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Gunshot Wound Survival

You’ve spent countless hours on the gun range, preparing to defend yourself or your family should the time come. Your grouping has greatly improved, and you’re becoming much more accurate with every squeeze of the trigger. You think you’re completely set, should you ever get in a firefight. There’s only one problem though, you haven’t prepared much on how to actually treat yourself or someone else if they get shot.

Being able to treat a gunshot wound carries the same amount of importance as being able to shoot accurately. You never know when you’ll need to deal with it, so it’s best to learn now so you can practice these highly important skills. Every day, people around the world are exposed to gun violence, so don’t think you’ll only need to know this if there’s some huge collapse and everyone’s in a panic.

Don’t get me wrong, I’m a huge supporter of firearms (I own firearms, myself). However, if you can’t treat yourself or someone else if they’re shot, that takes one less gun out of the fight. Not everyone who gets shot immediately dies (like the movies), it’s actually a very gruesome, disturbing series of events. If you start learning now, you may just have a chance at saving someone’s life, or your own.

As an Infantryman, my job is to close width, engage, and destroy the enemy. I can’t, however, do my job without a major risk of being shot at. In order to successfully perform our duties, Infantrymen are taught various classes that take countless hours throughout our careers that prepare us to treat various types of wounds. While we’re not medics, we need to be able to sustain ourselves or others until the medics arrive. We love our docs, but sometimes they get busy. For this reason, we learn how to treat gunshot wounds (and various other wounds).

Throughout my career, I’ve earned my CLS (Combat Life-Saving), first responder, and various other medical certifications. Medical advice is useless if it’s not shared with others, because if I go down, I would need to trust somebody else to be able to help me as well.

Gunshot wounds are very complex, so your medical supplies should be as well. While it may be a nuisance to carry extra weight due to many medical supplies, the weight is well worth it should you need it.

If you plan on bugging out with a group of preppers, you can always distribute the weight, while having the most medically-proficient prepper carry the majority of the medical supplies. I personally recommend having an aid-kit in your vehicle at all times, because you never really know when the situation will present itself to where you’ll need it.

Since there are a few knuckle-heads who like to sue everyone over everything in this world, I’ve decided to include a disclaimer regarding safety. This doesn’t mean that the contents of this article are sub-par, it simply means that human-error is a major factor when it comes to medical treatment. Practice makes permanent, so make sure you practice a lot (and the right way).

Disclaimer: The contents of this article are meant solely for information purposes. Nothing can substitute the aid of medically certified personnel. If at all possible, you should always seek professional medical attention immediately. Survival Sullivan, associates of Survival Sullivan, and the writer of this article are not liable for injury or death resulting in misuse, or human error regarding the contents of this article.

IFAKs (Improvised First Aid Kits)

These beautiful inventions are a great tool to have on your kit. Basically, IFAKs are pouches that come with MOLLE capability, so you can attach them on any vest/belt/bag with MOLLE loops. I personally recommend attaching them to your kit, this way you don’t have to reach for your bag if you’re shot. Ideally, everyone in your group will have their own IFAK. This is because you’re supposed to use the casualty’s own IFAK to treat them, in case you’re hit in the process of helping them.

The ideal IFAK will have numerous medical supplies to sustain yourself in case of a serious wound (such as a gunshot) until you can get to your extensive medical supply kit located in your bag. At a minimum, you’ll want your IFAK to have the following items:

Every item on this list should be in your IFAK at a bare minimum. If space in your IFAK allows, you should carry additional items in the following list. The more items you have at your disposal for quick access, the better. Remember, never use your own IFAK to treat a casualty that has their own.

If you have a prepping group, make sure everyone has the same “bare minimum” items in their IFAKs. Also, you should have a backup tourniquet located in a pocket that you can easily access outside of your IFAK. This way, you can be prepared in case there are multiple gunshot wounds where you’d need them.

Extensive Medical Kits

Every bug out bag should have an extensive medical kit in them with items used for different types of injuries. The ones on this list, however, are meant for gunshot wounds. If possible, add them onto the list you already have full of medical supplies. While you don’t need to get every item on the following list, I highly encourage you to if you want to be effective in treating gunshot wounds.

  • Eye Pad x2
  • Spare Tourniquet
  • ACE Wrap x3
  • Israeli Bandage x3
  • QuikClot Sponge x2
  • Small Bottle of Isopropyl Alcohol (for disinfecting)
  • Abdominal Bandage x2
  • Instant Splint x2
  • CPR Mask
  • Cervical Collar (C-Collar), *Optional

Like I stated before, you should definitely have more items in your extensive medical kit for your bug out bag. However, the items on this list are mainly geared toward major trauma caused by gunshots or other causes that have similar effects. Personally, I recommend having a duplicate of this kit in your vehicle at all times. Always have a spare of everything. If the list says three of one item, you should have four or five. The number of items on this list are a bare minimum.

Medical Terminology

Throughout the article, there will be numerous medical terms that might not make a lot of sense if you’re not familiar with the medical field. For this reason, I’ve included a list of the terminology I use in this article, and their meanings. If there is a word or two in here that you don’t understand, and they’re not on the list, don’t worry. There’s a fabulous invention called “Google” that you can always refer to as well.

  • BP – Blood pressure. Measured by systolic over diastolic (S/D)
  • Systolic – amount of pressure in your arteries during the contraction of your heart muscle
  • Diastolic – amount of pressure when your heart muscle is between beats. You need a cuff to measure diastolic.
  • Palp – means that you can palpate a pulse at one of the three major arteries (carotid, femoral, radial)
  • Example: BP is 80/palp (80 over palp). Used when you can’t measure diastolic BP
  • Capillary Bleeding – bleeding that can be observed as small amounts of dark red blood. Usually clots quickly, caused by a small scrape on the surface of the skin.
  • Venous Bleeding – bleeding that can be observed oozing from the wound, usually darker in color.
  • Arterial Bleeding – bleeding that usually spurts out of a wound, bright red in color.
  • Simple fracture – a closed fracture of the bone, meaning the bone still maintains its shape. The most common sign of a simple fracture is immense swelling
  • Compound fracture – an open fracture of the bone, meaning the bone has broken completely. Compound fractures will either protrude from the skin completely, or will nearly protrude from it.
  • NCD – Needle Chest Decompression
  • NPA – Nasopharyngeal Airway
  • CSF – Cerebral Spinal Fluid: Found excreting from openings in the head resulting from a spinal, or brain injury. Clear in color.
  • Intercostal – the muscle situated between the ribs
  • Anterior Axillary Line – a vertical line extending below the anterior axillary fold
  • Anterior Axillary Fold – two ridges of skin-covered muscle along the sides of the chest where the under-side of each arm meets the shoulder.
  • Catheter – a tubular medical device meant for insertion into body cavities for various purposes.
  • Progressive Respiratory Distress (PRD) – occurs when the patient increasingly has trouble breathing.
  • Carotid – the major artery that is easily located at the front of the neck on either side of the trachea.
  • Femoral – the major artery that is easily located from the inner-groin area extending down the leg.
  • Radial – the major artery that is easily located along the radial bone in the arm (the bone on the little-finger side of the forearm).
  • Brachial – the major artery that is located on the side of the arm facing the torso, that runs down the arm.
  • Ulna – the bone on the thumb side of the forearm.

