How to Handle a Gunshot Wound

Most likely, you'll never have to deal with a gunshot wound. Some paramedics even go their whole careers without treating one.

Treatment and recovery for a gunshot wound depend on the size of the bullet, where the bullet enters your body, and how soon you seek medical care. Prompt medical attention often prevents a gunshot wound from becoming deadly.

This article walks you through what to do and how to handle gunshot wounds in different parts of the body.

Call 911

If you or someone around you is shot, these three steps are vital:

• Get to a safe place. If the injured person can walk or run, help them get to safety.
• If it's an accidental shooting, make sure the gun is secured.
• Once you're safe, call 911. Follow the dispatcher's instructions.

Getting to a hospital quickly gives the victim the best odds of surviving a bullet wound. Ideally, the injured person should be in an ambulance within 10 minutes of being shot.

Stop the Bleeding

Stopping the bleeding is a crucial part of managing a gunshot wound. You can do that with:

• Strong pressure on the wound: If blood is coming out of a hole, put a lot of pressure on it. For heavy bleeding, don't be afraid to use your knee and really lean hard on the wound.
• Dressing: Dressings help the blood clot and seal the wound. Use whatever's available—gauze, towels, a shirt, etc.
• A tourniquet (maybe): Professional tourniquets work well. But using them properly takes practice. If used correctly, they're uncomfortable or even painful.

Improvised tourniquets often fail. If you don't have a professional version, focus on strong pressure. Really lean into it.

Don't Elevate Legs

In general, you shouldn't elevate a gunshot victim's legs. That can make abdominal and chest wounds bleed more quickly. It might also make it harder for the person to breathe. 

• If the person is conscious, have them sit or lie in the position that's most comfortable for them.
• If they're unconscious, put them in the recovery position (on their side with the top leg bent at a right angle.)

Treatment by Wound Location

Gunshot wounds are puncture wounds. Don't expect to be able to tell the difference between entrance and exit wounds.

It's a myth that one type is significantly worse than the other. There's no reliable way to tell and it actually doesn't matter.

Someone with a gunshot wound might have substantial internal injuries. That can lead to breathing difficulties, low blood pressure, and heart issues. Begin CPR if they're not breathing.

It helps to have some information about wounds in specific areas.

Chest Injuries

Chest wounds can injure the heart, lungs, and/or aorta (the major artery leaving the heart). This could be deadly.

Some gunshot wounds to the chest are sucking chest wounds. These allow air to enter the chest.

To treat a chest wound, seal the wound with some type of plastic to keep air from being sucked in. This helps prevent a collapsed lung.

If shortness of breath gets worse after you seal the wound, remove the seal.

Abdominal Injuries

A gunshot wound to the abdomen can cause:

• Severe bleeding
• Organ damage
• Abdominal wall damage

Be sure to hold pressure on it. A wound that punctures the stomach or intestines can lead to an infection. That's due to gastrointestinal fluid or feces leaking into the abdominal cavity.

You might notice rapid swelling of the abdomen. That can happen even with a relatively small puncture wound.

Emergency surgery is generally necessary with abdominal bullet wounds.

Limb Injuries

A gunshot to a limb is likely to cause a vascular (blood vessel) injury. It may cause nerve damage or break bones, as well.

In general, avoid moving a limb that has been shot. Prevent blood loss by holding pressure until medical help arrives.

Neck Injuries

A gunshot wound to the spine can cause paralysis. A wound to the front of the neck can damage the carotid artery. That may prevent blood from reaching the brain.

Don't move someone who's been shot in the neck or back. Movement could damage the spinal cord and cause permanent paralysis.

If someone's shot in the front of the neck, hold pressure to prevent bleeding.

Understanding Bullet Wounds

Gunshot wounds are not straightforward. They can cause injuries beyond the visible puncture site.

Bullets can also bounce around inside your body. A bullet can remain in the body, or it can exit after doing substantial damage.

The physical damage caused by a gunshot injury depends on several key factors:

• Location of the injury
• Size of the projectile
• Speed of the projectile

All of these are important. But bullet speed is the most significant factor when it comes to the amount of damage.

Rifles, for example, produce significantly faster-velocity projectiles than handguns. Thus, they tend to cause more severe injuries.

The energy from a round can be calculated by multiplying its mass by the velocity squared (mass x velocity²). "Squared" means the velocity is multiplied times itself. Since the speed is squared, doubling the speed quadruples the energy.

Some bullets contain materials that can degrade inside the body. Surgical removal is often urgent. But it must be done carefully to avoid further damage.

Recovering From a Gunshot Wound

Bullets can cause a range of different types of injury from minor to severe. The location of the injury, the size of the bullet, your overall health, and how soon after the injury you received medical attention can affect how long it takes for your bullet wound to fully heal.

A simple injury that does not damage organs or cause a fracture may heal in as little as 10 days. More complicated injuries can take much longer to heal. As you recover physically, you may also experience mental health-related problems such as anxiety, nightmares, poor appetite, and emotional distress. If these are severe or persistent, contact your healthcare provider.

Complications

Gunshot injuries may cause complications such as:

• Nerve damage
• Infection
• Soft tissue loss
• Blood vessel injury

Bullets and bullet fragments aren't always removed after a gunshot injury. This is because removing the bullet can lead to additional tissue damage, infection, bleeding, and other serious complications.

If the bullet is not removed, there is an increased risk for later problems such as arthritis, lead toxicity, or bullet migration, though these are not common. Some people with a retained bullet may have it removed at a later time, but it is not always necessary. 

Summary

If someone is shot:

• Get somewhere safe.
• Call 911.
• Stop the bleeding with pressure, dressing, or a tourniquet.
• Don't elevate the legs.
• Put an unconscious person in the recovery position.

For sucking chest wounds, seal the hole. Avoid moving wounded limbs. Never move someone with gunshot wounds to the neck or back.

Faster bullet speed means significantly more damage. Some materials may degrade, making surgical removal necessary.