It’s no secret that firearms can be dangerous. Unfortunately, NDs and ADs do happen, and, just like in any other sport, people can, and do, get hurt while shooting and hunting. Whether or not somebody has the knowledge and skills of firearms first aid to help an injured person could, quite literally, be the difference between life and death.
This article will demonstrate some basic first aid skills pertaining to common injuries from gunshots, but it is in no way a substitute for proper, hands-on training from a qualified individual. And because of that, we at Calibre, cannot accept any responsibility for the outcomes of the application of these techniques. We strongly recommend that everyone, particularly those who spend a lot of time outdoors with dangerous tools, attend a quality training course. It is, in our opinion, the responsible thing to do.
Before dealing with any first aid situation, you must make sure the scene is safe for you to approach. You must then identify yourself to the patient and obtain their consent to help (in Canada, if a patient is unconscious, you have their implied consent). It’s also important to make sure that 911 has been called and help is on the way.
Here are a couple of scenarios where you might need some knowledge of firearms first aid; out in the wild, and on the range:
Firearms First Aid – Out Hunting
You and a buddy are excited to be out on the first deer hunt of the season. And you’re not the only ones. Unbeknownst to you, a group of youngsters, inexperienced, full of piss and vinegar, are on the prowl on the other side of the valley.
You’ve been stalking a good size Muley for most of the morning, when his trail leads you out of the bush onto the edge of a cut-block. The crack of the rifle report hits your ears at the same time 150 grains of boat-tailed lead and copper blasts through your friend’s chest. He gets spun around and hits the ground.
Not knowing any better, the shooter had fired an FMJ; not good for deer, but a small saving grace for your pal. The bullet entered the far right-hand edge of the chest and went clean through, and out the other side.
Despite the shock, your buddy is trying to talk in fast, gaspy words. He’s having serious trouble breathing on account of, you know, the two holes in his chest! So, now what?
Assuming that you have already yelled out to the shooter, alerting them to your presence and screaming for them to get help, it is now time for you to get to work:
Hopefully you’ve packed a first aid kit in an easily accessible place. After slipping on your nitrile gloves (these are important to protect both you and your buddy from infection), you grab your shears, cut away his backpack straps and move his gear to clear some space. Next you cut open his clothing and expose the chest. If you don’t have shears in your kit, you can use a knife, but be extra careful that you don’t add stabbing to his list of injuries! If the wound was more than a few minutes old, blood could start to dry and act as a glue sticking clothing to the wound. In this case, you wouldn’t rip the clothing off; you would cut away the material around the stuck portion and then dress the wound over the top of the remaining material.
Often, with this type of chest injury, you’ll hear a sucking noise coming from the holes; this likely indicates a tension pneumothorax. Air pressure from the outside world is flowing into the chest cavity. Contrary to what might be believed, this air is not entering the lungs, in fact it is squashing the lungs causing them to collapse and prevent normal breathing. Time to act fast.
Firmly place one gloved hand over the wound to seal it; keep the other hand free to work. If he’s able, tell your pal to do this with his own hand. Next you roll him over and check the exit wound; it’s a slightly larger hole, so you’ll start there.
You need an occlusive dressing. If you don’t have a specific chest seal, you can improvise one out of any air-tight material. The package from a regular trauma dressing works well; the cleaner the better, but in a pinch your PAL card or even an empty chip bag will work better than nothing! Whatever you use, it must be bigger than the hole in the chest; if you’re cutting something up, aim for it to have at least 2 inches of overlap all the way around the wound – anything small could be sucked into the chest.
Apply the plastic dressing to the wound when the casualty exhales. If you have tape, secure the dressing to the wound by taping it on three sides; duct tape is great for this. Make sure to leave the side on the outside of the chest untaped; this opening allows air to escape the chest cavity, but not go in – a rudimentary one-way flutter valve. It is very important to make sure that the unsealed edge is on the outer side of the chest for reasons that you’ll see later.
Now you’ll do the same thing with the smaller, entry wound. Once both holes have occlusive dressings taped in place, you can secure them further by applying a standard field dressing, or improvised padding and bandage, over the top, and tying it securely. Make sure to tie your knot when the casualty exhales, but don’t tie it so tightly that it restricts his breathing.
If you don’t have tape, or your tape won’t stick to the skin because of blood of sweat, then you can skip that step and just secure the plastic in place with a field dressing.
