Shooter puts a Round Through His Foot... What do you do NEXT?

[markj]

If you have not had at least an 8 hour class on first aid get one.

Yes, everyone should have this, wife is EMS on the VFD, we take classes together, she teaches this stuff at the hospitals she works at too. I got involed from riding motorcycles, seems someone will fall off and get hurt. Keep a kit in the bike, and the truck. One out in the barn too.

Had 6 wrecks myself, last one almost killed me. Lets not talk about the hunting accident where I was shot. or the bar brawl where I was also shot (was a bouncer) folks were there acted quick.

Saw a guy stick himself in his neck with a knife, cut the artery, 2 nurses in the bar took ice, towles and used pressure, he lived thru that. First aid is something you need but hope to never need to use.

Now when I was stuck in the back of my neck with a pig sticker, had to run myself to the hospital, made a mess in the truck.

[Catfishman]

I've heard that packing a wound in ice helps slow the bleeding. Is that true?

[scrubcedar]

At one point Ice was recommended when you had an EXTENDED period of time before you got help. The dangers are similar to, though not as bad as a tourniquet. Frostbite/ freezing tissue damage is remarkably easy to cause and the water can be a source of contamination in and of itself. It's not worth playing with. This is a great example of what we did at one point but found out later was harmful. I'll recommend again, first aid/CPR classes taken regularly so you don't end up with bad solutions to life and death problems. MarkDozier mentioned that he had been trained starting in 1975 in first aid and they were trying to get people to stop using tourniquets at that point. When we had patients come in with tourniquet damage quite often it was Grandpa who used the method in WWII to save his buddies life while under fire. His training was so effective he was still doing it that many decades later! Get good training, update it regularly. In my experience you are statistically more likely to have to use it on a family member, think of it that way.

[Mike38]

How many folks actually keep an IFAK/BOK with their range gear, just in case someone has a blow out?

I do. I'm an EMT. First thing I load into my Jeep, even before the guns and gear. I've never used my kit at the range, and hope I never have to.

[insomni]

Not too much to this one. Get someone to call EMS, and get a first aid kit. Put a knee into the femoral artery to stop bleeding while you apply a pressure dressing. pack the hole with kerlix or gauze. Lots of it (beware of sharp bits... Protruding bones are VERY sharp). Mostly, this is for 1 stopping blood flow, 2. Padding for the wound and bones. After that, wrap it with an ACE wrap or a decently tight bandage. Find any toes that may have been blown off, wrap them in some moist gauze and put them in a baggie of ice. Surgeons will most likely be able to reattach them if they show up cold. immobilize the patient, and wait for EMS. if you're incredibly rural, have the operator have EMS meet you half way.

I say call EMS instead of evac him yourself because EMS will have some things you don't: IV's with fluids, and more importantly immediate access without paperwork or a wait when he gets to the hospital.


Also, if you DON'T go to the range without an IFAK/first aid kit you're setting yourself up for failure.

[insomni]

for those of y'all that are wondering, here is a good begining packing list for a range first aid kit. Guys with experience and training, let me know if I left out any bandaging supplies. to reiterate what's been said a few times: Appropriately educate yourself. Go take a class. Learn from professionals how to put a bandage on correctly.

Look around at surplus stores, and on line and you'll be able to find something to hold it in, as well as good deals on some things inside it.

gloves (Stretchy Nitrile)
2 4" Israeli Bandages
- - - If you can't get these, use old style Army bandages for their bulk and
- - - absorbancy. Use the white part to stop the bleeding, and secure with an
- - - ACEwrap sports bandage for an instant homemade pressure dressing,
- - - though be careful not to cut circulation off in the process if you don't
- - - need to.
Tourniquet materials (CAT Tourniquet, or a cravat with a sturdy stick to use
- - -as a windlass)
Trauma sheers (BLUNT ROUND NOSED SCISSORS for cutting a pant leg if need be)
2x cravat (These are used to immobilize a shoulder, or to hold a dressing in place if it's on the abdomen or chest)
1 roll Kerlix (for stopping bleeding, and padding a wound.
1 roll 1" medical tape (sticks to absolutely everything.... except sweaty skin :[ )
Hand sanitizer. Small travel sized bottle will suffice.
Baby powder. Unscented, sprinkle it on your hands and your gloves will slip on like magic.
assorted bandaids. Yah I know, they're for kids, but you never know when
- - -you're going to nick yourself with with a knife, etc.