Not only is this list used for simplicity while you read this article, it is also useful to know certain terminology should you have to explain things to a paramedic after they arrive (if applicable). This will greatly assist them in knowing the status of the casualty, as well as any kind of treatment that you’ve given them. Not to mention, you’ll sound pretty damn smart to your friends when you’re teaching them.

Now that we’ve gotten the boring part out of the way, let’s get down to business learning how to treat gunshot wounds. Like I’ve said before, there are so many complex factors that come into play with gunshot wounds. Not one single gunshot wound is the exact same (I wish). Due to this, your treatment should never be the same. You need to be able to adapt to each and every gunshot wound you might face, but this article will give you a solid base of knowledge that you can use at your disposal.

Combat Casualty Care

This type of care is used during a firefight, due to the nature of immense danger revolving around them. Your first instinct when you see your friend go down because they’re shot is to help them, but you can’t rush to them right away. If you do, you risk taking yourself out of the fight as well, which will render both of you useless. Instead, you need to continue fighting until it’s safe to assist them.

If someone in your group goes down, you need to instruct them to get to cover immediately if they can. This may seem like common sense, but gunshot wounds tend to be painful enough to make common sense can go out the window at times. Once they’re behind cover, tell them to apply a tourniquet on themselves (if applicable) if they are able to while you continue fighting.

If they can’t move themselves to cover, you need to either have someone suppress the enemy, or do it yourself. Once the enemy is suppressed, move quickly to the casualty and assist them to the nearest covered position, then apply a tourniquet (if applicable) to them.

The only type of medical treatment you should give anyone (or yourself) during a firefight is applying a tourniquet. This is due to many reasons, the biggest one is the firefight itself. Additional treatment is time consuming, which takes away valuable time engaging the enemy that may be closing in on you. Before you attempt any further treatment, you need to finish the firefight.

Applying a Tourniquet

Tourniquets are tools made for cutting off blood circulation to an extremity very rapidly. If done correctly, they can greatly reduce blood loss in case of a punctured artery, and save a life. Due to the nature of the rapid circulation cut-off, tourniquets (if done properly) will cause a substantial amount of pain. For simplicity, we’ll use the “Recon Medical Gen 3 Mil-Spec” tourniquet as the tool for this block of instructions.

To apply a tourniquet on the leg:

  1. Position yourself between the legs of the casualty while prepping the tourniquet.
  2. Place downward pressure as close to the groin as possible over the femoral artery with your knee.
  3. Feed the thin side of the tourniquet under the injured leg with the windlass facing you.
  4. Feed the thin side of the tourniquet through the buckle near the windlass.
  5. Once the tourniquet is fed through the buckle, quickly remove your knee from the femoral artery and shimmy the tourniquet up the leg as high as you can.
  6. Pull the tourniquet as tight as you can.
  7. Wrap the tourniquet on itself so that the Velcro holds the tourniquet in place.
  8. Twist the windlass as many times as you possibly can (should be three or four times maximum, otherwise the tourniquet itself was not properly tightened before velcroing).
  9. Place the windlass inside of the “C” shaped holder to hold the windlass in place.
  10. Test the tightness of the tourniquet by attempting to fit a finger between the tourniquet and the leg. If you’re able to, the tourniquet is not tight enough.
  11. Fold the “Time” strip over the holder, then write the time that you applied the tourniquet on it (if time allows). Then, write a “T” on the casualty’s forehead. This lets paramedics (if applicable) know that a tourniquet has been applied to the casualty.
  12. If there is excess strap remaining after you Velcro the tourniquet down, tape it down if possible.

To apply a tourniquet on the arm:

  1. Position yourself between the casualty’s injured arm, and their torso while prepping the tourniquet.
  2. Place downward pressure as close to the armpit as possible over the brachial artery with your knee.
  3. Feed the thin side of the tourniquet under the casualty’s arm with the windlass facing you.
  4. Feed the thin side of the tourniquet through the buckle near the windlass.
  5. Once the tourniquet is fed through the buckle, quickly remove your knee from the brachial artery and shimmy the tourniquet up the arm as high as you can.
  6. Pull the tourniquet as tight as you can.
  7. Wrap the tourniquet on itself so that the Velcro holds the tourniquet in place.
  8. Twist the windlass as many times as you possibly can (should be three or four times maximum, otherwise the tourniquet itself was not properly tightened before velcroing).
  9. Place the windlass inside of the “C” shaped holder to hold the windlass in place.
  10. Test the tightness of the tourniquet by attempting to fit a finger between the tourniquet and the arm. If you’re able to, the tourniquet is not tight enough.
  11. Fold the “Time” strip over the holder, then write the time that you applied the tourniquet on it (if time allows). Then, write a “T” on the casualty’s forehead. This lets paramedics (if applicable) know that a tourniquet has been applied to the casualty.
  12. If there is excess strap remaining after you Velcro the tourniquet down, tape it down if possible.

You do not need to remove the casualty’s clothing prior to applying a tourniquet, however you may need to remove certain equipment that the casualty is wearing in order to properly apply it. Make sure you practice (A LOT) applying tourniquets to yourself, and willing friends or family members. You don’t want the first time applying a tourniquet to yourself or others to be when the SHTF, because you will more than likely not get it right, and they’ll bleed out.

