You may never be exposed to a gunshot wound. If you should be involved in providing help for a gun shot victim, here are some things to know.
- Safety first. Running into an active shooting scene without knowing the area is secure can result in another shooting victim, you.
- Call 911 and follow directions of the dispatcher.
- Address circulation problems first – stop the bleeding. Severe blood loss is the most frequent preventable cause of death in gun shot wounds (GSW).
- Direct pressure, elevation, and a pressure bandage work for most extremities. Pressure should be hard enough to trap the injured tissue against a bone and elevating the limb until the bleeding is completely stopped.
- Use a dressing to help the blood clot and seal the wound. Two main types of ready-made pressure bandages are the Israeli bandage and the H-type bandage. You should plan on adding one or two of these to your first aid kit and learn how to use them.
- Use a tourniquet if you can’t get bleeding to stop. Apply it 3-4 inches above the wound or above the nearest joint. When properly set up, it will be uncomfortable. It can be left on for up to three hours with no ill effects. Tourniquet use saves lives. 
- Look for signs of internal bleeding. There are initial vital sign changes that are warnings of internal bleeding:
- Decreasing alertness
- Weak pulse
- Lowering blood pressure, or faster and faster pulse 
- Rapid enlarging area
5. Check for a clear airway; what are respirations like? Is breathing spontaneous or raspy and irregular? You may need to do rescue breathing if the victim isn’t breathing on their own.
6. Treat for shock – Cover the victim to keep warm. Shock is a failure to deliver adequate oxygen to tissues. In blood loss cases, it results when the volume of blood and hemoglobin, which carries oxygen in the blood are reduced. Adults have approximately 5 liters of blood. As blood loss increases, physiological changes will become more prominent and severe. Systolic blood pressure begins to fall, pronounced heart rate increase to greater than 120 beats per minute, respirations increase to greater than 30 per minute. With greater than 40% blood loss (>2000ml), lethargy, ohs of consciousness and cardiac arrest can occur. 
7. For a gunshot wound in the head, attempt to control the bleeding with direct pressure. Make sure the blood doesn’t choke the victim. Have a conscious person sit up and lean forward. Turn an unconscious person on their side, bend the top knee forward and make sure tongue is not blocking airway. If you believe a carotid artery is nicked, apply soft direct pressure and include an occlusive dressing.
8. For a gunshot wound in the chest, determine if it is a sucking chest wound (sucks air into the chest when victim tries to breathe and can lead to a collapsed lung. Close it with an occlusive dressing – a plastic laminated driver’s license or plastic wrap can do this. This victim will need emergency treatment like a chest tube right away. Minimize movement of these victims because the spine could also be affected. If the heart, lungs, spine or a large blood vessel is damaged, immediate medical care is required.
9. If the gunshot wound is in the abdomen, think organ protection. Cover visible open wounds with sterile dressing. If intestines are ripped open, immediate medical care is needed. Here you have not only bleeding issues but severe infection from microbes inside intestinal tract. No food or drink by mouth should be allowed for a day or two. Slow drip IV fluid is useful during this time.
10. Gunshot wound to arm or leg – think bones. Elevate wound above the heart and apply direct pressure bandage. Tourniquets can be used on extremities if bleeding is unstoppable. When bullets hit bones, the bone can be shattered and may change the bullet’s direction.
11. Do not try to remove the bullet. It could be plugging a major artery. In any gunshot would, get expert medical treatment as soon as possible. If you see a bullet exit wound, apply direct pressure to that wound, too.
To avoid accidental gunshot wounds, remember these three gun handling laws:
LAW 1: Neve allow the weapon to point in the direction of anything that you do not intend to destroy.
LAW 2: Never allow a finger to be near the trigger until after you have aimed the weapon at what you plan to shoot.
LAW 3: Every weapon is ALWAYS loaded, even when it isn’t!
Good shooters obey these three laws as though they were sacred rituals, until they become unconscious habits. Never violate them, EVER! And never stay any place where anyone else is violating them.
Billie Nicholson, Editor