Given what’s been happening in the world lately, we’ve been talking about what to do when you or someone near you is injured through unexpected violence. Two weeks ago, I told you what I think are the most important immediate things to do for a gunshot victim until expert help arrives.

That post assumes help is coming right away. But what if emergency responders are delayed? For example, what if you’re caught in a riot and there’s so much chaos that the roads are completely blocked?

Here’s what you could do if help were not imminent.

First Steps: Fight Early Threats to Life

In addition to acting on the initial treatment tips in the first post, here’s what I would do if emergency help were delayed.

Keep the person warm. Hypothermia can be an overlooked danger. Unless it’s hot where you are or the person is well clothed and dry, cover them with a blanket or coat.

Keep the person flat (in most cases). Bleeding can cause blood pressure to plummet (that’s called going into shock), which can dangerously reduce blood flow to the brain. I’d have the victim lie flat on the ground so blood could hopefully still circulate to the brain effectively. If the person were conscious and I was sure there was no neck or back trauma, I might put something under the head for comfort.

Caveat: One time you might not want the person to lie down is if the gunshot is to the head and lying down causes the bleeding to choke the person.



Ensure a good airway. If the person were unconscious, I might place them on their side to keep the tongue from blocking the airway. If placing on the side were impossible or I suspected a neck injury, I’d do the jaw jut: I’d place my fingers behind each side of the person’s jaw and jut it forward, without moving the head. Someone would have to hold it that way. (Or, of course if you have an oropharyngeal or nasopharyngeal airway, now would be a good time to use it; learn more about these devices and the jaw jut in my training course.) Some experts have suggested, if nothing else, pulling the tongue forward and safety pinning it to the lower lip.

Look for more wounds. After quickly dealing with any bleeding as described in the previous blog post on gunshot wounds, I’d check every inch of the person’s body for further wounds. Remember, once a bullet enters the body it often doesn’t follow a straight line. It may ricochet off bones. The entrance wound may be in the abdomen and come out the back of the upper chest. Or vice versa. Keep the person warm while checking for the wounds.

These are general tips. Click here for more specifics on treating a gunshot wound to the head, abdomen, chest, or extremities.



Next Steps: Prevent Infection

When you’ve finished addressing the immediate life threatening problems, then you can work on preventing infection. In most cases, you won’t need to worry about this unless help is at least a few hours away.

Irrigate the wounds with drinkable water. Apply antibiotic ointment or honey if you have it. Apply a dressing. Give oral antibiotics if you have them and the person is conscious. Bullet wounds are dirty wounds. (I go into more detail about choosing and using antibiotics in The Survival Doctor’s Complete Handbook.) Of course, you could give antibiotics through shots or IV if you have them available and know how.

2 Things Not to Do

Don’t close the wounds. Even if you know how to close a wound with sutures or tape, remember that you shouldn’t close puncture wounds, including bullet wounds, for two reasons: Bleeding could start up again without you knowing it, and closing a puncture or gaping wound just makes a perfect place for bacteria to grow and cause a bad infection. Don’t discount flesh wounds. If it’s only a flesh wound, great. But still, be careful. From what I can tell in the movies a “flesh wound” is when a bullet doesn’t go into the abdominal, chest, or head cavity. It just goes in, say, one side of an arm or leg and out the other side. Well, that may be good sometimes, but there are blood vessels and bones in those areas. So beware. Look for bleeding, quick swelling (which may be from bleeding), or signs of a broken bone, and treat according.

What about removing the bullet or performing emergency surgery? I’ll cover those topics in future posts. You may be surprised at my advice. (Subscribe below to be notified when those are published.)

What about you? Have you ever been in such a situation as I’ve described?

Keep tips like these by your side with The Survival Doctor’s Complete Handbook, available now.

Photo: Flickr/Jonathan Kos-Read, “Bullet Hole in my Window :: iPhone,” shared via CC BY-ND 2.0.