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| Trauma |
| Medical history relevant to this medical condition |
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Ballistic trauma (Gunshot wound) When someone is the victim of a gunshot wound, the injury sustained is categorized as ballistic trauma. The most common types of ballistic trauma stem from firing small arms such as semi-automatic pistols, light machine guns, sub-machine guns, and assault rifles used during armed combat, sporting competitions, game hunting, and various forms of illegal activity. It is estimated that over half a million people suffer from firearm-related injuries per year; about 60 percent of these occur during armed conflict, and the other 40 percent arise out of non-conflict circumstances. Based on studies by the World Health Organization compiled from data gathered in 2001, ballistic trauma only accounts for about a quarter of the 2.3 million violent deaths occurring annually around the globe. When tending to a wound caused by ballistic trauma, a physician's primary concern is to determine the victim's probability of survival by analyzing the internal damage caused by the bullet entry. A bullet can easily shatter a bone, and pieces of bone or shrapnel can puncture vital organs or damage the person's spinal cord. In addition to assessing the likelihood of survival, medical staff will need to figure out what the future holds in regards to the patient's health by examining the severity of the injury. Then, it can be decided whether a preventative or treatment-based approach should be taken. The following variables should be considered when determining the severity of a gunshot wound: Type of weapon fired Caliber of weapon Structure of bullet and its propellant charge Distance between victim and shooter Site of injury Quantity of wounds Even nonfatal bullet wounds can have devastating long-term effects ranging from disfigurement to physical disability. It is the norm for any gunshot injury to be treated as a medical emergency and require expedited hospital care. What information must be reported to police? 1. The injured person’s name, if known; 2. The fact that the person is being treated, or has been treated; and 3. The name and location of the health care facility or where an emergency medical assistant treated the individual. How is the information to be reported? When is the information to be reported? Disclosure is to be made as soon as reasonably practicable without interfering with the injured person’s treatment or disrupting the activities of the facility or emergency medical assistant. Who is required to report? What types of wounds are required to be reported? All gunshot wounds are required to be reported. Reportable stab wounds are wounds caused by a knife or other sharp or pointed instrument or a prescribed wound, however; it is not the intent of the legislation to capture stab wounds that have been self-inflicted or are accidental. Do health care professionals have to determine if the wound is criminal in nature? Does this infringe doctor-patient confidentiality? If a gunshot or stab wound is reported to police, does this absolve other reporting requirements, such as for suspected child abuse or neglect or elder abuse? No. Health care facilities still have other statutory duties to report: including suspected child abuse; elder abuse; health-care fraud; sexual abuse by a health professional; communicable diseases; and reporting of lost or stolen drugs, among others. This new legislation pertains to information sharing between health care and police relating only to gunshot and stab wounds. In smaller clinics, what if the doctor is the only one there to report an incident and he or she isn’t comfortable reporting? Signs of Internal Bleeding Since you can’t see all the bleeding, it’s important to note the initial vital signs. Warning signs of internal bleeding include: •Decreasing alertness •Nausea/vomiting •Weak pulse •Lowering blood pressure, or faster and faster pulse. For a Gunshot Wound in the Head 1.Attempt to control the bleeding with direct pressure as best you can (no tourniquets around the neck). 2.Make sure the blood doesn’t choke the person. You can have a conscious person sit up and lean forward, or turn an unconscious person on their side and bend the top knee forward to keep them that way. 3.If you believe a carotid artery (that large artery on either side of the neck that supplies the brain) is nicked, you can apply soft direct pressure, and include an occlusive dressing. (See the box to the right.) For a Gunshot Wound in the Chest Think about: air sucking, spine injury. 1.Open chest wounds are also nicknamed sucking chest wounds because they suck air in and can lead to a collapsed lung. You can help stop the sucking by closing the open wound with an occlusive dressing. 2.Remember the spine is also included in the back of the chest. Be very careful about movement of these victims. You want to keep them as still as possible and not damage the spinal cord. 3.If the heart, the lungs, the spine, or a large blood vessel is damaged, there’s not much you can do outside getting immediate expert medical care. For a Gunshot Wound in the Abdomen Think about: organ protection. 1.If the wound is open and you can see the intestines, find a moist, sterile dressing to place on top of the wound (to protect the organs). 2.If the intestines are ripped open, the victim needs immediate medical care. If they don’t bleed to death, they’ll likely die of the coming severe infection. 3.The victim should take nothing at all by mouth until the pain lets up, and then wait a _________. This is obviously a difficult situation, but this step is very important and a time when a slow drip of IV fluids would be useful. If an arm wound won’t stop bleeding despite direct pressure to the wound and elevation, press on the brachial artery around the place where the arrow in the left picture is pointing (below the armpit). Do this by grabbing underneath the person’s arm, wrapping your fingers to the artery (inner arm), and pressing firmly on it with your fingers. You’ll know you probably have it right when the bleeding slows down. If it’s still not controlled, try pressure nearer to the heart. Get a partner, and find the person’s radial pulse (in the wrist on the thumb side). Then grab the upper arm as described above. You should feel the pulse stop. Only do this for a couple of seconds, of course, since you’re stopping blood flow. For a leg wound that won’t stop bleeding, apply pressure to the femoral artery, shown in the picture on the right. The best place to do this is in the middle of the bend between the front of leg and the hip. (This is not the place where the arrow is pointing; it’s above it.) For a Gunshot Wound in the Arms or Legs Think about: bones. Tips: 1.Direct pressure, elevation, pressure bandage—in that order. Elevate the wound above the heart, and apply a pressure bandage. Then if it’s still bleeding, take your fingers and apply pressure to the brachial artery for the arm or the femoral artery for the leg. (See the box to the right.) 2.If all else fails in an extremity, go to a tourniquet. (It may come down to “lose a limb or lose a life.” See The Survival Doctor’s Guide to Wounds for dos and don’ts of tourniquet use.) 3.If the area is rapidly swelling, that’s a sign of internal bleeding. Also, consider that a bone might have been injured, even shattered. If you suspect this, the area needs to be splinted. For a Superficial Wound If the gunshot wound is superficial, clean it as much as you can and follow the steps in “Puncture Wounds” in my e-book The Survival Doctor’s Guide to Wounds. Start antibiotics when you’re finished taking care of the wounds. One More Thing: What About the Bullet? In most circumstances, you don’t want to remove an implanted bullet. It’s almost impossible to find, and it may actually be corking up a big blood vessel. |