What to do if you are shot

A little something from MinimalMed, a name you’ll be seeing around here a bunch.

minimalmed's Blog

Even if  the S does not HTF, in our society, if you are out and about, there is a small but real possibility you could be shot (see my last post). If S DOES HTF, the potential for death and disability,  which could lead to death, increases dramatically. Shot folks continue to die with the finest, state of the art trauma care, even if they make it to a level 1 center in that critical first “golden hour”.

Gunshot wounds cause death by a number of mechanisms: first, by direct destruction of a vital organ, most obviously heart and brain (although not every brain shot kills, aka Gabbie Giffords. Location and kinetic energy transfer are key. Had Jared Loughner been loaded with 147gr JHP rather than 115gr FMJ,and  shot her in the midbrain the Congresswoman would have died at the scene.). A 36gr HP 22LR behind the ear is an…

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13 responses to “What to do if you are shot

  1. Treating GSWs and blast injuries are a stand-alone science that takes considerable amount of knowledge and training. Basic rule of thumb in the field is, stop the bleeding and immobilize the limb or if its a chest wound, stop the poor air exchange and get the injured to someone with advanced training as quickly as possible. This is where TCCC training saves lives. In grid down. that may not be possible so like Doc says, we now find ourselves back in 1864. The tissue damage from a GSW is often massive internally. It will require surgical skill under aseptic conditions, time, a safe place and antibiotics to treat. So what if you don’t have all that ? Simple answer; you better start planning to have all that now before we get to grid down.

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    • In lieu of ABO in wound care – options include:

      -extensive and repeated debridement of devitalized tissue
      -continuous flow drip irrigation
      -wound vac
      – use of surgical drains
      – healing by secondary intent or with loose retention suture assist.

      various wound packing solutions for chronic wounds
      honey
      sugar
      root crops like carrot, potato, garlic
      silver compounds used topically, not injested.

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  2. I think you win the contest for coolest homework assignment. Never occurred to me that anatomy lessons should be mixed with range time. “There is no sport that cannot be improved by the addition of firearms.”

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  3. Pingback: Hogwarts: What To Do If You Are Shot | Western Rifle Shooters Association·

  4. I’ve read of using tampons for penetrating wounds, such as bullet wounds. Is there a company that mates a tampon-style bandage impregnated with kaolin, the substance (a pure form of clay, IIRC) used in QuikClot?

    (Yes, the double pun was intended.)

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    • So if I can purchase hi quality state of the art pressure dressings /hemostatic agents without government permisison why the heck would I go shoving tampons into a wound? Odds are its bigger than the GSW and is not going to fit without some level of pain to the patient. Sure they are cheap and if you got nothing else then applicate away but an IBD and some quickclot are had for about 20.00. Whats your life worth?

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      • Gosh, Grenade Man, can you imagine that someone might not try to ram it in a hole too small? Odds are you haven’t worked in an ER and/or seen many GSW’s, especially through-and-throughs, which tend to be a bit larger on the back side. Odds are trying to force a Z-fold QuikClot into a GSW hole might hurt too, but a penetrating GSW might need something better than QC gauze over both holes.

        In the ER we certainly didn’t use tampons (years ago when I did that sort of thing, anyway), but in the field they just might be kinda neat, even for us unsophisticated guys who do want to save a life, maybe our own.

        The point is, if some company _did_ make a sterile, kaolin-infused tampon-shaped device, there could be occasions in a combat environment when it _would_ be appropriate for use. I seem to recall some of our guys in the Navy carried tampons from time to time. I think I heard they even made them smaller, for young ladies just starting out with that sort of thing. You know, so it wouldn’t hurt so much when they pushed them in?

        Perhaps there is someone who reads this blog who has heard of such a thing, or talk of the development of same? Maybe even if you _do_ need “government permission” to buy them?

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    • I hear this “use of tampons in GSW” myth repeated often. I would love to find the person who started this and give him a GSW and a tampon and say ” here fix that”. If you want to pack a narrow GSW track you can roll up some Quick Clot gauze or cut it to fit. Lacking that, plain surgical gauze or a torn up T-shirt will work too. A tampon is designed to do one thing, wick up blood. If all you are doing is wicking blood then all you are doing is keeping you floor nice and clean, blood is still leaving the vessel it is needed in. Wound packing without pressure is nothing but fancy window dressing. The other problem with tampons is, pieces of it can dislodge and becomes a bacteria harbor in the wound. Yes, the wound will be debrided later but the less things you put in it, that can be accidentally left in, the better the wound will heal without major infection. The only medical tampons I have seen that work are nasal tampons used by ENTs and vaginal tampons used by women. Other than that there are balloon inflated tampons like IABPs and Blakemores for esophageal tears. Point is, use tampons for what they are designed for and treat GSWs with the best tools for the job,
      knowledge and skill.

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      • You know, since it appears no one is interested in answering the question I ask (is anyone making . . . ), I’ll just drop it. Since you folks seem to want to reply with what is in current use vs GRID_DOWN work-arounds or applications, thinking outside of the box, etc., I’m obviously wasting everybody’s time. Including my own.

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    • Regt2000, Here is something that is new on the scene that might be what more in line with what you are thinking.
      http://www.revmedx.com/#!xstat-dressing/c2500

      It’s a syringe type device filled with pellets of hemostatic sponge that can help form a clot. At this point, it is purely under investigation and not available to the public. I believe it is being used in tests in military and law enforcement applications.
      From the site:
      Indications for Use:
      *XStat is a hemostatic device for the control of bleeding from junctional wounds in the groin or axilla not amenable to tourniquet application in adults and adolescents.
      *XStat is a temporary device for use up to four (4) hours until surgical care is acquired. XStat® is intended for use in the battlefield.
      *XStat is NOT indicated for use in: the thorax; the pleural cavity; the mediastinum; the abdomen; the retroperitoneal space; the sacral space above the inguinal ligament; or tissues above the clavicle.

      We’ll keep an eye out for it as more data comes out on its efficacy.

      Hope this helps.

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  5. regt……..I saw the seals who were shot on the movie “Lone Survivor” use dirt for packing and they shoved it in very deep and hard. Is this a last resort application or just movie crap? I can understand doing this to help you live a little longer to help defend your fellow seals.

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    • I haven’t seen this being done in real life, but when your world is upside down and you have a choice of bleeding to death in two minutes or packing the wound with dirt and applying massive pressure to form a clot so you can live a few hours and get definitive care, I can see the logic. Of course, you are introducing all sorts of infection longer term as well as possibilities for all sorts of funky emboli, but if it keeps you alive and out of the hands of ISIS and /or al Qaeda, I won’t throw rocks at it.

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