Never remove a tourniquet from a casualty until professional medical attention is present, or you have completed additional medical treatment entirely. Never remove a tourniquet quickly, as this can cause blood to rush quickly from the previously suppressed artery, making the wound spurt blood again. Instead, unwind the windlass very slowly, gradually allowing blood flow to return to normal.

Assessing a Casualty

If you’re not in a firefight and you come across a gunshot victim (or yourself), you’ll need to follow the proper steps to assess them before you will know how severe their wound is, and what type of treatment should be given. Remember, the status of the casualty can change at any time. Don’t just assume since they’re okay when you initially assess them, they’ll live. Gunshots cause mayhem internally, so there’s a lot of factors that come into play that determine how the casualty’s progress will unfold.

Call for Assistance

Two pairs of hands are always better than one when it comes to assisting a gunshot wound casualty. Call out for help to whomever you can. If you’re lucky, another medically-proficient person will come to aid you. Another part of this step is instructing people around you to call 911, this will help expedite the time it takes for an ambulance to arrive (if applicable) while you’re giving the casualty initial treatment.

If nobody else is around, call 911 yourself before you give treatment. Keep the call short and sweet, let them know that you have a gunshot wound victim and your location. Then hang up, you can’t waste time on the phone, because every second counts when it comes to giving aid to a gunshot victim.

Find the Alertness Level of the Casualty

This is another critical step in the assessment process, as this will tell you how you should conduct your initial treatment of the casualty. Like I said, never assume that your casualty will remain at a certain level of alertness just because they were when you first assessed them. The acronym you’ll want to remember to follow is “AVPU”. The alertness levels (in order) are:

  1. ALERT – Fully conscious. responds clearly to your initial question “Are you okay?”.
  2. VERBAL – Not fully conscious. However, will respond to words with words.
  3. PAIN – Not fully conscious, and doesn’t respond to words. However, will show responses to pain. For pain response, use the “sternum rub” technique. This technique is conducted by curling your hand into a fist, and using the second knuckles on your fist (door-knocking knuckles) to rub firmly on the casualty’s sternum in a vertical motion. Do not use this method if you suspect an injury to the casualty’s torso, back, head, or neck. Instead, flick them in the eye (unless a head, or facial injury is present).
  4. UNRESPONSIVE – Casualty does not respond to words, or pain. This is the most critical level of alertness, usually requiring CPR.

No matter the casualty’s alertness level, you should always update them with everything you’re doing to help them, as you’re doing it. This way, you’ll reduce the risk of them becoming flustered, making it more difficult to provide the necessary treatment.

Remember, just because the casualty is conscious, doesn’t mean they don’t require CPR. In most cases, however, CPR is required for casualties showing the alertness level of unresponsive. The only way to tell if the casualty requires CPR, is by conducting an airway/breathing check, as well as a pulse check. To conduct an airway/breathing check:

  1. Utilize the “head tilt chin lift” method to open up the casualty’s airway, unless you suspect a head, neck, or back injury. If one of these injuries are suspected, perform the “jaw thrust” method instead.
  2. Place your ear directly over the casualty’s mouth with your eyes facing the abdomen.
  3. Listen for breathing, while being attentive to feel their breath hit your ear.
  4. Look at their abdomen and chest for the rise and fall associated with breathing, while your ear is next to their mouth.

Once you’ve finished your airway/breathing check, you’ll need to check their pulse. Never use your thumb to check the status of a casualty’s pulse, because you risk feeling your own pulse as well through your thumb. There are three major methods to finding a pulse that are to be done in order:

  • Radial
  • Femoral
  • Carotid

Radial

This is the first area you should check for a pulse, as it can help you determine their systolic BP. Never skip ahead unless you are doing an initial pulse check on their carotid as you approach the casualty to see if they’re alive. To check the radial pulse:

  1. Place your forefinger and middle finger about two inches below the casualty’s thumb knuckle, on the inside of the wrist between the ulna and the tendons.
  2. Feel around for a pulse. If there is no pulse present, skip to the femoral pulse method.
  3. Once a pulse is detected, use your watch to count the number of beats for 15 seconds.
  4. Multiply the number of beats by four (to compensate for 60 seconds).
  5. Don’t waste time counting the number of beats for 60 seconds, as this will waste valuable time that you could use for treatment.
  6. Once you reach that number, that is their pulse rate.
  7. If a radial pulse is present, their BP will be an estimated 80/Palp or higher.

Femoral

If a radial pulse is not present, then move on to the femoral pulse detection method. To find the femoral pulse:

  1. Place your forefinger and middle finger between the casualty’s genitals and inner thigh, inside of the crease and press upwards toward the abdomen.
  2. Feel for a pulse. If there is no pulse present, skip to the carotid pulse method.
  3. Once a pulse is detected, use your watch to count the number of beats for 15 seconds.
  4. Multiply that number of beats by four (to compensate for 60 seconds).
  5. Once you reach that number, that is their pulse rate.
  6. If a femoral pulse is present, but a radial pulse isn’t, their BP will be an estimated 70/Palp.

Carotid

If a femoral pulse is not present, then move on to the carotid pulse detection method. To find the carotid pulse:

  1. Place your forefinger and middle finger on the casualty’s larynx (Adam’s Apple).
  2. Move your fingers to either side of the larynx until you feel a vertical groove in the throat muscles and feel a pulse.
  3. If there is no carotid pulse present, the casualty’s heart is likely not beating.
  4. If there is a carotid pulse present, count the number of beats for 15 seconds, then multiply by four.
  5. Once you reach that number, that’s their pulse rate.
  6. If a carotid pulse is present, but a femoral and radial pulse isn’t, their BP is an estimated 60/Palp or lower.

If breathing isn’t present, or if it’s very faint, rescue breaths may be necessary. This is why I recommend having a CPR mask in your extensive medical kit, in case the casualty has blood or other bodily fluids protruding from their mouth/nose. In some cases, however, you won’t have access to your CPR mask.

If they require rescue breathing for survival, don’t waste time running back to your bag/vehicle to retrieve the mask, as this will waste valuable time. Conduct rescue breathing, then be assessed by medical personnel at a later time (if possible). To conduct rescue breathing:

  1. Conduct the “head tilt chin lift” airway opening method, unless you suspect a head, neck, or back injury. If you suspect one of these injuries, conduct the “jaw thrust” airway opening method.
  2. Pinch the casualty’s nostrils closed, to prevent air from escaping through their nose while you’re conducting rescue breathing.
  3. Place your mouth over the casualty’s mouth, sealing any openings to prevent air escaping through their mouth.
  4. Exhale deeply.
  5. Repeat every five or six seconds.

