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Firearm Safety , Help, I've been shot!

After seeing this video (hat tip Tam), it struck me that, as a firearm owner, I am woefully underprepared to deal with a gunshot wound. Sure, I carry Band-Aids in my range bag, but those little strips will be useless against a 10mm wound. And even if I had all the correct gear, what pray tell would I do with it should that situation arise?

Turns out, I don’t even have the knowledge.

So, to correct this horrific oversight, I am on a quest to learn how to deal with gunshot wounds. Self inflicted, being shot, shooting others, legs, chests, arms, noggins, etc. I plan on doing much more than just perusing Wikipedia, I’m going to attempt to get real information from any credible source I can, maybe even make a few videos or just keep links to good ones that I find.

While this is something I am doing for myself, I’m hoping it benefits everyone else. If you have information (especially if I appear to get anything wrong) feel free to chime in. We can make this a group effort, I can deal with not being in the spotlight for a while.

Here’s to hoping we never will have to use this information, but stay tuned for more posts on this topic.

posted @ 7/6/2011 10:18:38 AM

Comments

That Guy says:

on 7/6/2011 10:24:39 AM

I saw that video this morning, and it freaked me right the hell out. Pretty sobering thing to watch.

And you are right, I need to brush up on my first aid skills.

Freiheit says:

on 7/6/2011 10:30:08 AM

Any opinions on the Red Cross first responder training?

chiefjaybob says:

on 7/6/2011 10:34:16 AM

Pantsless one-
It's not as complicated as you think. As a paramedic who has treated gun shot wounds, there are only a few things you need to take care of things until the cavalry arrives:
1. "Trauma Dressing." These are bulky bandages to absorb blood and stop bleeding. When I first started in this business, we carried a box of heavy-flow-day sanitary pads. Better options are now available at your local drugstore. Usually 6"x6" or so. Apply to heavily bleeding wounds and apply direct pressure.
2. Smaller dressings. As you saw from the video now floating around, even a .45 GSW to the leg might not bleed all that badly. It depends on the track of the wound. A handful (10-12) of 4"x4" dressings will work well here (again, local drugstore or WalMart will carry these). Direct pressure and tape. Which brings us to #3.
3. Tape. Get cloth medical tape from the first aid section. A couple-three rolls, 1 inch wide.
If you want to get fancier, an occulsive dressing is used for chest wounds. Tape down 3 sides to create a one-way valve. Finally, a CPR mask, and some disinfectant wipes. That will be a basic kit. Direct pressure to stop bleeding. Lay victim down, elevate feet, keep warm if getting shocky (pale ashen skin, anxious, sweaty, rapid heartbeat. Take a CPR class. Sorry for the long post. Somebody probably already beat me to it.

PhillipC says:

on 7/6/2011 10:35:51 AM

Immediate management of a gunshot is basic.
Keep blood in, keep dirt out, and stay calm. But it's not something that there's a specific class for in central Fl, so if you find something, let me know.

Robb Allen says:

on 7/6/2011 10:42:24 AM

chiefjaybob, please be as wordy as you'd like, this is hopefully going to become a good resource. The more information the better.

Jake says:

on 7/6/2011 10:50:08 AM

Taking a Red Cross or American Heart Association (AHA) First Aid class is the best place to start. It's also good for knowing what to do in other situations, too. A CPR class would be a good idea, as well - I think even the basic CPR classes also cover AED usage, since those gizmos are just about everywhere now.

Larry says:

on 7/6/2011 10:50:08 AM

@chiefjaybob - Any specific instructions for someone on blood thinners (Plavix, Coumadin) who suffers a GSW? Stopping bleeding for them can be pretty damn tough, and it's quite possible that a substantial non-GSW injury could cause life threatening internal bleeding.

MikeJ says:

on 7/6/2011 10:54:57 AM

This course might be of interest, even if it is on the other side of the counrty. http://www.insightstraining.com/view_course.asp?courseID=11

Jake says:

on 7/6/2011 10:56:40 AM

@ Larry: I can't speak for chiefjaybob, but here we essentially do the same things we do for everyone else (direct pressure, elevation, tourniquet, QuikClot) and "treat with diesel". Even hospitals have trouble stopping bleeding with blood thinners, so doing it in the field is nearly impossible. The main idea is to get those patients to the hospital ASAP for more advanced treatment.

chiefjaybob says:

on 7/6/2011 11:20:45 AM

@Larry (and Jake): Yep, what Jake said. I've got no experience with QuikClot, except to say our Medical Director wants nothing to do with it. I suspect this has more to do with having to deal with it once the patient arrives. YMMV. I would not exclude it from your kit if you can get it. The only other thing I would add to Larry's list would be a cold/ice pack, but these have a shelf life. Something to keep in mind.