other things to note:
*NSAIDs like Asprin, Ibuprofen, Naprosyn (found in Aleive, Excedrin, Motrin), though they work very well to control pain, negatively affect blood as far as clotting goes (which is why asprin works for people during a heart attack). Tylenol (acetamenophen) is a much better choice since it has analgesic effects, and does not "thin" the blood.
*Tampons. well they kinda work for exit wounds, but look at the size of an entrance wound and tell me a tampon applicator will fit in that!
*Gloves: There's nothing inherently wrong with latex gloves, they work quite well. However there are enough people with latex allergies out there that you want to stick with Nitrile, Vinyl, or another latex free. Yes it's a good idea to put gloves on before touching blood.
*Bandages: practice with them. You DEFINITELY don't want the first time you bandage someone to be when they're bleeding. Take a class in first aid one weekend. Try to take a Red Cross or similar class through Gander Mountain or the NRA if possible so it's geared towards hunting accidents, or some sort of penetrating trauma.
*Gauze: Regular gauze. 4x4's or 6x6's. Get about 4 or 5 of each. There is a product called Combat Gauze. It isn't plain old regular gauze. it has a clotting and chemical cauterizing agent in it, and requires extra familiarization and training to use.
*POUCH - make it easily accessible, and PORTABLE. You probably don't want to be lugging your whole range bag to someone in need, but you definitely want this pouch to be IN your bag. Find something that either has a full clamshell zipper, or an old style plastic box that can hold everything, but is easily accessable.
*Sterility: Don't open the packages till you need to use the contents.
* KNOW YOUR LIMITS: You are doing this to keep some sort of control over bleeding until the emergency crew arrives. Don't try to be a hero.


cheaperthandirt.com sells LOTS of these items, Amazon.com does as well actually.

[scrubcedar]

I'm sorry to have to disagree with you about the tourniquet insomni, here are a couple of links that might help everyone understand better. The first is from the American red cross site.
http://www.redcross.org/email/safety...9/firstaid.asp
It specifically lists the idea that a tourniquet is the best method as a "Myth" The red cross is considered the gold standard for up to date information. Notice the title of the article "Ten Common First Aid Mistakes".

Tourniquet use in surgery is even being looked at because the tourniquets are permanently damaging the nerves, in some cases in a matter of minutes.

You guys made me curious so I accessed a couple my old medical sites as well as doing more normal research. Found some interesting things a fairly recent army manual thought they were a good solution, providing you had already diagnosed severe arterial bleeding that couldn't be stopped with pressure,and you were under HEAVY fire. That's almost an exact quote, I couldn't figure out how copy off of the type of file it was. If you're at the range and he is pumping blood,at the same time someone is shooting at you, the Army is on your side.

The next quote is from military research as well. The rate of limbs with fasciotomies
with tourniquet time <2 hours
was 28% (75 of 272) and >2 hours was
36% (9 of 25, p
0.4).
Fasciotomy or fasciectomy is a surgical procedure where the fascia is cut to relieve tension or pressure (and treat the resulting loss of circulation to an area of tissue or muscle). Fasciotomy is a limb-saving procedure when used to treat acute compartment syndrome.

DO NOT CLICK ON THESE PICTURES WHILE EATING!
http://en.wikipedia.org/wiki/File:Fasciotomy_leg.jpg
http://en.wikipedia.org/wiki/File:Fasciotomy.JPG
http://en.wikipedia.org/wiki/File:Fa...kin-Graft).jpg

The figures come from a study published in 2008 in The Journal of TRAUMA
Injury, Infection, and Critical Care and were compiled in the field in Iraq. I was in trauma nursing for more than 20 years, as well as being a CPR instructer. I have no idea how many dearly held beliefs from my training I had to walk away from! It was very hard each time but sometimes it was the difference between life and death.

