https://www.youtube.com/watch?v=K2s6ZhrWjVY
This past weekend was the monthly 3-gun shoot at the Best of the West Shooting Sports near Austin, Texas. I’ve been trying to get back into fighting condition for competition shooting (using iron sights, as previously mentioned), and so I was looking forward to a fun day on the range challenging and honing my shooting skills. That’s what I was expecting…but what I experienced instead was a challenge for my emergency medical skills. I’d never treated a gunshot wound on a range before, and I’d like to go over what happened that morning, both as a way to give y’all a framework for dealing with these events and as a debrief for myself to see if there’s something I missed or could have done better . . .
I had just finished shooting the first stage of the day. I decked my shotgun and dropped my cameras in my range bag when I heard someone shouting from the bay across the road. I looked up, and they shouted again. “MEDIC!”
I hesitated. Not because I was scared, but because I was out of practice. I was first licensed as an EMT in Pennsylvania while I was in college, and since then I had served a few happy years with Fairfax County Volunteer Fire & Rescue station 421 (ironically just down the street from the NRA Headquarters).
When I moved to Texas, I realized that my Pennsylvania and Virginia certs meant exactly squat — Texas only uses the NREMT system, and I would have to challenge the whole test again to become certified. Even then San Antonio uses a paid ambulance service for 911 calls so there were no volunteer squads I could embed myself with, so really there wasn’t any point unless I wanted to do it for a job. Which meant that when the call for a medic went out, it had been nearly three years since the last time my name tag was on the riding card of an ambulance.
A couple seconds passed. Everyone was standing around with a shocked look on their face, not knowing what to do. There was no one taking charge of the scene. I felt compelled to act, so I raised my hand and jogged over expecting to find a lacerated hand or some minor burn. I shouted to the person who was calling for help: “what’s wrong?”
He replied, “gunshot wound to the leg!”
I started running. Not for the patient, but for my car. I’ve always carried a small bag filled with medical supplies for just such an occasion, and when I needed it the most it was parked at the opposite end of the range. Uphill. As I was sprinting towards the car I was suddenly very thankful for the countless hours of cardio I’ve been putting in and the 65 pounds that I’ve lost in the last few months. Without that, I may have had a heart attack before I even got to the car.
Less than a minute later, I parked my car next to the bay and hopped out. As I grabbed my emergency kit from the back seat, that old EMT training had already kicked in and I was starting to roll through my old processes as if I had never left.
Is the Scene Safe?
Question #1 is always scene safety. If the scene isn’t safe, there’s no point going in and making two patients instead of one. In this case, it was a competition shooting event that had gone awry somehow. Normally when there’s a shooting we EMTs are asked to stage away from the scene to let the police check it out and secure it first, but in this case I was happy that the RSO had served that function. If there was a lunatic on a shooting spree we would have known already, so more than likely this was an accident and the scene was safe.
BSI
As I walked from my car to the bay, I reached into the front pocket of my bag and produced a set of latex-free gloves. BSI or “Body Substance Isolation” was something that was drilled into our heads from day one, and is especially important these days. I already knew that we were dealing with a puncture wound of some sort, so there was guaranteed to be some blood. I wanted to be prepared to provide any necessary interventions, and that might mean touching that blood and the pathogens within. Gloves ensured that I could do that without endangering myself.
Initial Contact
One of the things I’ve learned is that attitude is infectious. If you roll up on a patient flustered and scared, they are going to freak out and treating them will be that much harder. I made sure to walk deliberately and slowly between my car and the patient, trying to be as calm and composed as possible. I removed my safety glasses so he could see my eyes and read my emotions a little better, hopefully to keep him calm as well.
I approached him and held out my hand. “Hey there, my name is Nick and I’ll be your EMT today.” Calm. Professional. In control.
General Impression
When I first saw him, he was being led to the driver’s side seat of his truck. I noticed two distinct holes in his pants on his right upper thigh, one higher than the other, and some significant signs of bleeding around the lower hole. My primary concern became assessing that wound and stopping any possible bleeding, with a secondary consideration being shock.
Focused Trauma Assessment
I needed to get a look at the wound, so I asked him to remove his pants — there’s no privacy concerns when you might be bleeding to death — and he happily dropped trou. What I saw was remarkable.
