Strict laws within the UK lower the prevalence of gunshot wounds compared with countries such as the United States of America. However, this doesn't mean that they do not occur and first aiders need to be prepared for when they do.
Gunshot wounds are life-threatening, causing severe external and internal injuries during the entry and sometimes exit phase of the bullet. Time can be of the essence whereby the casualty needs immediate treatment in order to stand the best chance of surviving.
Scene Safety
The threat of danger is the first priority at the scene. Ask yourself if the gunman is still at large? If the answer is no then it will be safe to approach the casualty/s. Where there is doubt, liaise with the emergency services because the first rule is to never become a casualty yourself.
In an isolated event you may be the first person who reports the shooting to 999 / 112. Remember the quicker the emergency services are called the quicker they will arrive.
Also shout for help at the scene. Ask bystanders to fetch a first aid kit or bleed control kit where available.
Tip - In the case of an accidental shooting ask yourself if the gun is now secured? Then no further harm can be caused
Symptoms
Gunshot wounds will cause severe / catastrophic bleeding. When approaching and then examining the casualty look out for the following:
Large quantities of blood pouring out of a wound
A second area (exit wound) where blood is also pouring out from a wound
Casualty showing signs and symptoms of shock / unconsciousness
When left untreated, gunshot wounds can lead to cardiac arrest and the casualty would need immediate Cardiopulmonary Resuscitation (CPR) to help replicate the natural circulatory process.
Treatment
The highest priority when treating the casualty is to apply direct pressure onto the wound itself. Trauma bandages are preferable which are designed for fast application and are highly elasticated, to assist with pressure. In the absence of trauma bandages, use shirts, t-shirts and other pieces of cloth to apply a high level of pressure to the wound.
Larger holes?
If there is a large hole at the site of impact then this will need to be packed to limit further blood loss. Preferably use a haemostatic gauze dressing which is best described as a ‘Z’ shaped piece of material which can be stuffed inside of the wound. The reality is that the first aider won’t have one of these so instead use other dressings or items of clothing.
Both the trauma bandage and haemostatic dressing can be found within a bleed control kit which is readily available to buy on the internet.
Further Pressure
Generally speaking bandages alone will not be enough to limit blood loss from a gunshot wound. Where willing, the first aider will also need to apply direct / firm pressure using the hands over the wound until the emergency services arrive.
Tip - Don’t be afraid to use your knees or even foot to apply maximum pressure. Remember it could be a case of life or death
Tourniquet?
If the gunshot wound is on a limb and catastrophic bleeding is occurring then a tourniquet can be used to save the casualty’s life. The tourniquet is tied roughly 5 cm above the wound to close the artery shut and limit further blood loss.
The problem with tourniquets is that it takes some practice / knowledge to know how to tie it correctly. Consider taking a first aid training course or at the very least watch a youtube video to see how to tie one correctly.
Chest
Gunshot wounds that have entered via the chest can sometimes cause air to get sucked into the chest which can lead to life threatening complications. In these cases use a small piece of plastic and tape it on three sides over the wound. Don’t tape the 4th side as air still needs to be able to escape.
If the casualty reports that their breathing is getting worse after applying this type of dressing then it will need to be removed.
Hint - Look out for frothy blood that is bubbling which indicates the inner lungs have been affected
Recap
Don't become overwhelmed at the scene because you can only do your best and without your help the casualty/s would be getting no treatment at all. Keep things simple and remember the below points:
Dial 999 / 112 and make sure the area is safe
Act quick and apply direct pressure to wounds with bandages / clothing
Consider using a tourniquet when the gunshot wound is on a limb
Use a taped dressing if the gunshot wound has affected the lungs
Continue pressure with hands until the emergency services take over
Remember - There could also be an exit wound to deal with as well
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