Gun Shot Wounds-need your help

[trainer23]

I have been asked to make a presentation to my EMT class about Gun Shot Trauma or GSW.

What are some good sources of information? Any experience, pictures, or stories? I especially want to address the different level of trauma based on handgun vs long guns; different caliber expectations: FMJ vs HP. Where can I find good illustrations, pictures of wound channels?

Has anyone treated GSW? What were the special considerations? How about survival rates?

Thanks for the help.

Hope I posted in right place. Feel free to move if not.

[festus]

If they have a criminal justice program, they will have books with a lot of really grisly photos.

Talk with local Veterinarians. They see more GSW type injuries than most doctors.

The US army uses it's veterinarians as combat surgeons in aid stations. Contact the nearest Army base to you and ask for some assistance. As long as you have credentials thay should share info as part of the Global War On Terror.

[Sidewinder]

On a side note-

When I saw the title of this thread I was like, "Hmm, if he has a Gunshot Wound and needs help, shouldn't he call 911 or something"

[AZSATT]

I'll see if I can dig out any of my US Army Combat Life-Saver course materials, for references for you. In the meantime, if you Google that course title, you may find some of the info you're looking for.

Some of the best pics I've seen - other than real world hands on I mean - were in our Crime Lab's library. They had references for some seriously nasty stuff. (I'll never forget the guy, who while high on PCP, literally carved the skin off his own face, because it was 'evil.' Even his eyelids...)

The Crime Lab's reference books had the handgun vs. rifle vs. shotgun effects on various body placement hits. Something like that would probably help you out a lot, with pics and data. If there's a Metro PD near you with a IBO/CSI unit attached, they'd probably be like a one-stop-shop for you. Hope this helps. Sounds like a fun class!

[AZSATT]

Oh and stories and experiences?.... LE and Army stories regarding all kinds of firearms-related "ventilation". I'll PM you.

Check this link out. Looks like a resource with all kinds of data you're looking for:

http://library.med.utah.edu/WebPath/.../FORIDX.html#5

Scroll down for the list of gunshot related data. Hope this helps.

[HiCarry]

Originally Posted by trainer23

I have been asked to make a presentation to my EMT class about Gun Shot Trauma or GSW.

What are some good sources of information? Any experience, pictures, or stories? I especially want to address the different level of trauma based on handgun vs long guns; different caliber expectations: FMJ vs HP. Where can I find good illustrations, pictures of wound channels?

Has anyone treated GSW? What were the special considerations? How about survival rates?

Thanks for the help.

Hope I posted in right place. Feel free to move if not.

In 20+ years in the ED and in the field, I have seen and treated many GSWs. There are many good sources of info available but in general the treatment remains the same. The ABC (Airway, breathing, and circulation) come first, although there is some debate about changing that under some tactical situations. After those primary concerns are considered, the specifics of the actual or presumed injuries/trauma can be addressed, but in all realities, your concerns as an EMT/paramedic should be the ABCs and rapid transport to an appropriate facility, with enroute care focused on gaining vascular access for possible fluid resuscitation and monitoring vital signs and the patient's airway. On-scene time should be minimized even if that means not getting that second (or first) IV or having to use a secondary airway device.

Here are a few links for you:

Surgical-tutor.org.uk - a free online surgical resource

Current concepts of gunshot wound treatment: a tra...[Clin Orthop Relat Res. 2003] - PubMed Result

Gun Shot Wounds - Wheeless' Textbook of Orthopaedics

Force Science News #119: More on downed officer rescue & important new court rulings at Force Science News

[GeneralSumter]

Originally Posted by AZSATT

Check this link out. Looks like a resource with all kinds of data you're looking for:

Forensic Pathology Index

Warning: graphic

[fitebak]

HiCarry pretty much sums it up. I was a street medic for 20 yrs. and then ran a paramedic agency. I was a platoon commander in Viet Nam. ABCs and rapid transport to a trauma facility are key. Do the care you are qualified to to on the way. Always call ahead so that the trauma team can be ready. I have read some new theories on tourniquets and clotting materials used in the sand box but can't speak to those directly.

Make sure you do a complete head to toe survey on any victims as they may still be armed, and if conscious at all, may view you as the "cop" or others they want to kill. I've seen one x-ray from an ER where the outline of a revolver showed up in the small of the back when they did a supine x-ray on a patient brought in by paramedics. Whoops for those medics. It could have been deadly for them or the ER staff.

[HiCarry]

Originally Posted by fitebak

HiCarry pretty much sums it up. I was a street medic for 20 yrs. and then ran a paramedic agency. I was a platoon commander in Viet Nam. ABCs and rapid transport to a trauma facility are key. Do the care you are qualified to to on the way. Always call ahead so that the trauma team can be ready. I have read some new theories on tourniquets and clotting materials used in the sand box but can't speak to those directly.

Make sure you do a complete head to toe survey on any victims as they may still be armed, and if conscious at all, may view you as the "cop" or others they want to kill. I've seen one x-ray from an ER where the outline of a revolver showed up in the small of the back when they did a supine x-ray on a patient brought in by paramedics. Whoops for those medics. It could have been deadly for them or the ER staff.

Some of the new clotting stuff seems pretty good, but I've been told (haven't actually gotten to use the stuff, yet...) that you need to wipe off the majority of the blood before pouring the material into the wound. Seem that an exothermic reaction occurs when the blood and clotting material mix, and the more blood there is, the larger the area of heat production and the possibilty of burns.

Your concern about the patient being armed is valid. I've seen a few such instances both in the ED and in the field. When I was in the field, our uniforms looked just like the SO's (dark green pants, white uniform shirt with a "badge" on the left breast) and we were frequently mistaken for LEOs. After one too many patients accused me of being the "cops" I started removing my "badge" at the start of the shift....it wasn't worth wasting time arguing with them.

Another thing that bears mentioning is that as a medic responding to a GSW call, you should make sure some law enforcement agency has cleared the scene before going in. The last thing you want to do is go running into an active shooter situation carrying only your trauma kit.....

Aloha,