Robb Allen says:

on 7/6/2011 11:23:58 AM

Shelf life is an important thing to consider. When I get my bag put together, I'll put on my calendar dates when I need to rotate stuff out.

Hooz says:

on 7/6/2011 11:34:52 AM

Thank you for sharing this. I have the current Combat Lifesaver FM floating around somewhere and I need to read it again... and upgrade my range bag...
Thanks again.

Skullz says:

on 7/6/2011 12:01:24 PM

I believe a basic first aid and CPR course are a great start - and something everyone should do, regardless of if they are a gun nut or not - especially if you have children.

Anyone who has been through a first responder course will tell you "ABC" Airway, Breathing, Circulation.

I'm a former paramedic, so I'm extremely comfortable with treating traumatic injuries and working in dynamic environments. And while my "kit" is significantly less capable (lapsed certifications reduce what I am legally allowed to do) than it was, it can still handle a gunshot wound pretty easily.

I can't tell you the number of times that I've treated small and large lacerations on a kid while mom or dad stood frozen with absolutely no idea what to do or how many times I splinted a fractured extremity while someone's mom or significant other hyperventilated to the point of unconsciousness. Those reactions come about because of a lack of preparedness.

As gunnies, for the most part, we're a breed that desires to be self supporting and reduce the requirement of some outside party's involvement to "rescue" us should the need arise. I think basic training in first aid would be a prerequisite for our mind set.

Even though I am no longer a paramedic, I have pulled out my first aid kit WAY more often than I have ever had to draw my gun (range work excluded). I wold argue that a first aid kit a far more useful kit to have on hand at all times than a firearm. That said, You'd rarely find me with neither close at hand.

Robawen says:

on 7/6/2011 1:18:11 PM

I would be very interested in any good information you can find about GSW first aid... Looking forward to the new series!

SPQR says:

on 7/6/2011 1:19:50 PM

While learning how to deal with a GSW is a good idea, and I do endorse it (note that its tough to find good layman first aid training on that topic), the reality is that the only time I've had to use my first aid training at the range the issue was a mild heart attack.

So starting with the basics of first aid, and follow up with a good modern CPR course is the foundation.

Robb Allen says:

on 7/6/2011 1:24:11 PM

SPQR, that is good advice as well. I'm going to refresh my basic first aid skills anyway (I did quite a bit when my kids were first born, of course focusing on younger children rather than adults) but I will indicate that GSW first aid is in addition to a foundation in regular first aid.

Skullz says:

on 7/6/2011 1:38:33 PM

For the layperson, treating a GSW is not significantly different from any penetrating injury - be it a nail gun, a falling icicle, or stab wound.

However, treating a penetrating injury to the calf is significantly different from treating a penetrating chest wound.

Gregory Morris says:

on 7/6/2011 1:56:51 PM

When I was getting ready to deploy, we had a pretty good training session on dealing with gunshot/shrapnel wounds, specifically chest, abdomen and extremity wounds. There's a lot you can do with an MRE wrapper and duct tape.

I keep some battle dressings handy (can be used as a normal bandage, a pressure bandage, or a tourniquet), also some Celox. I have some other "kit", like a nasopharyngeal airway, various scissors, scapels, suture kits, etc... but the battle dressings and Celox are all I could ever imagine needing while I'm in a reasonable range of real paramedics.

The YMCA offers first aid (mostly CPR, etc) classes, but they have "first responders" classes which are a little more in depth than you community swimming pool life guard class.

Gregory Morris says:

on 7/6/2011 1:59:51 PM

@Larry (and Jake, etc): Celox advertises that it clots even when the patient is on blood thinners like coumadin. No direct experience, of course.

DirtCrashr says:

on 7/6/2011 2:59:01 PM

There's a group called LMS that does carbine and pistol and all that tactical ninja stuff, plus a "defensive medicine" class that I want to take - but of all the things my shooting Club does safety-wise, I'm more worried about a young guy with a bum-ticker going-off on an overly hot August day than a gunshot.

chiefjaybob says:

on 7/6/2011 3:11:19 PM

Gregory Morris brings up some good points, one in particular I forgot and want to highlight: trauma shears. Amazon.com has a plethora to choose from (yes, I said "plethora." If Robb can go pants-free, I can say, "plethora."). They're cheap and damn handy.

Jake says:

on 7/6/2011 3:46:55 PM

+1 on the trauma shears. They will cut nearly everything, and most of it easily. I have cut full motorcycle leathers off of a patient with trauma shears, and the only time they had difficulty was with the armour plates inside - and even those would be cut, it was just faster and easier to go around them instead.

