and direct pressure fail to stop the bleeding.

We adopted #1 before the GWOT kicked off and have had good success, and no issues with loss of limbs due to extended tourney time as far as I know.

Curlex the living snot out of it to pack the wound, and finish with a dressing and or more curlex and or ace bandage to keep it all in place.

Get them to a hospital.

Torso shots are a bit different in that we don't pack the wound and use a chest seal / expedient in case of possible lung shot...

Bottom line: The human body can often times take more of a beating than you can imagine. Do your best to keep the patient calm by reminding them of that fact, and get them evaced. YOUR confidence and the simple fact that you are treating the wound can have a significant beneficial impact on the wounded individual, even though you may not do things exactly the way a doctor/medic/emt might.

 

[essayons21]

divemedic:

Throughout this entire thread I believe you are the only person who brought up the issue of shoving a tampon in a sucking chest wound. It was never suggested by any other poster. You are right, the idea is ridiculous.

Tampons are for GSWs to limbs, and yes they are based on a military model. Get shot in the arm? Shove a tampon in it, wrap an ace bandage or isreali bandage around that and you are back in the fight.

Of course if I come across someone lying on the street with a GSW, I'm not going to mess around with tampons, or even get too involved with bandaging. In that situation the best choice is to call 911 and monitor ABCs, maybe put on a tourniquet if there is arterial bleeding.

However, remember the OP was asking about what to do for an accidental gunshot wound while hunting or out at the range, where there might not be anyone else around or EMS is an hour or more away.

We are talking about self-rescue here, not by-the-book ALS techniques. Most of the "alternative" techniques put forward here have been developed into doctrine over the past 8 years of combat operations in the middle east, by very experienced and competent people. As a medic instructor I'm sure you know that many BLS/ALS notions have been shattered by lessons learned by the military over the past years. I remember my first Red Cross basic first aid class where I was taught that once you put a tourniquet on, that person would lose a limb. Trauma surgeons now tell me that even with complete shutdown of circulation, a tourniquet can stay on a leg for 4 hours, an arm for 6 hours, and the limb can still be saved. I know for a fact that people have died because trained responders did not recognize life-threatening blood loss immediately, and hence were reluctant to apply a tourniquet until it was too late. In fact, I know of one National Guard trauma surgeon who also works in the ER stateside who recommended a CAT tourniquet as the FIRST step to control bleeding in an extremity.

Its fine and dandy to discuss the finer points of proper EMS, but I believe the OP was more concerned about self-rescue and buddy-rescue when EMS is unavailable or too far away.

All of this is internet advice anyway, and worth what you paid for it. Anyone who would apply these techniques with no training has no business providing medical care in the first place.

 

[EvanWilliams]

I stand by the tourniquet if you cannot control (AND QUICKLY) with direct pressure and elevation. If you are dealing with an extremity it is OK. However, don't anyone feel obligated to do anything more than direct pressure if you are afraid of being sued.
And one poster was correct. Divemedic is the only one talking about putting stuff in punctures.
Divemedic, how long are tourniquets placed on legs for knee and ankle surgery and upper arm for hand surgery? Don't bother looking it up. 2 hours is not uncommon. There is slight risk but it is done routinely and to no ill effect. And that is 275 to 300 mmHg.
So, while some are watching someone bleed out I will GD sure take off my belt and at least try and get some hemostasis. And I will easily defend my actions in court.

Now. It is true. Don't take advice like that over the internet. But if it is your wife or kid. Put the tourniquet on. Geez.

 

[TYY]

Just to add to the above debated- it is indeed true, we tourniquet limbs in the OR all the time. We monitor tourniquet-up time very closely, but times over 2 hours are not out of the realm of safety. However, threat of thromboembolism and pulmonary embolism are just as great as threat the the limb, which is why exsanguination of the limb is performed. Is it possible to have a massive PE immediately after taking off a tourniquet.

 

[EvanWilliams]

Just to add to the above debated- it is indeed true, we tourniquet limbs in the OR all the time. We monitor tourniquet-up time very closely, but times over 2 hours are not out of the realm of safety. However, threat of thromboembolism and pulmonary embolism are just as great as threat the the limb, which is why exsanguination of the limb is performed. Is it possible to have a massive PE immediately after taking off a tourniquet.

Very true.

BTW, since I am dishing out some questionable advice, let me dish out some good advice.
When you put direct pressure on the wound, DONT LET GO. Don't sponge it, wipe away the blood, look awhile, put some pressure, sponge it some, look again.
Put pressure on and hold on tight.

 

[divemedic]

Throughout this entire thread I believe you are the only person who brought up the issue of shoving a tampon in a sucking chest wound. It was never suggested by any other poster. You are right, the idea is ridiculous.

and the rest of you saying that no one suggested this:

All of our medics carried tampons for GSWs. Its basically a perfectly sized bandage to shove in a GSW.

What are the current recommendations for treating sucking chest wounds? Years ago, in our combat first aid classes, they emphasized that any wounds to the chest area should be closely checked. If air was either being sucked in or blown out, it should be plugged immediately to prevent a collapsed lung. At the time (we didn’t have tampons)

 

[essayons21]

Both myself and the other posters were referring to using tampons for generic GSWs, not the smaller percentage of GSWs that were sucking chest wounds. You are taking words out of context.

 

[-v-]

Most cities/towns/municipalities have volunteer rescue squads that are usually desperate for people. They'll typically pay for you to get your NREMT-B, which gives you an excellent foundation putting you well ahead of the ordinary citizen in terms of first aid knowledge.

BIG +1

I am also with divemedic, how the use of tampons was brought up by everyone, the implied use was to treat sucking chest wounds. Either way, shoving things into wounds, both sucking and not, is a bad idea.

Yes, you can do it, and you will be dragged into court, and you can go all high-horse of "I did it in the interest of saving their life!" and you can be convicted of practicing medicine without a license, which is a felony in some states. Good Samaritan laws will cover you only so far.

Something to think about, before you think of popping a tampon into a GSW and trying to do needle-chest decompression from some instructions you read on the internets.

Like I said in my other post, in case of any traumatic injury, your first action should be to call 911 and activate emergency medical response. Paramedic may do anything from treat and transport to request airlift to a level 1 trauma center. Next action will be to look after the ABC's until help arrives. If they are not breathing, reposition their airway, if they are still not breathing, breath for them. If they have no pulse, do chest compressions. If they are bleeding stop the bleeding with direct pressure, elevation, pressure point, and finally tourniquet.

I know of one National Guard trauma surgeon...who recommended a CAT tourniquet as the FIRST step to control bleeding in an extremity

Which, if he is your medical control or medical director, is all good. After all, if patients start having an large number of complications associated with this approach, it is HIS license on the line, not yours.

But, direct pressure, elevation, pressure point, tourniquet is the standing NATIONAL protocol for controlling bleeding.