The bullet had plowed a path through his leg and cut a huge swath of skin and meat out of his upper thigh, but the bleeding had more or less stopped. What you see in the above image (taken with permission in the hospital later that day) is exactly how it looked on the range. I was expecting it to still be bleeding, but it looked like the speed and the heat of the bullet had cauterized most of the capillaries and stopped them from leaking.
I checked the rest of his leg, but couldn’t see any other injuries. I removed his boot and checked his foot for pulse, movement, and sensation, and everything looked good. It really looked like a single minor flesh wound, and didn’t require any immediate interventions to save his life. His ABCs were good — airway was patent because he was talking with me, breathing was regular and normal, and he had a strong pulse and wasn’t leaking profusely. The patient was stable.
Transport Decision
This guy needed to go to the hospital. The extent of the injuries and the mechanism of injury was sufficient that I wasn’t comfortable letting him anywhere out of my sight. The bleeding wasn’t profuse right now, but I’ve seen injuries take a couple minutes to really start flowing to a life-threatening level.
The nearest hospital to the range is roughly 20 minutes away by car. The place is just remote enough to be annoying, but not remote enough to be inaccessible. I evaluated my transport options:
- Helicopter: I could call 911, set up a landing zone, and have a helicopter come and pick him up. I keep four flares in my bag for exactly that purpose, and there was sufficient space on the range to make it happen. This would be the fastest route to the hospital and guaranteed to be traffic-free, but it would cost him a ton of money and might actually be more dangerous than the wound itself. Nope.
- Ambulance: I could call 911 and ask an ambulance to come pick him up. The ambulance is much better equipped (and trained) than I am, so they could provide a superior level of care to what my small kit was capable of doing for him. The downside was time — it would take them time to arrive, have the scene cleared by the police, and then drive to the same hospital. Those 20 minutes could turn into 45 very quickly. Possible, but not preferable given the firearms present.
- Drive: I could drive him to the hospital myself. This was the simplest solution since it didn’t involve any police delay, additional expense, or require units that might not be available right then. Depending on the state of his injuries, this might be the best option.
I decided that driving him — in his car, not mine, so he doesn’t bleed all over my seats — to the nearest hospital was the way to go. But before then, I needed to package him for transport.
Wound Care
In my bag of tricks, I have a number of options for how I could have bandaged him for transport. I took a glance in my “leak management” area of the bag and assessed the options from most radical to least radical:
- CAT Tourniquet: The injury met the criteria for an area capable of being controlled by a tourniquet and transport time was under 1 hour, but the bleeding was under control. No need to take such a potentially risky option.
- Clotting Agent: Again, the bleeding was under control. No need.
- Pressure Bandage: No pressure was required to control the bleeding. There was some minor seepage, but nothing concerning. Not required.
- Standard Dressing: The wound was open to the elements, and did need some covering to keep it clean until we could get to the hospital. Also, I needed a quick way to see if the bleeding had increased and a big bright red splotch on formerly white dressings would do that. Bingo.
To package the patient for transport, I placed two sterile gauze pads over the long wound. I then wrapped some roller gauze around those patches to secure them in place. Finally, two passes of cloth tape secured the whole thing to his leg and applied a little pressure to control what bleeding there might be.
Transport
A wound on the gun range poses a unique challenge. The hospitals in Texas are gun free zones, which means we will need to be disarmed before setting foot inside. My patient had already divested himself of his firearms and equipment when he was first injured, and I asked one of the onlookers to grab my handgun and magazines off my belt and throw them in my gun case on the side of the road. Properly disarmed, it was time to leave.
The patient hopped around to the passenger side of the car and got in. I jumped into the driver’s seat, and we started rolling. At this point the match director walked up and started talking to the patient, and I was shocked when he started just bullshitting with the guy. Who in their right minds would want to delay a patient’s treatment so that they could have a nice little chat? I cut it off, the patient plugged the nearest hospital into the GPS, and away we went.
While en route, I started asking him the usual SAMPLE questions. The charge nurse at the hospital will need all of that information when he arrives, and its best to get it well in advance just in case something happens on the way.
