More than 67,000 Americans show up in emergency rooms each year with injuries from handguns, rifles, and shotguns. Most are nonfatal and many are accidents, but all require proper care. The extent of damage, and the outcome, varies, depending on which part of the body is hit and the circumstances of the shooting.

Gunshot injuries can damage skin, muscle, bone, tendons, nerves, veins, and arteries in the limbs, as well as organs in the body and head. Damages can result not just from the bullet, but also from fragments of exploded bullet or splintered bone within the body. The aftereffects also cause shock, anger, anxiety, depression, and other psychological problems.

Immediate First Aid

Without proper care, even a minor gunshot wound can result in serious problems. The wound could become infected or cause long-term damage to bone, soft tissue, or organs. That’s why it is important to call 911, get an ambulance to the scene, and get the patient to a hospital emergency room as soon as possible. But first, you must take care of yourself, especially in a crime situation.

"Don’t put yourself at risk of getting hurt," warns Randy Cordle, MD, emergency medicine specialist at Carolinas Medical Center in Charlotte, NC. "Barricade yourself, if necessary, and wait until the scene is controlled before providing care to someone else."

In a situation like this, if the victim is out in the open, ask them to crawl behind the barricade with you, if possible, Cordle adds. Once you and the victim are in a safer position, or if the shooting is an accident, there are several things you can do until you are in the hands of a medical professional.

  • Stay calm. This will help keep the victim calm. Take deep breaths. Look around to see if anyone else is available to help.
  • Protect yourself from the victim’s blood and other body fluids. Wear gloves if you have them on hand.
  • Keep the victim still. Moving someone with a gunshot wound could cause further damage, especially if there is a spine injury. Elevating a wounded arm or leg can help stop bleeding, but again, this is only done when it is clear that there is no injury to the spine.
  • Cover the wound with a cloth or bandage and apply pressure with the palm of your hand for at least 10 minutes to stop the bleeding. Layer new pieces of cloth or bandages on top of the old when blood seeps through; do not move or remove anything that is stopping the flow of blood.
  • Look for signs of shock. This can include any of the following: rapid and shallow breathing; pale, cold and damp skin; weak and rapid pulse, agitation, dilated pupils, dizziness, or fainting. Cover the person with a blanket, loosen any tight clothing, and do not give them anything to eat or drink, which could provoke vomiting.
  • Stay with the person to provide comfort and reassurance. Collect information that might be helpful to emergency responders and hospital staff, such as the person’s name if they are a stranger, family or friends who can be called, medications currently taken, and drug allergies. Asking questions helps distract the victim and let them know you are handling the situation as best you can.
  • Continuously monitor the victim’s breathing and check their pulse. If you’re not trained in cardiopulmonary resuscitation (CPR), try to find someone who is.
  • When health professionals arrive: Provide them with as much information as you can about the victim and everything that transpired before they arrived.

In the event the victim suddenly collapses, loses consciousness, stops breathing normally, or has no pulse, they may be experiencing cardiac arrest, the sudden loss of heart function. Someone trained in CPR can best check their airway for blockage and perform rescue breathing. Trained or untrained, you can perform chest compressions by pushing hard and fast on the chest to try to restore heart rhythm. Unfortunately, the chance of recovery from traumatic cardiac arrest is slim.

"Cardiac arrest that results from trauma, like a gunshot wound, is different than cardiac arrest that results from a heart attack," Cordle points out. "Performing CPR in this case is usually only helpful if you can get the victim to a trauma center within a couple of minutes."

Aftercare

If you are involved in a shooting victim’s follow-up care, the doctor will give you specific instructions. Aftercare may involve administering medications, cleaning the wounded area, and changing dressings. Do not use any soaps, creams, solutions or remedies on the wound unless you have the doctor’s approval, because the ingredients in some of these products could interfere with healing. Ask about showering, bathing, and activities to pursue or avoid. Contact the physician immediately if you notice anything unusual about the wound, if you see any signs of infection, such as elevated temperature or change in the draining pattern of the wound. If anxiety, fear, sleep issues, or any other psychological aftereffects persist, ask the primary health care provider for a referral to someone who can help.

Randolph Jay Cordle, MD, reviewed this article.

Sources

Cordle, Randolph Jay, MD. Email message to author February 2, 2016.

Burg A, Nachum G, Salai M, et al. "Treating Civilian Gunshot Wounds to the Extremities in a Level 1 Trauma Center: Our Experience and Recommendations." IMAJ 11 (Sep 2009):546-550.

Fowler KA, Dahlberg LL, Haileyesus T, Annest JL. "Firearm Injuries in the United States." Preventive Medicine 2015 79:5-14.

"Gunshot Wounds—Aftercare." MedlinePlus. Updated June 1, 2014.