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First Aid or Evacuation for Non-Extremity Wounds

Treat, Shoot, or Haul?

This article is meant to be a general overview, and not a detailed guide, on gunshot wound treatment. Seek professional first-aid training before attempting any of the techniques discussed in this story.

On the way home from work, you pull into the Kwik-E-Mart for a well-deserved Squishee and walk straight into a robbery gone wrong. The assailant just peeled out, but the result of his handiwork is all too apparent as you follow a trail of bloody handprints to find the cashier. She’s sitting on the floor, a gunshot wound in her belly leaking red into her cupped shaking hands. She’s looking up at you. What now?

Judging by the media coverage and online forum discussion, we’ve been conditioned to think “tourniquet!” as soon as we hear the words “gunshot wound.” This oversimplified Pavlovian response is understandable. We like tourniquets because they’re easy to apply. Of course, it also looks cool when we hook them to our backpack’s PALS webbing. We can’t wait for people to ask what those things are so we can explain, with a far-off Mad Max-style look in our eyes — I am the Nightrider! I am the chosen one, the mighty hand of vengeance, sent down to strike the unroadworthy!

Seriously though. The emphasis on tourniquets makes sense for the military and law enforcement communities. Since they wear body armor, they’re more likely to receive gunshot wounds in the arms and legs. However, as civilians who don’t often wear body armor, we’re just as likely to get hit in a non-extremity area, like the chest or abdomen, as anywhere else.

Recently published research by the Journal of Trauma and Acute Care Surgery makes this clear. A total of 139 fatalities from 12 civilian public mass shooting events in the United States were reviewed. They included Columbine High School, Virginia Tech University, the movie theater in Aurora, Colorado, and the Washington Navy Yard, among others. Of these victims, 58 percent had gunshot wounds to the head and chest, while only 20 percent had wounds to the extremities. Most importantly, none of the deaths occurred due to loss of blood from an extremity. Paramedics, or even prepared bystanders, could’ve arrived toting backpacks stuffed with tourniquets, and not one single additional life would’ve been saved.

internal-organ-diagram gun-shot-wound

So what does this mean; should we forget about tourniquets? Don’t be silly. Tourniquets serve a specific purpose, and ignoring them crosses into negligence. Although their usefulness in a civilian shooting situation may be less likely, life-threatening wounds to extremities are caused by car accidents, animal bites, or any other seemingly endless variation of unhappy endings. No, a responsible CCW holder will embrace tourniquets. But he or she should also embrace alternate treatment strategies, especially when the wound is to a victim’s chest, back, or abdomen. That’s the focus of this article.

Anatomy Under Pressure
Because the anatomy in your chest and abdomen is different from that in your extremities, treatment isn’t as simple or effective as slapping on a tourniquet. The reason tourniquets work is because they compress the muscle and veins against the rigid backing of long bones. By contrast, your abdomen is a squishy, flexible sack of organs. The chest is more rigid but has its own issues that we’ll discuss shortly.

Tourniquets apply circumferential pressure. This works well for arms and legs which are just thick tubes of meat. But the elliptical shape of your body’s trunk doesn’t permit the same treatment.

As shown in the anatomical diagram below, the abdomen holds your large and small intestine, solid organs like the spleen and pancreas, and hollow organs like the bladder and stomach. Along with the chest, this area is called “The Box” by medics. They fear hits inside the box because their treatment options are limited and the severity of the wound is so unpredictable.


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