Once the formalities were accounted for, we started talking about what happened. On that specific stage, the best way to shoot it involved holstering a hot handgun — something that he hadn’t practiced too much. He had already run the stage once, but a design malfunction meant that he had been given the ability to re-shoot the stage. He started out the re-shoot much faster than the first run, and he was hoping to get a better time so he ran a little faster than he’s comfortable. Together, we figured that the most likely thing to happen was that his finger was still near the trigger while re-holstering. Holster pushed finger, finger pushed trigger, gun went bang.
It just goes to show you that my philosophy is correct: never take the re-shoot.
The one step I probably should have taken is to alert the hospital that we were on the way. Giving a good en-route report is essential to ensuring that the proper resources are available on arrival, and minimizing spool-up time for the ER staff. I didn’t do that, and what happened next is my fault.
Arrival
When we rolled up to the emergency room doors, I left the patient in the car and went inside to get the staff and some means of transportation. I didn’t want him moving his leg at all, since any use of those muscles might tear open the wound further and produce additional bleeding. I walked into the vestibule for the emergency room, where a bored looking nurse sat behind a small cutout in the wall. She looked up from her book and gave me a questioning glance, the “can I help you with something?” implied on her face.
“I’m going to need a stretcher. I’ve got someone here with a gunshot wound.”
Her expression didn’t change. She reached over and pushed a button, and a nurse appeared to give me a hand getting my patient inside.
The stretcher took a little too long to arrive, so we grabbed a wheelchair and went outside to collect the patient. Opening the car door, I started my usual handoff report. “Today we have [John Doe], a 38 year old male with a non-penetrating gunshot wound to his right outer thigh. No known allergies, medications include…” Insert the rest of the SAMPLE information here, a little more condensed and to the point than when elicited from the patient. Years of giving handoff reports give you the ability to vastly shorten them without losing any information — long reports only annoy everyone involved.
At the Hospital
As soon as the handoff report is finished, my job is done. I have transferred the patient to a higher level of care, and as a lowly EMT I’m off the hook. Normally at this point I would retire with my crew to the break room, suck down a few free sodas and write out a trip report, but this time I didn’t have any of that to do. I stayed with the patient, and tried to organize some transportation for myself back to the range. After all, I couldn’t just take his car and leave him at the hospital.
About twenty minutes later, the police arrived. For any gunshot-related injuries, a police report is mandatory in the hospital environment just to make sure that there was no foul play involved. The Williamson County police were extremely friendly, and after a quick chat they checked our IDs, gave us a case number, and left with a smile and good wishes to the bedridden satisfied that this was just an accident and nothing more.
A bit later, RF arrived to pick me up. I had never had an opportunity to see a patient all the way through intake and treatment, but in this case I had been present when the doctor provided his analysis: it should heal on its own, and no stitches were required just yet. The injury looked awful on the outside, but in reality it would be fine without any major interventions. They started him on some antibiotics, and just as the IV started I shook his hand and left the room.
Back At the Range
By the time I returned to the range, a few hours had passed and my squad had moved on. The match director was nice enough to give me a shoot-through, so I spent the next couple hours shooting the remaining match (with some assistance from Robert). I finished, but not before slicing my own thumb open on my shotgun. And my ring finger as well.
I didn’t accomplish the goal I set out for the day. In fact, I’m pretty sure I can categorize that run as “terrible.” But I did get a chance to practice my medical skills in the real world once more, and I provided aid and comfort to a fellow competitor who was in need. He’s doing fine (and probably reading this post right now), and hopefully I’ll see him out on the range next month. I’m just thankful that everything worked out all right.
You build a kit like this, and do this:
https://youtu.be/ht_5M2lLLPo
Outstanding, Mr. Leghorn; I see nothing amiss with what you did. Fine job. And a nice tip sheet reminder for the rest of us as to what to consider.
Good job Nick!
First bit of advice for anyone experiencing a traumatic injury including blood loss. I have more than a little, actually more than a tremendous amount of practice with this:
1. SQUEEZE SQUEEZE SQUEEZE until the blood stops.
2. Get to the hospital.
This is a general thing, but only has very few exceptions. Just remember that and do it as fast as you can as thoroughly as you can. There is a lot more you can learn. But do this, and do it first.
Yep too many people have no clue what to do in emergencies. I’ve seen gunshot wounds and bleeding head trauma and yet in both cases people just stayed there and looked and those that were helping didn’t apply pressure and kept on looking to see if the bleeding had stopped. I took over in those cases and just held the pressure there for a few minutes and the bleeding would have stopped. I’m not an EMT, but I learned enough in Boy Scouts, the basics at least to know to not keep taking the bandages off to see if the bleeding stopped.