If a carotid pulse isn’t present, then you will need to perform chest compressions to assist the flow of blood through the body. To perform chest compressions:

  1. Place one hand over the other, and position them directly over the sternum roughly three inches below the collar bone.
  2. Press down firmly on the ribcage repeatedly.
  3. Follow the beat of “Staying Alive” by the “Bee Gees” to assist you in counting the number of compressions you should do per minute.
  4. Continue with chest compressions until paramedics arrive. If you’re in a post-collapse environment where no ambulance is available, continue with chest compressions until you’ve determined that the casualty is deceased, and chest compressions will not resuscitate the casualty.
  5. If breathing isn’t present, along with no pulse, pair rescue breathing with chest compressions simultaneously. Take a break from chest compressions every five to six seconds long enough to perform a rescue breath, then continue with chest compressions.

There’s an ongoing debate in the medical field as to if you should apply a tourniquet before performing CPR, or if this would waste too much valuable time. With me being a fan of common sense, I believe you should absolutely apply a tourniquet (if needed) before performing CPR. The reason I say this, is because if the casualty bleeds out, it kind of defeats the purpose of resuscitation in the first place. Don’t make things more complicated than they have to be.

Sweep for Blood

Conducting a blood sweep is a very important, very simple task that must be done to every gunshot wound, regardless if you know where the gunshot wound is or not. Even if the casualty is fully alert, they may not know about a secondary injury due to the primary injury causing so much pain (I know, it’s weird). The last thing you want, is to be scrambling around trying to save the casualty’s life after they were stable because you neglected to treat a secondary wound. To conduct a blood sweep:

  1. Position both hands (palm down) on either the head, or feet.
  2. Lift your hands up, and look at them for signs of blood loss.
  3. Continue performing this method throughout their body, working top to bottom, or bottom to top.
  4. Don’t move your hands around while they’re placed on their body. Simply place your hands on the next section, and lift them up.
  5. The only time your hands should move across their body, is when you’re checking the side facing the ground, as you will be sliding your hands under their back (or chest) and then back out to observe them.

Blood sweeping is especially important for gunshot wounds. If the enemy was using a full metal jacket round, or a round of higher caliber, there is a major possibility that there’s an exit wound. Exit wounds are usually more serious than the entry wound, so make sure you never neglect to perform this step while assessing your casualty.

Check for CSF

Cerebral spinal fluid is a clear, odorless liquid that protrudes from the openings in the head. CSF is most commonly seen leaking from the nose, and ears. These two areas should be your primary locations for seeking the presence of CSF. A casualty who is observed leaking CSF through the nose or ears is more than likely suffering from a head, neck, or spinal injury. If this is the case, make sure you don’t move them at all. If they’re alert (which they more than likely won’t be if they’re leaking CSF), you need to instruct them not to move to the best of their ability. Moving a casualty who has a head, neck, or back injury has a high chance of injuring them more than they already are.

Casualties who are leaking CSF have a high risk of dying, due to the underlying cause of what makes CSF leak. More often than not, CSF presents itself when there’s a major injury to the brain, which is untreatable unless they receive urgent surgical attention. Due to this, you need to seek professional medical attention immediately if possible if the casualty shows signs of CSF leakage.

Assess the Wound

Here comes the complicated part, assessing the individual wound. By now, you should have determined the status of the casualty, making it known how urgent their situation is. No injury is the same, so you need to read the signs that the casualty is showing by assessing them prior to treating their wound specifically. Let’s go over each type of common gunshot wound, and how to treat them.

Types of Gunshot Wounds

While there are thousands of different specific areas on the body where a small bullet can penetrate, I’ll go over the 11 most common areas affected by bullets, and how to treat them. By knowing how to treat these 11 areas, you will have a baseline of knowledge allowing you to adapt to almost any gunshot wound treatment. Like I’ve said before, your primary goal is to sustain the casualty until you can get further medical attention if at all possible.

Sadly, there may be a time where you don’t have access to such a luxury (collapse, major disaster, etc.), that’s why we’ll go a little further into treatment, so you can sustain the casualty long enough to get them back into the fight over time. Remember, there’s always a chance that the casualty will succumb to their wounds and die. You can’t save everybody, but you can sure as hell try.

Superficial

These types of gunshot wounds are almost a blessing in disguise, because (most of the time), they’re not life-threatening. Due to the infectious nature of the wilderness (or wherever you are), however, you’ll still want to treat them to prevent infections. Superficial gunshot wounds are usually caused by bullets that graze the skin, or penetrate a thin layer of muscle. Bullets that travel directly through the fingers, hand, toes, or feet are mostly superficial as well (but hurt like hell).

Most superficial wounds will show signs of capillary bleeding, or venous bleeding. If you observe arterial bleeding from a gunshot wound that you determined to be superficial, then it turns into a completely different type of wound and shouldn’t be treated as a superficial wound. To treat a superficial wound:

  1. Wrap a layer of gauze around the wound, stuffing some of the gauze into the wound if necessary.
  2. Wrap an Israeli bandage around the gauze, ensuring that you don’t touch the white padding of the bandage. The wrap itself should extend four inches above and below the wound after it’s fully wrapped, to make sure that the sanitary padding isn’t contaminated by outside elements.
  3. Ensure the Israeli bandage isn’t cutting off circulation of the casualty’s arm/leg, as this can cause further side-effects later on in their recovery.

Like I said, superficial wounds are easily treated and take minimal time to completely treat. Never assume that just because somebody has a superficial gunshot wound, that they’ll be okay. Everybody is different, so their reactions will be considerably different internally with every gunshot wound. Keep assessing the casualty after treatment is performed to ensure the stability of their health.

