GSW (Gunshot Wounds)
Gunshot wounds (GSWs) are among the most critical and unpredictable injuries you’ll encounter. They can range from superficial grazes to deep-penetrating trauma that damages vital organs, arteries, and bones. Each GSW demands immediate attention—with your priorities being bleeding control, stabilization, and rapid transport or surgical intervention.
At Scene Care
Graze Wound (Skin Only)
- Clean the wound with saline.
- Check if stitches are needed (if deep or long).
- Apply antibiotic ointment (like Neosporin).
- Cover with a clean bandage.
Through-and-Through (T&T) Wound
(Bullet went in and out)
- If bleeding a lot: apply a tourniquet (only on arms or legs).
- Clean both entry and exit wounds with saline.
- Seal both sides of the wound with sterile dressing.
- Wrap with a pressure bandage to slow bleeding.
Lodged Bullet (Still Inside)
- If bleeding a lot: apply a tourniquet (only on arms or legs).
- Clean around the wound with saline.
- Apply pressure bandage, but do NOT pack the wound—this could push the bullet deeper.
- Get patient to the hospital ASAP.
Useful Prompts
/me Looks Over Patient and Assesses for Injuries
/me Quickly Grabs IFAK Trauma Kit from EMS bag
/me Also Grabs Scissors and multiple Gauze Pads…
/me Carefully Cuts Away Clothing to Fully Visualise Entrance Wound
/me Applies pressure to wound with Gauze Pad to try stop bleeding
/me Opens QuikClot Package, Empties Contents onto wound
/me Grabs Tourniquet Belt from EMS bag, Wraps It Round Limb to Restrict Blood Flow
/me Grabs Intravenous Line and Establishes IV on Patients arm…
/me Pulls Out O2 Canister and Nasal-cain Lines from EMS Bag
/me Places Nasal-cain in Patients Nose and Opens O2 Value for Oxygen
/me Injects Tranexamic Acid (TXA) to help slow down blood loss
/me Grabs more Gauze Pads and Bandages
At Hospital Care
Surgery Prep & Procedure
- Move the patient to the OR.
- Put them on oxygen.
- If actively bleeding, give O-negative blood.
- Check vitals and keep monitoring.
- Decide on anesthesia (local for small wounds, general for serious cases).
- Carefully remove any packing from earlier.
- Do an X-ray or ultrasound to find bullets or fragments.
- Remove bullets/fragments with surgical tools.
- Flush out the wound to clean it thoroughly.
- Check for and fix any internal damage (muscle, organs, vessels).
- Double-check vitals again.
- Stitch up the entry and exit wounds.
- Apply antibiotic cream.
- Bandage the wound.
- Give IV antibiotics to help prevent infection.
- Move patient to recovery and monitor closely.