The purpose of keeping and bearing a firearm, whether in your house or on your person, is to save lives. When avoidance and de-escalation fail, the firearm becomes a last resort to stop a deadly threat. But once the gunfire ends, the fight to save lives may not be over — especially if someone has been injured. Knowing how to treat a gunshot wound could mean the difference between life and death.

Anyone who carries a firearm should have a first-aid kit and at least basic trauma care training. It’s not just preparation — it’s common sense.

What to Do First: Secure the Scene and Start Triage

The first and most important step after a self-defense shooting is to assess your surroundings. Is the threat truly over, or is the attacker just reloading or regrouping? Don’t assume you’re safe. Trying to help someone too soon can turn you into the next casualty. Before you think about how to treat a gunshot wound, you must ensure the scene is secure. Situational awareness isn’t a one-time task — it’s an ongoing responsibility. You need to stay alert both during the encounter and in the critical moments that follow.

Learn About USCCA First-Aid Classes

Once you’ve confirmed the scene is secure, call for emergency medical services immediately and then begin triage. The term “triage” comes from the French word trier, meaning to pick, choose or sort. In the context of treating gunshot wounds, triage means quickly determining who needs lifesaving care now, who can wait and who may already be beyond help. While full triage training takes hours to master, understanding the basics can make a critical difference.

How to Check Yourself for Gunshot Wounds First

Use your best judgment to decide who to help first — but don’t forget to assess yourself. Before treating others, check yourself for bleeding, torn clothing or unexplained pain — signs you may be injured without realizing it. Sometimes, getting shot doesn’t feel the way you might expect. If you’re in shock or running on adrenaline, you may not even realize you’re hurt until you physically see the gunshot wound. Knowing how to treat a gunshot wound yourself starts with recognizing that you’re wounded in the first place.

Build a Trauma Kit You Know How to Use

A basic trauma kit for gunshot wound care should include:

  • Tourniquet
  • Pressure dressing
  • Chest seal
  • Medical tape
  • Emergency blanket

These few essential items are likely all you’ll need before EMTs arrive. But gear alone isn’t enough. Before adding anything to your trauma kit for gunshot wounds, make sure you’re trained to use it properly. The best first aid for gunshot wounds comes from preparation — not guesswork under pressure.

Stay Calm — It’s Often Survivable

If you’ve been shot, the first thing to do is stay calm. No matter how severe the injury may look, keeping your composure can dramatically improve your outcome. People often survive wounds that appear catastrophic. In fact, according to the FBI, 87 percent of Americans shot with handguns survive.1 If you’re aware enough to recognize you’ve been hit, there’s a good chance it’s a survivable gunshot wound. Learning how to survive a gunshot wound starts with staying in control mentally and emotionally.

How to Assess Others for Gunshot Injuries

When checking others for injuries, remember that the loudest person isn’t always the one in the most danger. The individual who is unconscious, dazed or unusually quiet may have more serious injuries. If he or she is armed, safely secure his or her weapon to prevent accidental harm. Then begin a systematic gunshot wound assessment — check the patient from head to toe for wounds. A careful, full-body scan ensures you don’t miss hidden injuries when performing first aid for gunshot wounds.

Use the MARCH Protocol to Treat Gunshot Wounds

Now it’s time to focus on the actual medical treatment. The Committee on Tactical Combat Casualty Care (CoTCCC) teaches a proven step-by-step approach called the MARCH algorithm —an essential guide for treating gunshot wounds in the field. MARCH stands for Massive Hemorrhage, Airway, Respiration, Circulation and Hypothermia. This sequence helps you quickly identify and address the most life-threatening conditions in the correct order during gunshot wound medical care.

Massive Hemorrhage: How to Control Life-Threatening Bleeding

Address each MARCH component in order, starting with massive hemorrhage. This refers to severe blood loss — either external or internal — that poses an immediate threat to life. Minor bleeding that drips or oozes can wait, but if blood is spurting or flowing freely, it must be controlled immediately. Imagine spilling a 20-ounce soda on the ground — that’s the volume you should treat as “massive.” In cases of gunshot wound bleeding, if the patient has an arterial bleed and isn’t breathing, stop the bleeding first. The hemorrhage can prove fatal faster than the lack of oxygen.