Arterial (Limbs)

These are the uglier gunshot wounds that occur when the bullet either punctures an artery, or completely severs it. Arterial wounds are most commonly found in the arms or legs; however, these aren’t the only places where arteries are located. If the casualty is displaying arterial bleeding in their neck, torso, or any other area besides a limb, do not perform the following treatment. To treat an arterial wound:

  1. Apply a tourniquet.
  2. Once the tourniquet is applied successfully, immediately begin stuffing the wound with gauze. Don’t stop stuffing the wound until the hole is completely packed. Throughout this process, you should be applying direct pressure to the wound.
  3. Wrap any excess gauze around the limb, or cut it for future use.
  4. Place a QuikClot sponge over the gauze, and press down firmly to release the clotting agent.
  5. While maintaining direct pressure over the wound, begin wrapping the Israeli bandage around the wound and limb. Make sure that the Israeli bandage covers four inches above and below the wound to prevent further infection.
  6. Leave the tourniquet on the casualty until medical help arrives.
  7. If you’re in a scenario where there is no further medical attention possible, leave the tourniquet applied until at least one hour, then slowly release the tourniquet gradually until it’s off of the casualty.

Sucking Chest Wound

These ugly wounds occur when the casualty is wounded in the chest (or back), more than likely puncturing a lung. The reason it’s called a “sucking chest wound” is because with every breath, air is sucked into the cavity created by the bullet, which can be life-threatening. Treating a sucking chest wound without follow-on medical attention presents a low chance of survival, which is why I always suggest wearing body armor if possible during a SHTF scenario. To treat a sucking chest wound:

  1. Remove all clothing from the torso.
  2. Quickly wipe the blood, or any other major moisture away from the injured area.
  3. Apply a chest seal quickly once the casualty breathes out, so no air is present inside of the chest while the seal is being applied. You’ll also want to make sure that the wound is in the direct middle of the seal.
  4. If you have no chest seal present, a piece of plastic wrapping large enough to cover at least three inches of area all around the wound will work as long as there’s no holes in it.
  5. Tape the chest seal down on all sides, to ensure that it stays in place, and so air cannot escape the seal.
  6. Sometimes, chest seals need to be “burped”. This occurs when there is an air build up between the seal and the skin of the victim, you’ll clearly notice it if the chest seal begins looking like a bubble. To burp a chest seal, wait until the casualty inhales, then quickly remove one side of the chest seal while they exhale. Once they’ve completely exhaled, secure the chest seal back down to them. Repeat as necessary.
  7. Monitor the casualty for further signs of distress.

NCDs

A vast majority of gunshot wounds to the chest or back will puncture a lung, or the casualty will show signs of PRD. A common sign of PRD other than the increased difficulty to breathe, is the casualty’s lips will begin to turn a bluish-tint. This means that the casualty isn’t getting enough oxygen, which is a serious condition that may require an NCD. Most NCD needles are a 10 to 14-gauge needle, so make sure you check the size of the needle before you purchase one, as some companies like to falsify their products. To perform a needle chest decompression:

  1. Locate the second intercostal space (between the second and third rib) at the midclavicular line (approximately in line with the nipple).
  2. The alternate location for insertion is the fourth or fifth rib space at the anterior axillary line, this is to be used if the gunshot wound is located too near the primary site.
  3. Insert the NCD needle/catheter unit by placing the needle tip on the insertion site and firmly pressing the needle into the skin over the third rib at a 90-degree angle to the chest until you feel a “pop”. This pop means that you’ve penetrated the “pleura” (which is what you want). You should also feel/hear a hiss of air escaping from the chest at this point. If you don’t it’s okay, you will later.
  4. Hold the catheter in place as you slowly pull the needle out of the insertion, making sure you follow the line of insertion to avoid further aggravating the chest cavity.
  5. Tape the catheter down so it doesn’t come out of the insertion site, while making sure you leave the opening in the catheter clear. You want air to be able to escape the NCD.
  6. Monitor the casualty for further signs of distress.
  7. If the catheter becomes dislodged, or PRD progresses, follow steps 1-6 again.

You need to make sure your positioning of the NCD is very accurate, otherwise you risk puncturing blood vessels or nerves. Make sure you don’t insert the needle medial to the nipple line, otherwise you’ll risk puncturing the cardiac box (a sack surrounding the heart). You obviously don’t want to leave the catheter inside of the casualty for too long, so you need to know how to remove it safely as well if there is no possibility of follow-on medical attention.

Note – never, ever remove the catheter if follow-on medical attention is on the way. You risk causing serious complications should you make a mistake. This next block of instructions are based solely upon the situation where follow-on medical attention is not possible.

To remove an NCD catheter:

  1. Remove the tape surrounding the catheter.
  2. Very slowly remove the catheter. Never let the catheter sit for longer than 30 minutes in the casualty’s chest or blood clotting will occur, making the removal more difficult.
  3. Place a layer of gauze over the wound created by the needle/catheter combination.
  4. Wrap ACE wrap around the torso, holding the gauze in place. Don’t wrap too tight, however. Just tight enough to hold the gauze in place.
  5. Monitor the casualty for further signs of distress.

NPAs

Nasopharyngeal airway tubes are tools used to assist air flow into the body during PRD. If the casualty is showing signs of PRD, you’ll want to assist their breathing by inserting an NPA. These tubes are very easy to use, and can mean the difference between life and death. The best part, however, is they’re safe to practice on a partner (while NCDs are not). To insert an NPA:

  1. Position the casualty on their back. If this isn’t possible, any position will work (however, it will be more difficult).
  2. Perform the head tilt chin lift airway assist method, or the jaw thrust method.
  3. Unwrap the NPA from its original wrapper and lubricate it with the lubricant that comes with it.
  4. If there is no lubrication available, swab the NPA tube inside of the casualty’s mouth until it is covered with a substantial layer of saliva. If their mouth has blood in it, use yours instead. Never use blood as a lubricant, as it dries when it clots.
  5. Insert the tube into the nose of the casualty with the “needle” edge facing the septum (middle of the nose). Make sure you follow this step closely, as the pointed edge can irritate the nasal cavity if it’s inserted improperly.
  6. Keep inserting the tube until the flat surface of the opening is at the base of the nostril. To prevent gagging of an alert casualty, instruct them to continue swallowing as the tube is inserted.
  7. Once the tube is at the base of the nostril, secure it by taping it to the casualty’s face. Make sure you leave an opening at the base of the tube, otherwise air flow will be restricted.
  8. Monitor the casualty for further signs of distress.