I can’t tell you how many times I’ve arrived on the scene to see exactly this happening, someone taking off a bandage to see the wound. Don’t do that. The other thing I have witnessed, more than once, is a patient killed because someone propped their head up on a makeshift pillow, reducing their airway, suffocating them. Keep their head on the ground people.
It goes even further than that.
With children, they need a towel or something similar under their shoulders. Even keeping a child’s head on the same surface level as their back constricts their airway. Small children need their shoulders elevated a bit to allow their airway to straighten out.
Two thoughts: It would have made a much better story if he was spewing blood all over the place, but much more importantly, thank God he wasn’t.
A lot of gunshot wounds I’ve seen don’t bleed very much, surprisingly. Now when they do bleed a lot, however, it’s like a freakin spigot
lol you aint kidding took a S.I. GSW to the callous pad just below the L. pinky it was about a 9mm deep furrow and holy crap I was draining like an open tap…ruined my sister in laws best dish towel and a very embarrassed interview with the ER Doc. who thought it was just the funnest thing that a seasoned vet and farm boy plugged his own hand.
450.00 later for 4 of the sloppiest stitches I ever seen, promised myself I would take care of little things like this in the future myself and have the hard part is getting past the sting of numbing up.
see below for what i now keep on hand at all times, [i get nothing for posting the link just what i use]
suture kit
antibiotic kit
For me this was a good read, one that I had been waiting for… Didn’t really want it to be the result of a GSW, I would have rather it been a hypothetical analysis of what anyone can do in the event of such things.
Would it be possible to get additional, relevant write ups such as this one, but going over the steps that should be taken in the event of different severity of injury? I do 99% of my shooting at my range at home, and with friends and family. I don’t live within 30 minutes of a hospital, and the thought of having a GSW at home is something that stays in the back of my mind.
These guys might have some good info for you
http://lonestarmedics.com/
I’ll be sure to give that a look when I get out of work today, Thanks!
Good group of folks. JWT
I was hoping to get to meet the LSM guys at the ITS muster last year but didnt get to make it. Thanks for the link, really look forward to taking one of their classes.
TK great link already added, thanks
here is one by way of WRSA
Hogwarts School of Grid-Down Medicine and Wizardry
The only other thing I’d offer is don’t text your friends and say “I’m at the hospital and need a ride” without a disclaimer that you’re doing fine.
LOL Good point.
I wonder who lost more blood from their wounds … Nick or the guy with the leg wound?!?!?!?
Another case of ‘GLOCK leg’?
Supposition, could just have been a race gun of some sort. I dont think that detail is near as important as the fact that booger hook and bang switch met when they werent supposed to.
Aw come on! You are ruining my troll attempt with your rational and intelligent response. Guess I need to try harder.
lmao damnation! My troll-dar must be malfunctioning today. Carry on 🙂
Smith & Wesson M&P 9 leg, more like.
Yeah, doesn’t quite roll-off the tongue in the same way.
Kudos Nick. Well done. 1992 NREMT. NYS.
I really liked this write-up, especially the OODA style decision tree approach to assessments and decisions.
That approach has been hard-won, and it bears practicing it more than we already do.
Thanks, Nick. Very good stuff.
Great post. I learned a lot.
But I keep seeing people say that hospitals are no-carry zones in Texas. That was a concession to the get the original concealed carry bill passed but that was changed once the legislature could pass bills without Democrat votes. The original language is still in the law but an addition to the law says that that section is no longer valid. It also removed the prohibition on carrying in amusement parks, churches and at meetings of a governmental entity. All of those places must now display the 30.06 signage. The current open carry law in the legislature will clean up the language so as not to be confusing to those that don’t read all the way through that section of the law.
Most of the hospitals in the area (Central Texas) do display the 30.06 signage, with appropriate size and so forth, so yes, you have to disarm. Nothing I’ve seen in the current pending legislation will change that (although I’m admit to being confused by their listing of changes).
Good article, I’ve had basic first aid training (completing the course more than once, but not currently up to date), and I keep supplies both in my car and in my range bag. But I’ve not had to do any treating in real-life situations, so I can only hope my training holds. 🙂 I’m naturally calm under stressful situations, so I think I can handle that end of things, but I can definitely see it’s important to keep things low-key and under control.