"If, on your journey, should you encounter God, God will be cut."

LissaKay says:

on 7/6/2011 3:56:26 PM

Lotta former medics around here, I see. So yeah ... what they said.

I've held onto my textbooks from medic school. Even though it's been a good number of years, they are still good references, especially the trauma books. While the layperson cannot always do what a medic or doctor in the field could do - usually due to a lack of access to appropriate supplies or equipment - having knowledge of the next level of care is helpful in your own decision tree. It's possible to find such textbooks at used bookstores on the cheap.

Another point - study up on pediatric trauma. Kids are not just miniature adults. Their physiology is much different than ours, and they react to trauma in whole new and very scary ways.

If you really want to have some good useable knowledge on the topic, see if it is possible to take a Basic Trauma Life Support class. It's several steps beyond basic first aid. I believe it is offered by the Red Cross in most areas.

Boy I miss my alphabet soup some days ....

Freiheit says:

on 7/6/2011 5:04:22 PM

Do these classes cover legality?

I'm thinking that first aid can be a lot like CCW. If you have to use it, you become legally at risk if you do it wrong.

Robb Allen says:

on 7/6/2011 5:10:19 PM

Dunno about that. I always thought the Good Samaritan Law protected people from that kind of thing.

mariner says:

on 7/6/2011 6:27:36 PM

I've been taught that Good Samaritan laws only cover you if you do only what you're properly trained and certified to do, and do it properly. (But that, like everything else, varies from state to state).

It's not the Get Outta Jail law.

Sennin says:

on 7/6/2011 6:38:36 PM

John Farnum offers an excellent Tactical Treatment of Gunshot Wounds course which includes some of the legal aspects. The course was put together by "Doc Gun" aka A. M. Barrera, M.D. Check the schedule @

defense-training.com/courses/tacmed.html

TinCan Assassin says:

on 7/6/2011 9:15:38 PM

Have the makings of a tourniquet handy. That's one of the things they teach us in the Army's Combat Lifesaver course. If you can get it, Quick Clot for arterial bleeds that are too high up the extremity for a tourniquet, or, old school, lots of gauze and pressure. Maybe Feminine Hygene Products, but I've heard they may cause Toxic Shock. And of course, wait for the trained Cavalry.

Chris says:

on 7/6/2011 10:29:58 PM

I carry a TacpakQC.

http://traumapacksstore.com/tac-packqc.aspx

It's designed specifically with gun shot wounds in mind and fits in a cargo pocket.

Not cheap,and you could probably make your own for less if you're not as lazy as I am.

chiefjaybob says:

on 7/6/2011 11:33:31 PM

As far as the Good Samaritan stuff goes, the main thing is, don't try to do something you aren't trained, qualified and authorized to do. In other words, dressing a wound, doing CPR if appropriate, etc., will GENERALLY keep you ok. The trouble will start when you try to do a cricothyroidotomy with a Swiss army knife and a ball point pen.

Michael Hawkins says:

on 7/7/2011 4:06:33 AM

ThePatiotNurse has some info on this on her youtube channel

http://www.youtube.com/watch?v=L7p2P-ibR7A

Rob Crawford says:

on 7/7/2011 5:35:37 PM

What about gloves?

Ambulance Driver says:

on 7/7/2011 8:37:53 PM

The longer I stay in EMS, the smaller my trauma pack gets.

When I was a new medic, I carried a $1500, fully stocked Thomas ALS pack. Now, 18 years later, my trauma supplies can fit in the cargo pockets of my action-adventure britches.

Chiefjaybob made some good, low-cost suggestions that I will add to. One handy little prepackaged bandage/sling/dressing combo is the Cederroth Bloodstopper.

You'll also want a decent tourniquet. One thing we've learned in our great big trauma labs in Iraq and Afghanistan is that tourniquets are not a last resort. In fact, unless you're an octopus, you probably don't have enough arms to stop a decent femoral artery bleed, and direct pressure, pressure points and layering dressings usually mean that the patient bleeds to death more slowly, but still bleeds to death.

Right now, combat has never been more survivable for the U.S. serviceman. Perversely, our current wars have seen far more amputees than all previous conflicts, and it's not because of IED's. It's because those guys were dying of uncontrolled extremity hemorrhage in previous wars. Now, they're living, albeit sometimes missing a limb. Tourniquets are often left on for hours until the soldier gets to a field surgical hospital, and the limbs are still salvageable, so forget what you may have heard about periodically releasing a tourniquet.

Get yourself a good tourniquet like the Combat Action Tourniquet.

On the subject of hemostatic dressings, I'd give them a try. Chitosan bandages are pricey, but Quikclot is not.