To remove an NPA:

  1. Remove the tape from the face of the casualty, as well as the tape around the NPA tube.
  2. Remove the tube from the nasal cavity at a moderate pace. The faster you do it, the less discomfort it will cause the casualty. Make sure, however, you don’t remove it so fast that you cause possible damage to the septum or the nasal cavity.
  3. Monitor the casualty for further signs of distress.

Spinal

Taking a bullet to the spine is one of the worst places to get shot. There’s not a lot you can do for someone who’s spine has been punctured or severed as far as long-term recovery. However, there are methods you can use to ensure they have a better chance of surviving the injury. Due to this, follow-on medical attention is absolutely essential (when possible) if the casualty has a spinal injury. To treat a spinal gunshot wound:

  1. Perform the jaw thrust airway assist method.
  2. Attach a C Collar if possible.
  3. Gently place a patch of gauze over the wound and secure it gently by wrapping ACE wrap around the torso. Most gunshot wounds to the spine won’t bleed by the spine itself as much as they will on the front of the casualty. If there is excessive bleeding, use an Israeli bandage to secure the gauze instead.
  4. Place a stretcher directly beside the casualty.
  5. Gently roll the casualty on one side. ONLY perform this if there is no follow-on medical attention possible. If follow-on medical attention is on the way (or if it’s possible), never move the casualty onto a stretcher. Stop at step three and wait for further assistance.
  6. Move the stretcher under the casualty.
  7. Roll the casualty back over the stretcher.
  8. Transport away to a safe location to monitor the recovery process of the casualty.

Abdominal

This is usually a particularly ugly gunshot wound internally, and can be ugly externally if the exit point is through the front of the abdomen. Abdominal gunshot wounds are hard to treat, because you can’t see what kind of damage the bullet has done to the casualty’s internal organs. All you can do for a casualty without follow-on medical attention who has an abdominal gunshot wound is slow the bleeding. To treat an abdominal gunshot wound:

  1. Assess the casualty for shock. If they’re displaying signs of shock, elevate their legs (explained later in the article) if there’s no back or leg injury present.
  2. If they’re displaying signs of only minor shock, or no shock at all, position their legs so they’re bent with their feet near their buttocks.
  3. If clothing is sticking to the wound, cut or tear away the clothing for access to the wound.
  4. If there are chemical agents present, do not remove any clothing from the wound or expose it.
  5. Don’t remove any debris from the wound, or attempt to clean it in any way.
  6. If an internal organ is exposed, never try to shove the organ back into the abdomen. Never touch it with your bare hands unless absolutely necessary. Simply take a dry object and lift the organ to position it over the wound while you treat it.
  7. NEVER pack gauze into the wound. The abdominal cavity will swallow any gauze you try to pack, thus wasting your gauze.
  8. Place an abdominal bandage over the entry and exit wound (if applicable).
  9. Secure the abdominal bandage(s) with ACE wrap, ensuring that you don’t compress the wound unnecessarily, as this can further aggravate any internal injury caused by the bullet.
  10. Don’t tie the ACE wrap over the wound itself, make sure you tie it securely on the side of the abdomen where the wound isn’t present.
  11. Don’t give the casualty anything to eat or drink. If they’re thirsty, moisten their lips with a damp cloth.
  12. Monitor the casualty for further signs of distress.
  13. If you must leave the casualty temporarily, instruct them to lie on their back with their knees up.

Armpit

The severity of these types of gunshot wounds all depend on the shot placement. If you’re lucky, they will be a fairly simple wound to treat. If you’re not, you will have an armpit gunshot wound that is combined with a sucking chest wound. If this is the case, you will need to be able to combine the two treatments and adapt accordingly. To treat an armpit gunshot wound:

  1. Pack the wound with gauze.
  2. Place a QuikClot sponge over the gauze and press firmly to release the clotting agent.
  3. Wrap ACE wrap under the armpit, then tie a half small knot above the shoulder tightly to secure the ACE wrap, then continue the wrap by moving the long end across the back and under the opposite armpit.
  4. Keep wrapping in a tight figure eight pattern along the back.
  5. Don’t wrap in front of the neck, it will impair breathing or blood flow of the carotid.
  6. You may need to place the treated arm in a sling, as most gunshot wounds to the armpit wreak havoc on the shoulder internally.
  7. Monitor the casualty for further signs of distress.

Joints

These types of gunshot wounds are incredibly painful, and without proper medical attention, will cause permanent damage to the operation of that joint. Thankfully, gunshot wounds to a joint aren’t life-threatening (usually) unless an artery is punctured. If an artery is punctured, refer to the artery gunshot wound treatment before treating the joint itself. While most joint wounds may not be life-threatening, there is still a lot of work that needs to be done to properly provide aid. To treat a gunshot wound to a joint:

  1. Place a layer of gauze directly over the wound. Do NOT attempt to pack gauze into a joint, as you can cause much more damage to the ligaments and tendons.
  2. If there is excessive bleeding, wrap another layer of gauze around the joint.
  3. Secure the gauze to the wound by wrapping the joint (positioned as straight as possible) with ACE wrap tightly, but no too tight as to where you cut off circulation.
  4. Monitor the casualty for further signs of distress.

Most gunshot wounds to a joint will require a splint, so you will more than likely have to make one. Most people don’t carry splints in their extensive medical kits (even though I suggest it). If there is a shoulder, wrist, or ankle injury, you won’t be able to successfully splint it. For a shoulder, place the arm in a sling. For a wrist or ankle, wrap securely with ACE wrap to prevent movement.

To make a splint:

  1. Find two sturdy objects to place as far up and down the limb as possible along the injured joint.
  2. Position the two objects together over the joint, but not directly over the injured area.
  3. Tie multiple tight knots around the two objects around the limb (preferably at least two knots above and below the joint) to secure the splint in place and prevent movement of the joint.
  4. Monitor the casualty for further signs of distress.

Head

Not all injuries to the head are fatal like the movies. With that being said, if you survive a gunshot wound to the head, you’re one lucky SOB. Most of the time, however, you’ll be using this treatment for superficial wounds to the head, or shrapnel injuries. Regardless, it’s still a vital tool to place in your aid-vault in your head. To treat a head injury:

  1. Place a thick layer of gauze directly over the wound.
  2. Wrap another layer of gauze around the head firmly so that the gauze doesn’t move on its own
  3. Wrap ACE wrap around the head so you don’t impair breathing, or sight.
  4. Secure it so it doesn’t move easily.
  5. Monitor the casualty for further signs of distress.