[insomni]

Yah, I was thinking on that one a bit last night. I dont think I would use a tourniquet at the range for a foot either. Its risky, especially without training or fast access to a hospotal. Im going to edit the above post for that one.

[Rob Pincus]

Great stuff, guys...

Here are the suggestions we came up with, as part of the PDN Update Last Week: PDN Tour Update #10: Emergency Gun Shot Wound Response

Personally, If one of my student's gets an extra hole in the middle of a class, I am not going to be taking the time to put on gloves before I start trying to help.

-RJP

[insomni]

that's a really great video!

I especially liked the finer points like ensuring Emergency crews know it was accidental, and moving vehicles for ease of access for the ambulance.

Thanks a ton! Hope people learn alot from all of this.

[CarbineWilliams]

Breathing, Bleeding, Shock... etc. use the old Army first aid method. The guy was still breathing, take care of the bleeding. Then deal with the shock. Plenty of people with otherwise survivable wound go into shock and don't make it.

Found this:


http://www.me.ngb.army.mil/units/rti...ion_C_ALMS.pdf

Worth a look. It's kind of dated so if anyone has a more recent FM drop a link.

[Sport45]

It took fourteen posts before someone said to make the gun safe.
You don't need two, or more, people hurt.
Make the gun safe then tend to the victum.

I don't agree. Tend to the injured first and leave the gun alone. It's not going to go off all by itself. Tell others to leave it alone too, if necessary.

[Nanuk]

Actually current combat medicine calls for tourniquet use. Last year I attended an advanced combat trauma management class. The most common cause of preventable death on the battlefield is bleeding from extremities. A CAT or similar TQ that is at least 1" wide does NOT harm tissue underneath it and prevent it from being viable when properly used. The second most common cause of preventable death on the battlefield is bleeding from the torso. In this situation, you must locate the severed artery and pack the wound in such a manner as to stop the bleeding. It has nothing to do with being a hero, it has to do with saving a life. Treating a GSW is the same where ever you find yourself, hopefully you will not be getting shot at while doing it. I was a NREMT, EMT instructor and clinical instructor.

If you are going to be around guns as a hobby or profession you owe it to yourself and your shooting friends/partners to obtain realistic trauma management training.

Every shooter should carry a blowout kit and know how to use it.

A shot to the foot will rarely require much first aid, it is usually load and go. The funniest one I saw was a hunter that put his rifle in the truck and shot himself in the foot with a 270, put a nice neat hole thru his boot, foot, transmission, deflecting into the front tire.

[scrubcedar]

Nanuk, you might want to go back and read through all of my posts. A tourniquet is still a viable tool to save a life, no one is disputing that.
In my first post I emphasized that a tourniquet was to save a life that was bleeding away. Multiple GSW's, damage from explosions and shrapnel, those are the things that are most likely to need a tourniquet and that is why they teach combat medics to use them.
This was a different scenario than that. The statistics you saw above about limb damage were compiled in Iraq by our military in 2006 and published in 2008. Obviously they are concerned about whether their training is teaching the medics to use this tool appropriately.
If it becomes a choice between loss of life due to bleeding (exsanguination), or loss of limb due to tissue damage, you sacrifice the limb. That is the yes/no question for it's use, will they die without it? Combat medics are trained quite well to make that call. I've seen way too many civilians get that call wrong. Maybe your class was good enough, I don't know.Keep in mind most of the people I saw get the call wrong were military vets thinking like they were in a combat situation.

[Nanuk]

Scrub,

I agree that too many untrained people use the wrong thing for a TQ, electrical cords and such, causing irreparable damage. Its really quite simple, if it's not called for its not called for. In this example I would probably have not even removed his shoe/boot until arrival at the ER.

