The purpose of keeping and bearing a firearm, whether in your house or on your person, is to save lives. When avoidance and diplomacy fail to keep you out of harm’s way, the gun is a last resort to stop a deadly threat. After such an encounter, you, a loved one or a bystander may be injured. If that’s happened, the fight to save lives is not over. You need to be prepared to perform self-aid or first aid until emergency responders arrive. Anyone who carries a gun should have a first-aid kit and some first-aid training. It’s just common sense.

Triage First

The first step you need to take following a self-defense shooting is to assess the situation. Is the fight over, or is your attacker just reloading? Don’t stop trying to end the threat. You won’t do anyone any good if you become a casualty yourself by trying to give aid before the fight is over. Along those lines, assessing the situation is not something you do once . You need to maintain situational awareness both during the incident and after it ends.

Learn About USCCA First-Aid Classes

After you deem the scene as safe, get EMS responding to your location and then start triage. Triage comes from the French term “trier,” which means to pick, to choose or to sort. Figure out who needs help immediately, who can wait and who is beyond help. Training soldiers to assist with triage is a multi-hour class and beyond the scope of a single article.

Use your best judgment to determine who to treat, which includes assessing yourself.  Before you help anyone, check yourself out. Look for blood, holes or tears in clothing or if something just doesn’t feel right. Getting shot may not feel as you expect it to. You may need to see the gunshot wound before realizing it exists.

What to Include in a Trauma Kit

I would include the following in a personal trauma kit:

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

This is probably all you’ll need before EMTs arrive. And before you put something in your trauma kit, make sure you know how to use it.

If you have been shot, stay calm. No matter how bad a wound may look, keep your composure. People survive horrific-looking wounds more often than you might think. According to the FBI, 87 percent of Americans shot with handguns survive.1 If your brain is able to comprehend that you have been shot, then you have a survivable wound.

When assessing others, know the person screaming loudly may not be the person you should treat first. Look for the quiet one who might be unconscious, just sitting there or walking around dazed. If he or she is armed, consider taking the weapon away so he or she doesn’t accidentally hurt anyone. Check the patient from head to toe, scanning his or her entire body for wounds. Be systematic in your check so that you don’t miss anything.

Using ‘MARCH’ to Determine Medical Care

Now for the actual medicine. The CoTCCC teaches what is known as the “MARCH” algorithm, which is the acronym for “massive hemorrhage, airway, respiration, circulation and hypothermia.” It is a step-by-step guide on what to look for and treat first.

Identify and treat each of these conditions in the order listed.

A massive hemorrhage is when a person is losing large amounts of blood, either externally or internally. Bleeding that drips or oozes in small amounts can wait. Bleeding that shoots out or is flowing freely in large quantities needs to be treated immediately. Spill a 20-ounce soda on the ground and get an idea of what that volume of liquid looks like. That amount of blood or more counts as “massive.” If a patient has an arterial bleed and is not breathing, treat the bleeding first. The hemorrhage can kill the patient by the time you treat the breathing.

For a limb wound, use a tourniquet. A tourniquet is a band placed around a limb that is tightened to stop blood flow. Though it used to be thought that using a tourniquet would automatically lead to amputation, the evidence shows that is not the case today. Use of a CoTCCC-approved tourniquet rarely leads to the need for amputation.

For other locations or if a tourniquet is not available, use direct pressure. There are many devices you can use, such as pressure dressing iTClamps, to help control bleeding if you have them and are trained in how to use them. And if you are not trained in how to use something, don’t use it. You can end up causing more harm than good.

In most of the United States, where EMTs can be hands-on in five minutes or so, direct pressure may be all you need. I’ve used just my gloved fingertips to control a carotid artery bleed from the point of injury until a trauma surgeon took over. That patient fully recovered.