Neck

More often than not, a gunshot wound to the neck will produce an arterial bleed. However, you can’t place a tourniquet on a casualty’s neck (use your common sense, people). Due to this, you’ll need to follow a very precise method to treat a neck wound, and fast. Due to the complex nature of gunshot wounds to the neck, I’ve included a video in this segment to explain how to treat it.

The only thing I would suggest you do differently than this video, is packing the wound with gauze prior to applying the Israeli bandage. Remember, you must maintain pressure the entire time while you treat the wound. If the casualty is alert, instruct them to hold the recently-packed gauze with a lot of pressure while you prepare to wrap it. To treat a gunshot wound to the neck follow this video:

Facial

This type of gunshot wound is classified by either a graze, or a bullet that traveled across the face. Since there are many different bone structures in the face, there will be a lot of fracturing. Due to this, you need to use extreme caution when treating this type of gunshot wound so you don’t further compromise the bone structure. To treat a gunshot wound to the face:

  1. Gently clean the affected area from debris with gauze, or another means.
  2. Place a layer of gauze over the affected area.
  3. If the wound is small enough, cut a piece of ACE wrap and stretch it over the gauze.
  4. Tape the ACE wrap to hold the gauze securely in place.
  5. If the wound is too large for the above method, wrap ACE wrap around the head once or twice while making sure you don’t obstruct breathing or eye sight to hold the gauze in place.
  6. If one eye is injured, secure an eye pad to both eyes. If the uninjured eye is left open, it will cause the injured eye to move when the uninjured eye does while they look around simultaneously. This will cause further damage to the affected eye, so you need to cover both eyes. Once the eye patches are applied, secure them by using tape.
  7. Monitor the casualty for further signs of distress.

Groin

Gunshot wounds to the groin can be extremely complex, because they have the potential to travel up into the abdomen, causing major damage to internal organs as well. Due to the complexity of this injury, I’ve included a video of (not me) an army medic training on one of his buddies while applying treatment to a groin injury. I’ve also included my own instructions to follow along on if the video is hard to follow. To treat a gunshot wound to the groin, follow the video or my instructions below:

  1. Pack the wound with gauze.
  2. Place a QuikClot sponge over the gauze and apply pressure to release the clotting agent.
  3. Tuck elastic bandage under the belt on the injured side while maintaining pressure over the sponge and gauze.
  4. Tie a loop in the short end of the elastic wrap that was tucked under the belt while still maintaining pressure over the wound.
  5. Pull the long end through the groin over the packed wound, tuck it under the belt in the back and pass it back through the groin as many times as possible.
  6. Pull it back through the tied loop and tie it together to hold.
  7. Tie the legs together at the knees to prevent the patient from opening their legs. This serves a dual purpose, as it also uses the thighs to keep pressure on the bandaged injury.
  8. For extra hold, wrap additional elastic bandage around the wound and upper leg.
  9. Monitor the casualty for further signs of distress.

Shock

Now that we’ve gone over the 11 most common gunshot wound affected areas, I’ll cover a common side-effect that comes with gunshot wounds: shock. Shock is defined as the sudden drop in blood flow through the body, cutting off important circulation to vital organs.

It’s very common after a serious injury like a gunshot, so it’ll behoove you to learn how to recognize the signs and be able to treat it. If left untreated, shock can potentially be fatal. Not to mention it’s a terrifying, miserable way to die.

Signs and Symptoms of Shock (In Order of Precedence)

  1. Cool, clammy skin
  2. Pale skin
  3. Rapid pulse
  4. Rapid breathing
  5. Nausea or vomiting
  6. Enlarged pupils
  7. Weakness or fatigue
  8. Dizziness or fainting

Shock Treatment

  1. Lay the patient down if possible. Elevate their feet 12 inches (unless there’s a head, spinal, hip, or leg injury).
  2. Begin CPR if necessary.
  3. Keep patient comfortable, warm, and dry if possible.
  4. Monitor the casualty for further signs of distress.

Treating shock isn’t hard, and doesn’t take a lot of time. If you notice the casualty showing the signs and symptoms of shock, you need to act fast to negate these symptoms in order to progress in your treatment.

Monitoring the Casualty

You’ve heard me say “monitor the casualty for further signs of distress” quite often in this article, which should hint at the fact that it just might a very important factor when it comes to treatment. You can’t just expect to throw some gauze on the casualty and call it good, you need to continue monitoring them, so you can assist them further if their condition worsens over time.

The first step in the monitoring process is checking their vitals. While there are more steps to perform to go “by the book” for checking vitals, you won’t have all the tools required (thermometer, BP cuff, stethoscope) in your aid kit, so we’ll go over the shortened (and practical) method for checking vitals. You should check the casualty’s vitals every five minutes for critical casualties, and every ten minutes for non-critical casualties. Remember, the casualty can quickly be placed in critical condition in a split-second so monitor them closely.

To check for vitals, check the casualty’s:

  • Pulse
  • Respiratory progress (breathing capabilities)
  • Blood pressure (systolic only, by referring to the pulse finding methods listed in the beginning of the article)
  • Other signs such as: shock, involuntary urination, involuntary bowel movements, CSF, etc.

On top of checking their vitals, you need to observe other aspects of your casualty. If they showed signs of PRD previously, they’re at a higher risk of reverting back to it again. If they slip into PRD again, follow the steps to treat it that I listed before in the article. You also need to keep the patient as calm, and alert as possible throughout the process. Keeping the casualty calm and reassured is a crucial aspect for their recovery. Keep everything as simple as possible for them, and don’t make them panic by explaining the severity of their injuries in-depth.

Making a Litter (Stretcher)

Since it’s very unlikely you will have a store-bought stretcher readily available in a SHTF scenario, or even in an every day scenario, you’ll need to be able to know how to safely transport a critical casualty to safety. If you’re smart, you’ll have a tarp in your bug out bag packing list, which is a necessary material for a trustworthy stretcher. While there are plenty of other methods to making a stretcher, the tarp method is the fastest-built one, taking less time away from transporting the casualty.

To make a stretcher, you’ll need:

  • Two durable 6-foot-long logs (light weight because you’ll have to carry them).
  • Tarp (8×10 foot), at the very least you’ll need a 6×8 foot.