How to Use a Tourniquet for Gunshot Wounds

For a gunshot wound to a limb, the best tool for stopping massive bleeding is a tourniquet. A tourniquet is a tight band applied above the wound to halt blood flow and prevent further loss. While older beliefs linked tourniquet use to inevitable amputation, today’s medical evidence tells a different story. When used properly — especially a CoTCCC-approved tourniquet — the risk of amputation is extremely low. When used correctly, a tourniquet can be the most effective tool to stop bleeding in the field.

When to Use Direct Pressure Instead of a Tourniquet

If the wound isn’t on a limb or you don’t have a tourniquet, apply direct pressure to stop the bleeding. If you’re trained and equipped, tools like pressure dressings or iTClamps can be extremely effective. But here’s the key — if you’re not trained to use a device, don’t improvise. In trauma care, using unfamiliar tools can cause more harm than good.

In most parts of the U.S., emergency medical responders can arrive within five minutes — which means direct pressure may be all that’s needed to stabilize a victim until help arrives. I’ve personally used just my gloved fingertips to control a carotid artery bleed from the point of injury until a trauma surgeon could take over. The patient made a full recovery. It’s a powerful reminder: even basic techniques can make the difference in emergency gunshot wound care.

Why You Shouldn’t Use a Tampon for a Gunshot Wound

Let’s clear up a dangerous myth: do not put a tampon into a gunshot wound. Despite what some corners of the internet claim, this approach is not only ineffective — it can be harmful. Inserting anything into a wound without proper training risks pushing metal or bone fragments deeper into the body, potentially damaging organs or blood vessels. The safest way to manage bleeding is with pressure or trauma tools you know how to use.

Airway Management: How to Keep a Gunshot Victim Breathing

Airway management is the next priority in treating a gunshot wound. The airway is the path air travels through — the mouth and nose down to the lungs. If the patient is conscious and breathing on his or her own, no immediate action is needed. But if the patient is struggling to breathe, help him or her find a position that eases airflow. Effective first aid for breathing problems means staying calm and letting the body do what it can — while preparing to act if conditions worsen.

What to Do If the Airway Is Blocked

If the patient is unconscious and their airway is blocked, oxygen can’t reach the lungs — and the situation becomes critical. Fortunately, the most effective intervention is also one of the simplest: reposition the airway. If you’ve taken a CPR class, you’ll recognize techniques like the head-tilt/chin-lift or jaw thrust. These basic maneuvers can restore airflow quickly and are essential when treating an unconscious gunshot wound victim. If you haven’t had CPR training, you can take a free course online in under an hour. Knowing these steps could save a life in a gunshot wound emergency.

How to Clear a Gunshot Victim’s Airway Safely

If blood, broken teeth or other debris are blocking the patient’s ability to breathe, gently roll the patient onto his or her side. This position uses gravity to help clear the airway without invasive action. Never attempt to “sweep” objects out of a person’s mouth — you could accidentally push the obstruction deeper, making the situation worse.

Respiration: What to Do If a Gunshot Victim Isn’t Breathing

Once you’ve confirmed that the airway is patent — meaning it’s open and unobstructed — check if the patient is breathing. If not, give two rescue breaths. This may be enough to restart natural breathing. In my experience, this simple act works about half the time.

When to Stop Rescue Breaths During First Aid

If rescue breaths don’t restart the patient’s breathing, you’ll need to make a judgment call — whether to continue or suspend treatment. That decision should depend on several factors: how many patients need help, whether others are available to assist and your own skill level in emergency care. In gunshot wound triage situations, resource management is just as important as medical intervention. Knowing when to act — and when to move on — can be one of the hardest parts of first aid decision-making.

How to Seal a Sucking Chest Wound

A penetrating trauma to the chest can allow air to rush into the chest cavity through the wound, creating what’s called a “sucking chest wound.” This kind of injury disrupts normal breathing. If you have one, use a commercial chest seal — they’re designed specifically for this purpose. If not, any plastic sheet (like part of a trash bag) can work in a pinch. Place it directly over the wound and tape it down on all sides to prevent air from entering. If you don’t have tape, hold it firmly in place. While vented chest seals are ideal for regulating trapped air, even an improvised non-vented seal is better than leaving the wound open.