Excellent report, Nick, and also fascinating to read how you went through your decision-making process. I went through a lot of emergency lifesaving training in the military, but I will admit I’m rusty and could use a refresher course. I’m guessing the protocols have probably changed as well over the past 20+ years. Hey, also congrats on the weight loss!
Solid BLS. Makes me proud, also reminds me I need to update my kit.
Good read Nick, glad it all worked out. He lucked out it was only a grazing wound and didnt need stitches.
And people have looked at me funny (and even asked why I had it) when they see I have an IFAK on my range bag, I guess they wouldnt be so funny lookin if they had an extra hole they werent too fond of. This reminds me I need to go check the dates on my stuff now 🙂
TX Law Shield had a great article about this recently also:
http://www.uslawshield.com/gunshot-wounds-to-extremities-be-trained-be-prepared-be-competent/?src=tx-newsletter-5-2015
Excellent write-up Nick. Your decision process brought back a lot of my training. It’s been years since I had to do any of that. I am going to keep this whole thing in my files.
God bless you Sir.
Ok theres gotta be a more detailed explanation than “Holster pushed finger, finger pushed trigger, gun went bang.”
Afterwards the RO was (partly) attributing it to the holster that was used. It was some sort of Kydex holster with passive retention. Basically what he was saying was the holster requires quite a bit of pressure to insert the pistol, pushing past the molded trigger guard retention. He thought the shooters hand slipped forward while pushing down on the gun and it was the middle finger that got stuck between holster and trigger. I dunno, but as a huge gear nerd I think its worth examining. Then again maybe there’s really nothing more there and it was just an unfortunate chance incident.
Bravo, sir.
But calling a TQ a “potentially risky option”? Come on… get with the 21st century! Lol 😉
Yea. In our EMT classes, a TQ is entirely a viable way to stop bleeding in a limb. The hoary tales of people losing limbs to TQ’s comes all the way from WWI, where men would have a TQ on them for 12 to 24 hours before being seen by a doctor.
Recent studies show that because people get to medical care (ie, the ER) within an hour to 90 minutes worst cast, the call between letting someone possibly go into hypovolemic shock or putting on a TQ is pretty much a no-brainer now. Slap on the TQ, high-flow O2 and transport emergent.
I think Nick decided since the wound was not flowing there was no need for a TQ. Didn’t even need a pressure bandage, so why use a TQ? And since he was talking, O2 probably wasn’t needed, if Nick even had any.
I’m talking in terms of general protocol for severe limb bleeding. Should have made that more clear.
Due to the position of this wound high up on the thigh, there’s no way to get a TQ above the wound, so it wasn’t ever really an option.
You can easily get a tourniquet on a wound in that position, wouldn’t be that hard at all. Incredibly painful though.
You don’t want a TQ on the wound – you want a TQ above the wound. There’s not much “above” available there.
When I say get on the wound I mean as high into the leg as possible. And you can easily get a tourniquet on a wound in that position. You have plenty of room.
High flow O2? Get into the 21st century! If thier SPO2 is above 96% then high concentrations of oxygen actually do more harm than good by introducing free radicals into the blood stream and also causing vasodilation(ie. bad for bleeding). If they arn’t shocky, or having any type of respiratory distress hold off on the O2 or consider a nasal cannula first.
That’s true in heart attacks and strokes. The current protocol in MI’s and strokes is to apply O2 and titrate to 94% saturation.
In major bleeding events, you’re to apply high flow O2. It’s on the National Registry exam sheets.
Here’s the NREMT “psychomotor” evaluation on bleeding and shock control:
https://www.nremt.org/nremt/downloads/E213%20Bleeding%20Control%20Shock%20Management.pdf
You’ll NB that a failing criteria is “did not administer high concentration of oxygen.”
If you call 911 never say “there’s been a shooting” or “somebody has been shot” unless you want SWAT to roll up in full force.
Everything is a “training accident” as far as the dispatcher is concerned.
Even better, learn the “regular, non-911 number” for the county dispatcher. It comes in real handy when you want to communicate non-emergent information to them. 911 and the “back” number are treated differently by the dispatchers around here.
