Gunshot Treatment When You Can't Find a Doctor

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

What To Do For A Gunshot Wound—and How the War Changed the Treatment

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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  • John Hance

    If you don’t have Cayenne to follow Clara’s sage advice, there are other astringent and antiseptic herbs that will be available at different times of the year. Many of them can be obtained by simply walking out to your yard, or going for a short stroll in your area…even urban areas! Bistort root (Polygonum bistorta), a beautiful, short plant with pink flowers (see http://www.ontariowildflower.com/images/pink_plumes_bistort_polygonum_bistorta_keno_hill_july2708%20copy.jpg for an image) is the strongest known astringent in the plant world. There are many others, too, such as goldenrod (stems, leaves, and flowers), white oak (bark), fireweed, alum (root), bayberry (bark), even dandelion root!

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  • http:www.3rddayrootsandshoots.com Clara

    Cayenne tincture will stop bleeding internally and externally. If you do not have the tincture 1 teaspoon in water.

    • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

      Ciara, maybe to a point. Thanks.

  • http://www.medplus-florence.com Robbie Robbins

    Great info-never know when or where it may be needed

    • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

      Thanks, Robbie. Hopefully no one you know ever will.

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  • Linda McLean

    Don’t be embarrassed! Improvise! Off with your shirt – make bandage…Off with your pantyhose – make a tourniquet! Got Kotex in your purse? Use them for bandages! Yell for help (anybody know First Aid?)You need a helper. Yell for bystanders to use their cell phones to call 911 while you are busy kneeling on the wound! Seconds count – don’t get paralyzed with fear or indecision or worry about being partially clothed.

    • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

      Great advice, Linda

  • Debbra W

    I’m not a medical professional. I read the posts and comments and would like to know what kind of training I should try to get and where to get it. AAAAANNNND! What the heck is an Israeli bandage?

    • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

      Thanks, Shorty. Debbra, don’t worry about the Israeli bandage. I just threw that in for people who have one. As far as training, check with the Red Cross and local hospitals in your area.

    • Shorty

      Here is a great demo on the Israeli Bandage

  • Matt in Oklahoma

    Cant say enough about quick clot (new recipe) and celeox (even better IMO) along with what Doc has posted.
    When he talks about direct pressure in the field it means you have your body weight on it guys, seen to many trying not to hurt them. If it’s arterial then the pain isnt anything to worry about because you only have minutes or less.

    • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

      Thanks, Matt.

  • http://www.newatlantean.com Robert Hewes

    Hey Doc,

    What do you think of QuikClot and the like? Good to keep in the first aid kit? My dog had a growth burst, and was spraying arterial blood like from a hose. I was amazed that QuikClot stopped the bleeding in seconds.

    • http://www.thesurvivaldoctor.com James Hubbard, M.D., M.P.H.

      Robert, I wrote about Quckclot on The Survival Mom blog.http://thesurvivalmom.com/2012/03/15/the-case-against-quikclot/

      It’s worthwhile to have, and to use if someones’ bleeding to death and you can’t stop it with direct pressure, pulse points, or a tourniquet.