Circulation: How to Treat Shock in a Gunshot Victim

When it comes to circulation, there’s not much a layperson can do internally — but you should reassess any tourniquets or pressure dressings to make sure bleeding has fully stopped. Then treat for shock: loosen any tight clothing, and elevate the patient’s legs — unless doing so causes pain or could worsen another injury.

Preventing Hypothermia in Gunshot Wound Victims

In trauma care, responders often refer to the “triad of death” — a deadly combination of coagulopathy, acidosis and hypothermia. Each condition can kill on its own, and each one worsens the other two. If you’ve already controlled bleeding and ensured the patient is breathing, you’ve addressed the first two threats. That leaves the third: hypothermia. Even in warm conditions, gunshot wound hypothermia is a real risk due to blood loss. Understanding this final piece of the puzzle is key to providing effective gunshot wound treatment in the field.

Put simply, hypothermia occurs when the body loses heat faster than it can produce it. For trauma patients — especially those suffering a gunshot wound — this can happen quickly, even on a warm day. The primary cause? Severe blood loss. While a drop in body temperature might be just uncomfortable for a healthy person, it can be deadly for someone already in shock. That’s why preventing hypothermia in trauma patients is a critical part of field treatment for gunshot wounds.

So how do you treat hypothermia in a gunshot wound victim? The truth is, you likely can’t reverse it in the field — but you can prevent it from getting worse. The best move is to wrap the patient in a blanket, creating a barrier between him or her and the cold. If the patient is lying on the ground, place the blanket beneath him or her as well as over the top. Don’t forget to cover the patient’s head — significant body heat escapes there. These simple steps are vital when treating gunshot wounds in the field, especially when trauma first aid must sustain the victim until EMS arrives.

Should You Render Aid to the Attacker? Know Your Rights

One final consideration: Do you have to treat an attacker’s gunshot wound? The short answer is no. As a layperson, you are not legally required to render aid to anyone — especially someone who just tried to harm or kill you. Even in combat, medics won’t treat an enemy unless they have backup to ensure the scene is secure. The same principle applies in civilian self-defense scenarios. First aid after a self-defense shooting must never come at the cost of your own safety. If the situation remains dangerous, wait for law enforcement to secure the area. You are never obligated to risk your life to save another — even if that person is injured.

Why Training Now Can Save Lives Later

Don’t assume you’ll rise to the occasion if you’ve never trained for it. Just like you train to improve your shooting skills, you also need to train to provide first aid for gunshot wounds. Most people haven’t learned how to use airway adjuncts or properly pack a wound — and in a real emergency, that lack of preparation can cost lives. Consider taking a course like the Army Combat Lifesaver Course, which nearly qualifies you as an EMT-Basic. Whether you’re treating yourself or someone else, the biggest mistake is assuming you’ll know what to do. Invest in gunshot wound first aid training now, so you’re ready to act before the professionals arrive.

Endnotes

(1) Vincent J. M. Di Maio, Gunshot Wounds: Practical Aspects of Firearms, Ballistics, and Forensic Techniques, 2nd ed. (Boca Raton, FL: CRC Press, 1999).

❓ Frequently Asked Questions

How do you treat a gunshot wound?
First, secure the scene to ensure the threat is gone, and then call for emergency medical services. Begin with triage to identify who needs help most. Use the MARCH protocol: treat massive bleeding, clear the airway, support respiration, assess circulation and prevent hypothermia. Basic tools like a tourniquet, pressure dressing and chest seal can save lives.

Do you have to treat an attacker’s gunshot wound?
No. As a civilian, you’re not legally required to provide aid to someone who just threatened your life. Your safety always comes first, and you should wait for law enforcement to secure the scene before rendering aid — if at all.

How do you treat a sucking chest wound?
Cover the wound with a commercial chest seal or plastic sheet and tape it on all sides to prevent air from entering the chest cavity. This helps restore normal breathing and prevents lung collapse.