Instructions:

  1. Spread out the tarp and lay the log (or pole) down at a position about 2/3 of the distance between the edges
  2. Fold the short side of the tarp back over the pole, then lay the other pole down on top of the previous fold, at the edge
  3. Fold the remaining section of tarp over the second pole
  4. You don’t need to, but you can tape the final fold down, so it doesn’t flap up while you’re placing the patient on it *optional*.

Make sure you transport the casualty head-first, unless you are traveling down a hill. In that case, you’ll want their feet facing down the hill in case they’re dropped. Killing your casualty by dropping them after all of your hard work to save them initially seems pretty pointless, right?

Special Considerations

There are a lot of factors that come into play when it comes to gunshot wounds, as they’re the most complex wounds on the battlefield (other than explosions). You need to understand that you can’t save everyone, some casualties will die, no matter how well you’ve treated them. It’s one of the most traumatizing experiences you will face as a prepper, but you need to realize that (unless you F’d up) it’s not your fault, it’s just the way things go sometimes.

You need to keep the casualty as calm as you possibly can while you’re providing treatment to them, as well as keeping them updated with everything you do. Don’t just keep repeating “you’ll be okay” while you’re in a frantic rush to save their life, this will make things worse. By concentrating your nervous energy into keeping the casualty calm, you’ll find that you’re keeping yourself calm in the process. Remaining as calm as possible is crucial to ensure you don’t forget treatment techniques and make unnecessary mistakes.

Never give the casualty food or water until you’re sure they’ve been in a stable condition for at least a few hours, only then can you begin to slowly integrate small amounts of food and water. If the casualty is thirsty, you can moisten their lips with water, but don’t let them chug water or scarf food down. This can complicate their internal organs’ recovery process, especially if they’re in shock or if they have an internal injury.

NEVER try to extract a bullet yourself. While there are plenty of articles and videos describing how to extract a bullet from a gunshot wound, I cannot professionally advise you to do it yourself. This is especially true if there are medical personnel on the way. Even in a SHTF scenario, you should be extremely hesitant when you think about extracting a bullet.

In most arterial gunshot wound cases, the bullet is lodged either between, or near the artery. If you attempt to extract it, you may further aggravate the artery, causing the casualty to bleed out. Most of the time, bullets will fragmentate inside of the body, leaving small metal pieces inside that are impossible to find unless they have surgical attention.

If at all possible, always seek professional medical attention. At no point should you try to play surgeon if you have access to a certified one. With that being said, there are some possible SHTF scenarios that you may need to perform minor surgeries. However, I’m not medically qualified to give surgical advice, so I won’t lie to you and say that I am. If you wish to learn minor surgical techniques, please do extensive research. You don’t want the death of someone on your hands due to your own mistakes or neglect.

Wrap-Up

While there are many different areas that can be affected by gunshot wounds, these 11 areas are the most common. By learning how to treat these areas, you will be able to use this knowledge to adapt to many other areas, as most gunshot wounds require similar treatment. Your primary goal isn’t to extract the bullet, but to slow/stop the bleeding until follow-on medical attention can assist you and the casualty (if possible).

While throughout this article, I refer to the gunshot victim as the “casualty”, that doesn’t mean that you can’t use these methods on yourself should you need to. I geared this article towards being able to treat others should you come across a situation where you need to, but you can definitely use every method I listed here on yourself.

I highly recommend that you practice each and every treatment method I’ve listed in this article, and practice them a LOT. When you’re practicing these methods of treatment, you should practice both on yourself, and on others (with the exception of the NCD, which you need to simulate unless you need to in real life). Never leave a tourniquet on a practice partner for longer than a few minutes. The only time you should leave a tourniquet on for a prolonged period of time, is in a real-life situation.

The primary goal of the treatment methods listed in this article are purely survival-based. In the Infantry, we are taught survival over everything when it comes to trauma aid. In the civilian sector, they may teach you to do some of these methods slightly differently, to reduce long-term side effects (tourniquets for example). Either way, both civilian and military trauma courses teach the same aspects, just slightly differently.

Personal Note from the Writer:

It’s not very often that I include a personal note in my article, but this particular article is extremely important to me. Saving someone’s life is no joke, you really do need to practice very often to keep your skills sharp in case you need to use them in real life. A real trauma situation is very scary. Don’t worry, if you train constantly, and do your research, you’ll revert back to your training when the SHTF.

I’ve been involved in multiple real-life scenarios where I’ve been put in a position to save someone’s life, and every time I didn’t realize everything I did until after the fact. Trust your training, but don’t get all of your training from one source. Make sure you are learning from multiple trusted sources. Stay Safe,

-Reaper

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About Reaper

Reaper
I’m an active-duty infantryman with the U.S. Army, and I’ve served a combined-service of over 5 years. Throughout my career, I’ve learned various survival techniques, as well as self-defense techniques. I specialize in weapons, long-range reconnaissance, distance shooting, and long-term isolation survival. I’m a very conservative, very “to the point” kind of person.

4 comments

  1. You have accidentally reversed the description of the radius and ulna. The radial artery is on the thumb-side of the wrist above the radius, not the ulna. Thanks for otherwise very useful information.

  2. After 31 years as a Paramedic, it is my considered opinion that gunshot wounds cannot be managed in the field other than to provid supportive care and limited symptomatic treatment. Definitive treatment can ONLY be done in the surgical suite. PERIOD! !

    • Gulp,
      Respectfully speaking, you are correct when there are resources available. However, this situation does not reflect those times. This is if SHTF. I can tell you I’ve seen, and done this in real life, and I am well aware of the outcomes.

  3. cockeyedhomestead

    Reaper as Gulo gulo says I second it. 30 years as a paramedic and a life flight nurse here. I would add a couple of basic items to your kit from a females perspective. Sanitary pads make excellent compression bandages. Tampax put in puncture wounds will compress and expand to fill the puncture wound. Vasoline (petroleum jelly) smeared on a 4×4 or larger gauze pad will form a pretty good seal for a sucking chest wound. In a SHTF scenario, these normal household items will do in a pinch.

    I also have seen bullets removed with tweezers in the field. The outcomes you mentioned: permanent nerve damage, infections leading to amputation, permanent loss of function, excessive bleeding, and a painful death.

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