Quikclot got a bad rap early on in the sandbox because of the way it was packaged (you squirted it into the wound, and arterial pumpers usually just washed it back out), and some medics got it in their eyes. It also produced a pretty significant exothermic reaction, resulting in 2nd degree burns on a lot of patients.

The active ingredient in Quikclot is a hydrophilic mineral called xeolite. The makers of the stuff are now packaging it in a little cheesecloth bag you apply directly to the wound, and they've reduced the xeolite concentration enough to bring the exothermic reaction down to about 110 degrees, so no more 2nd degree burns.

As a final note, I'll remind you that the current first aid sequence is not Airway - Breathing - Circulation, it is C-A-B.

Turns out that breathing is really important, right up until the time your heart stops... and then its importance goes way down the list.

So if you choose to ditch the CPR mask and instead provide uninterrupted chest compressions, you're probably doing the patient some good, and the science indicates this is a far more effective approach for laypeople. Even with the tools and training that I have, I let nothing interrupt chest compressions, not even breathing. That approach has tripled our cardiac arrest survival rates in 5 years.

In the instance of penetrating trauma, C-A-B is even more apropos, because you're reasonably assured the guy had a heartbeat and breathing right before the trauma, and probably still does. What's going to kill them is uncontrolled hemorrhage.

Stop that first, and worry about airway and breathing later.

Treat for shock by lying 'em flat, cover them with a blanket, and forget about raising the legs - it doesn't work, and just makes it harder for the patient to breathe.

Keep talking to the patient while you're working on them, and as long as they're answering, you know that airway, breathing and heartbeat are managing themselves just fine while you plug the holes.

DJMoore says:

on 7/7/2011 11:00:59 PM

Skullz said, at 7/6/2011 1:38:33 PM:

treating a GSW is not significantly different from any penetrating injury - be it a nail gun, a falling icicle, or stab wound.

I am a layman, so this is an honest question:

Is it still considered good first aid practice that if the penetrating object, such as a nail or knife, is still in the wound, you leave it alone? Let the pros pull it out, because it might be plugging a big leak.

Similar point: don't poke your finger into the wound, unless you know, absolutely, that what caused it is no longer there, because there might be sharp shards that could injure you, or that you could push deeper into the wound, causing more damage.

(This is from my C.E.R.T. course, and that was several years ago. Let me know if I'm out of date or incorrect.)

Pop N Fresh says:

on 7/8/2011 12:10:47 AM

every range bag should have a blow out kit. stopping the bleeding until the pro's arrive is important, a google search will turn up a combat medic course open to "civilians". Unfortunately the sale of the good celox and the like has recently been outlawed to non-medical/non-leo individuals (fda is regulating it now as an internal medicine.)
celox combat gauze is still available to the public and is a good option.

I carry a blow out kit in my range bag or car and have one at the house.

Skullz says:

on 7/8/2011 9:09:13 AM

Is it still considered good first aid practice that if the penetrating object, such as a nail or knife, is still in the wound, you leave it alone?

Yep - leave it there, stabilize it, and let the Doc handle it.

Firehand says:

on 7/8/2011 10:11:30 AM

I've got a first-aid kit in the truck, but it's short on stuff for this kind of injury. Now I know for sure a couple of things I can buy for the purpose.

I'll throw in: don't know about other places, but at the dollar stores here(OKC) you can get elastic bandages and such; handy to have for a pressure bandage and such.

dave says:

on 7/8/2011 5:52:38 PM

I keep 2 4" and 2 6" Israeli battle dressings in my first aid kit, along with some Quik Clot, fast and easy to use, even one handed. Fairly cheap on Amazon, too.

FiftycalTX says:

on 7/8/2011 5:56:27 PM

Well, if you don't try and mimic fast draw mcgraw, you shouldn't have the problem in the first place. I have 2 Serpa's and my deadly Glock hasn't shot me yet.

PT says:

on 7/8/2011 6:46:47 PM

GSW to the abdomen or thorax:

1: Lots of bandages to stop the bleeding.

2: Drive fast to the nearest ER and hope the trauma surgeon is good.

Skip says:

on 7/9/2011 5:36:49 AM

Fuck

Fuck Serpa, Dragonworks works for me.
In my range bag is a first aid kit, duct tape, and a charched up phone.

Kevin says:

on 7/18/2011 10:56:35 PM

The tactical response Immediate Action Medical course seems highly regarded by people who took it. Not looking like it is going to be local for you. http://www.tacticalresponse.com/course.php?courseID=36

I'm taking a 3 day TCCC course this week at the EMS conference. $300, but in theory you need a first responder cert or higher to attend. Tomorrow mostly scenarios and is supposed to run from 8 am to 11 pm. ...

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