I shouldn’t have to say this, but do not put a tampon into a gunshot wound. The internet is just flat-out wrong on this one. It won’t help, and it can actually inflict additional harm. You could end up pushing sharp metal or bone fragments into an organ or blood vessel. Most medical devices that are inserted into a wound to control bleeding are sold only to medical professionals in order to keep the untrained from causing harm. Trust the professionals on this one and leave the feminine hygiene products for their intended purpose.

Oxygen

The airway is the set of structures through which air travels from the mouth and nose to the lungs. If the patient is conscious and breathing well, then you don’t have to do anything. If he or she is having trouble breathing, then help the patient move into whatever position lets him or her breathe better.

If the patient is unconscious and his or her airway is blocked, it means air can’t get to the lungs and the patient is dying. The medical intervention that will most often fix a blocked airway is also the simplest: Reposition the airway. If you’ve ever taken a CPR class, you should be familiar with the head tilt/chin lift and jaw thrust. If you have never taken a CPR course, you can find a free one online and complete it in about an hour.

If blood, broken teeth or other obstructions are interfering with a patient’s breathing, roll him or her onto his or her side. That should allow gravity to move the obstruction out of the way. Do not try to “sweep” anything out of the patient’s mouth or you may end up forcing something farther back into the airway.

Assuming the airway is intact (the technical term is “patent”), is the patient breathing? If not, give him or her two rescue breaths. That may restart the patient breathing naturally. In my experience, this works about half the time.

If it doesn’t, you are going to have to decide if you will continue rescue breaths or suspend treatment. You are going to have to base that decision on the number of patients, whether anyone else is there to help and your own skill level.

Penetrating trauma to the chest can allow air to enter the chest cavity through the wound. This is known as a “sucking chest wound.” This type of wound will prevent someone from breathing properly, so you’ll have to seal any open wound to the chest. There are commercial chest seals made to address sucking chest wounds. If you don’t have one, any plastic sheet, such as a piece of a trash bag, will do. Place it on the skin directly over the wound and tape it down so that no air can get sucked into the chest cavity. If you don’t have tape, hold it in place. Vented chest seals are ideal, but a non-vented chest seal is better than no chest seal.

There is little a layperson can do when it comes to circulation. Reassess any tourniquets or dressings you have placed. Make sure the bleeding has stopped. Treat for shock by loosening restrictive clothing. Elevate the patient’s feet unless it causes pain or could cause further injury.

Hypothermia

In trauma care, there is what is known as the “triad of death.” The three components are coagulopathy, acidosis and hypothermia. Each one of these can kill a patient on its own, and each one will make the other two worse. If you have stopped the bleeding and the patient is breathing, you have done all you can do for the first two components. That leaves hypothermia.

Simply, hypothermia is when a person is too cold. Even if it is a warm day, a trauma patient can still get hypothermia, and the leading cause of hypothermia in trauma patients is blood loss. A drop in body temperature that would only be uncomfortable in a healthy person can kill a trauma patient.

So how do you fix it? You pretty much can’t fix it in the field; you can only stop it from getting worse. The best thing you can do is to wrap the person with a blanket. If the patient is lying on the ground, put the blanket under and over him or her. Also be sure to keep the patient’s head covered.

Another point to consider is whether to render aid if the person who attacked you is wounded. As a layperson, you are not legally required to render aid to anyone. As a medic, I would not render aid to an enemy combatant unless I had another soldier covering me should the patient attempt to attack me. If a situation is dangerous, nonmilitary EMTs will wait a safe distance away until the police have made the scene safe. Remember: You are never required to risk your life to save someone else.

Don’t Assume

If you want to improve your shooting, you need to train. And if you want to improve your ability to render aid, you need to train in that too. Unfortunately, most people do not have the training to use airway adjuncts or to pack wounds.

Consider the Army Combat Lifesaver Course, which will almost qualify you as what’s called an “EMT-Basic.” When lives are on the line, the biggest mistake you can make is to assume you will be ready to respond without good training. Get the proper instruction now so you can perform self-aid or first aid until 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).