Excellent idea and why I keep both the Hays & Travis county non-emergency phones on my phone. 🙂 Those folks are happy to transfer you to the right place too, once they sort out what you need.
I probably should add Caldwell and Bastrop, since I shoot in those areas.
No love the write up.
Pleasantly surprising to me that the thought process you used was nearly identical to what was taught years ago in my lifeguarding classes.
Well done. Only point of critique: having your kit in the car is good. Having it closer in a range bag is better. I fully understand how this can be inconvenient or altogether impractical though, so to each their own. I usually keep a tourniquet quick clot, gauze and gloves on me or in my range bag/case/belt whenever I’m shooting, or running my chain saw.
Thanks Detroiter, I was going to add that tip. I have a “blow-out” kit in my bag after I was tapped to be a first aid person at a shooting class. Our cars were about 100 yards away and I thought that that was a bit too far away for my big kit.
So, I bought an empty IFAK bag and added 2 Israeli bandages, a CAT, 2 chest seals, an abd pad, a clotting agent, shears, and gloves. Whether I’m at the range, a match, or a class, something is within reach.
Good story, Nick, and nice work when it counted!
“It’s just a flesh wound!”
“Come back, I’ll bite your kneecaps off!”
On a completely unrelated note….Nick at 2:03 in the video you are constantly “walking in place” while shooting pistol targets. Any specific reason you do that? I mean I get not wanting to be shooting flat footed in 3 gun but this seems kinda extreme haha.
The rules for the stage were that you couldn’t stop moving. If you stopped, you got a procedural.
Oh. I was told required movement for rifle only. I’m pretty sure every single squad did just about every single stage differently though that day. Oh well.
Nice work, and excellent writeup.
The only gripe I would raise is, why did you drive the patient yourself? Did you consider drafting a “volunteer” to do the driving while you continued care? That also would have freed you up for that call to the ER to tell them you were inbound.
Thanks for the post – – great reminders for shooters and first aid givers both.
/cb
In case you wanted to know, VA also uses the NREMT system now (as far as I can tell in the literal mess of medical letter agencies and certifications). I was cert’d this previous January through it.
Now that’s a smart guy, quick on your feet. I too learned along time ago, if you need to fight or have to help someone, always let them bleed in another persons car.
Nick, Great write-up, even better reaction.
I’ve never been to a competition. Wouldn’t it be prudent to pay an off duty EMT to be there for the duration? Or would it just cost too much?
It would be expensive to keep an EMT on site. It is a very rare occasion. When we did the big, annual match, there was always an EMT on site but not for the monthly matches (mostly he did bandaids and eye washes). The usual match director was an army medic but he was not there this month.
I have been shooting competitions for 19 years. First time I have been there when it happened, and on my squad, too. Couple years ago, a shooter had an implanted defibrillator shock him and he needed assistance, and when the ambulance was inbound, and the range had a cease-fire while it was there.
Great write-up. Favorite line: “He happily dropped trou. What I saw was remarkable.”
All that great info, and all I can do is be a kindergartener.
Dang Benny. It completely went over my head, and I’m ALWAYS a kindergartner. hehehehe
check with police n local EMTs / hospitals many have Free or cheap classes you can take. even just the boy scout training will cover most First Aid and emergencies.
here is an example… not promoting it.
Basic First Responder Kit
http://www.thefirestore.com/mobile/store/product.aspx/productId/216/EMI-Trauma-Pac-EMS-1st-Responder-Kit/
good to have around. if you ever plan on Remote site Camping, hunting, anything hrs from help…. at least one if not all should be trained beyond basic first aid. even you never do it as a job. get the skills. trust me it can save lives. you never when you might need to set a couple Broken legs stop arterial bleed then hike to a place to get help. or on a different day have to stich your leg up from a 6″ gash and hike 2 days to get to safety. your GPS/Phone/tech will not always work.
even at the most basic a baggy with gloves, clotting agent, gauze, and at least one good size bandage can save a life.
you should be just as good in first aid as you are trained with your firearm.
Nick, the only thing I could suggest – which you already noted – would have been a call-ahead to the hospital. For that I would suggest dragooning a third person along to handle the comms end route – you’re busy driving, the passenger might not be capable/coherent/awake, and literally the last thing you’d need is to have a car crash on the way to the hospital.
Definitely!