[insomni]

Torniquets are really good stuff. if the shooter had a femoral or other arterial bleed, i'd throw one on in a second (hence why its in my kit), but if the foot is intact and attached, I think i'd go for a pressure dressing first. tourniquet if bleeding couldnt be controlled with pressure. It isn't combat afterall, and this day in age you have to consider you might very well get sued if the patient lost a body part for whatever reason. You have to be able to medically justify everything you do in court. Combat medicine: tourniquet. Civilian: pressure dressing, then tqt as last resort.

Civilian medicine, though the trauma management principles are the same, is a completely different legal beast than combat medicine.

[Nanuk]

It isn't combat afterall, and this day in age you have to consider you might very well get sued if the patient lost a body part for whatever reason. You have to be able to medically justify everything you do in court. Combat medicine: tourniquet. Civilian: pressure dressing, then tqt as last resort.

I partially agree, however, most states have good Samaritan laws for a reason. In all my years of law enforcement, and emergency medicine I have never once had to justify performing first aid on anyone.

[scrubcedar]

Insomni, Nanuk, I think we're all agreeing how we would treat the example in the video. What the threshold is for tourniquet use seems to be the question. The last time I checked the minimum level of class that was teaching tourniquet use was the EMT-B (basic) class and I'm not completely sure of that. As an old CPR instructor, this would be my best advice. If you're curious about these things, and sincere about wanting to help( it sure sounds like you are) taking one of these courses probably costs less and takes less time than you think. They will teach you the most up to date and effective methods and teach them well. Having trained folks around makes us all safer, and I'll say once again your family/friends are the most likely people to benefit. You both sound like men who can keep your heads on straight when the blood starts to flow, trained people like that are rare and valuable. That sort of person is who my patients were (literally ) praying for out in the field. If there is any way to twist your arm to get you to do this consider it twisted.

[Nanuk]

LOL, well if you read my first post, I was an NREMT for 9 years, EMT instructor.

[jason_iowa]

My range is only about 10 minutes from a hospital driving the speed limit so with a minor gun shot wound I would get the victim to the hospital in 5-7 minutes. I think any time spent with my less then expert combat medical training would be detrimental. Lots of good info here though about things you should have with you when ya go to the range. Most of them are things I have in my car at all times anyway.

Be a good boy scout and always be prepared.

[Sport45]

My range is only about 10 minutes from a hospital driving the speed limit so with a minor gun shot wound I would get the victim to the hospital in 5-7 minutes.

I suggest driving the speed limit. Doubling it to get him there in 5 minutes puts the injured party at more risk than they were already in.

If the bleeding is bad, try to control it and dial 911. They are much better equipped to take care of someone in transport than any of us are in a POV (privately owned vehicle).

[Nanuk]

I suggest driving the speed limit. Doubling it to get him there in 5 minutes puts the injured party at more risk than they were already in.

ABSOLUTELY!

If the bleeding is bad, try to control it and dial 911. They are much better equipped to take care of someone in transport than any of us are in a POV (privately owned vehicle).

If you are that close it is usually faster to load and go. We did that with one officer that was shot, loaded him in the patrol car, and took him to the hospital. But we were code 3 and on the radio, letting them know we were on the way, with an escort also going code 3.

[jason_iowa]

I drive to fires that quickly. I drove to emergencies as a police officer that quickly. I'm fairly confident I could get us there fairly quickly in one piece. Mostly empty roads most of the time and only 3 or 4 blocks in town. If it was dire I do have emergency lights for "firefighting". But I would take the hit if I thought it were life or death.

[scrubcedar]

Nanuk, there was a push years ago to get ambulance drivers to slow down. Far enough back that I can't remember clearly. Were you around for that? Seems like they had stats that indicated speeding just meant that the traffic became more of a hazard and slowed you back down to the point it was very seldom worth it. You're right I missed your qualifications, let's blame aging eyes and a 9 inch iPad screen

[Nanuk]

Scrub,

I don't remember that. Besides my wife who likes to fight horses and hay balers, my emergency medical experience has been wilderness SAR and LE related. I have never driven an ambulance though I have ridden in a few.