I’m sure many of you have seen movies where the medic then sticks the hero’s chest with a heavy gauge decompression needle, and then he takes a deep breath of relief. And whilst Hollywood makes it look simple enough, do not attempt it unless you have been properly trained. There is a high risk of doing more harm than good if done incorrectly.
Now roll your buddy onto his injured side and place him in the recovery position. This allows blood and other fluids to drain out of the unsealed side of the occlusive dressing, and not collect inside. It may not be comfortable for the casualty, but too bad; it’s the best position for him.
Make sure you monitor the occlusive dressing regularly to make sure the flutter valve is still working. If the casualty’s breathing does not improve, it is possible that the air inside the chest cavity is not able to escape through your flutter valve. Leaving the casualty on his side, try lifting the bottom edge of the occlusive dressing to see if it allows air to flow out.
This is all you can do from a first aid perspective; this life threatening injury needs advanced medical care as soon as possible.
Firearms First Aid – On The Range
You’re getting ready to practice on your local range, when you hear a bang and a scream from the next bay. A shooter has taken a round to the thigh.
This time, the bullet involved is a hollow point. HPs are very unfriendly to human flesh; they expand dramatically and transfer a lot of energy into the subject. The exit wound, if there is one, is usually large and messy.
Blood gushes out of the entry hole in violent spurts. The femoral artery has been hit. Unless you can stop the bleeding, this girl has probably only got a couple of minutes to live. First step is to apply firm, direct pressure to the wound. Enlist the help of other people if they’re available. Make sure everyone has nitrile gloves on to protect themselves. If your direct pressure is not enough to stop the bleeding, then you may need to apply an emergency tourniquet.
If your kit has a purpose built tourniquet such as, my favourite, the CAT (Combat Application Tourniquet), then applying it and cranking down the pressure is fairly easy. If you don’t have a CAT, you can improvise an effective tourniquet by taking any strong piece of cloth or cord, like a folded triangular bandage and tying it firmly around the limb well above the injury. Tie a simple overhand knot and then place something onto to act as a windlass; a section from a cleaning rod works well. Next tie another overhand knot on top of the windlass and turn it to tighten the tourniquet. Keep turning and tightening until the worst of the bleeding stops. Note that this will not be a pleasant experience for the casualty! Secure the windlass in place with another piece of cloth, cord, or tape.
Make a note of the time you applied the tourniquet; better yet, use a marker pen to write the time on the casualty’s forehead or chest. This information is important for the medics when they arrive on scene.
Now you’ve slowed the worst of the bleeding, you can deal with the wounds themselves.
Starting with the largest hole – the exit wound – first, pack the wound with sterile gauze; if you don’t have gauze, any clean material will be better than nothing. Once packed, place a large dressing over the top and bandage it securely in place. Make sure that the bandage completely covers the dressing to keep out any dirt.
Trauma dressings (aka field dressings) are an excellent addition to any first aid kit; they combine a dressing and a compression bandage in one, easy to use pack. The Israeli Bandage or OLAES Bandage are both good choices, and a worthwhile investment.
This process will hopefully stymie the blood loss long enough for the casualty to get to hospital.
If a casualty falls unconscious, and they’re unresponsive and not breathing, then they need CPR right away. Unless you have had some CPR training, and you have the necessary face barriers to keep yourself healthy, then don’t even bother with rescue breaths. Instead, you can do Compression Only CPR, which is very simple:
Place one hand on top of the other, in the middle of the patient’s chest. Lock your arms straight, and position your torso directly over theirs. Keeping your arms straight, allow your body weight to press down firmly on the patient’s chest approximately 2” deep. Then lift your body back up, and then repeat the process at 100 presses per minute (time it to the beat of “Stayin’ Alive” by the Bee Gees).
Once you have started, do not stop CPR unless the area becomes unsafe, the patient regains consciousness, another qualified person takes over, or if you become physically exhausted. The patient’s life could be in your hands, so you must do everything you can to keep CPR going.
First aid really isn’t that complicated, but it is an essential, yet often overlooked, skill. Hopefully, this was either a great refresher, or, it has inspired you to go out and get some training; after all, one day it might be you who needs the help, and you’ll be glad to have a trained first aider near by.
My sincere thanks goes to Marley and Chris for enduring a cold, wet day of torn clothing and fake blood to pose for these photographs.