The times I’ve played first responder and then driver, I’ve made sure I have someone else along to handle the “whatevers” that aren’t compatible with paying attention to the road.
Good work Nick. And a great write up with plenty of reminders.
Note to self. Trauma kit for range bag, in addition to the one in the car.
Good work but you asked for critique and here it is:
“I removed my safety glasses so he could see my eyes and read my emotions a little better, hopefully to keep him calm as well.”
NOPE. Eyes (actually the conjunctiva) is a mucuos membrane through which you can absorb foreign fluids and contract disease (AIDS). Safety glasses are a must when dealing with bodily fluids and/or expectorating patients.
Other than that, pretty solid work.
I did the same when dealing with an accident resulting in serious injury at a swimming hole where I was hanging out one hot summer day. Letting the gal see my eyes and face helped calm her; I became a person and not just a figure hiding behind the glasses.
But I did put them back on immediately, at first because it was quicker than putting them away, but secondarily I realized it was a good idea when I went to wipe sweat off my forehead and caught myself before wiping her blood on myself.
I did take them off briefly a second time in order to get a clearer look at the wound to inspect for glass fragments, but made sure she stayed motionless.
Good call.
Great job, Nick. And great write-up of the events. Thanks.
2 things I suggest would have been the jump kit near the range area and if your going to transport P.O.V. use a vehicle YOU know. Cheap $1.99 tarp for the seat. If he was almost on E and going to top off on way home running out of gas half way woulda been interesting. In reality I always wear a vest if I’m range master because of ad/nd.
Nice job Nick!
I took a course a couple of years ago on gunshot emergency treatment from an EMT. I intend to take it again. Everyone should learn how to treat a gunshot wound, just in case their personal Nick is not around when they or a friend gets shot.
Great post. You left me wondering just what would have happened had you called that ambulance, though. Maybe one of the group could approach local LE in Liberty Hill to find out. I mean, that is a big range, and with competitions going on will LE show up and confiscate everybody’s guns?
On a side note, who is paying for the onslaught of ads that just arrived on TV opposing Campus Carry? I don’t even know if they are TX or national at the moment, but I guess I’ve seen the same very stupid and condescending ad 15 times this morning!
Nice job ! I’m a Fire LT and emt . Now ems is not my dept number one job ( thank God) but I’ve been to a couple hundred shootings easy. I agree many don’t bleed much at least external , they either don’t want to put down their cell phone or they’re close to dead not much middle ground .
I keep dressings and clotting agents in my range bag .
I’m not driving them either, ok perhaps a friend when I know I can get to the hospital before the rig can get to us , that’s the only exception though .
Nice work Nick, and a great post…….one of those days the victim can reflect back on and be damn glad you were there…
You should have put a tourniquet on it. They are the number one thing that has been learned the battlefield. Tourniquets have 3 hours before nerve damage occurs and 4 hours before tissue death. Its simple and proven at this point and the first thing any 18D will tell you to do, doesn’t matter how much blood is coming from it, if its a legit bullet entry tourniquet it.
But… why?
I’m spending resources I don’t need to spend, to fix a problem that doesn’t exist. TKs are fantastic for controlling bleeding, but why perform an intervention that isn’t necessary? Especially since a loss of PMS distal to the wound in the extremity can be an excellent diagnostic indicator of something terrible happening.
In my opinion, adding a TK where it isn’t required is a waste of resources and removes a diagnostic indicator. Not something I want to do unless really necessary.
Cause its a preventive measure that cost you nothing but a tourniquet and your not a doctor. Plenty of people have died due to the fact people have bled out, died of tension pneumothorax, or other easily preventable deaths due to the fact that the wound didn’t look that bad, they were fine/coking and joking 5 minutes ago. Your statement that a tourniquet is a risky option tells me I have far better training than you when it comes to dealing with GSWs or any sort of trauma training. The fact that you assessed a gunshot wound to the leg to dictate treatment is bad training that is a holdover from the days when people thought tourniquets were last resorts. This is one of my biggest pet peeves. The military has learned a lot from the civilian shooting community, but all the lessons learned in blood about trauma treatment has yet to make its way over to the civilian side for some reason.
Your “training” might be better. But his training and EXPERIENCE clearly show.
A tourniquet is still not the best option, the key to placing one is time. If it is only going to be on for the time of transport then sure they are great for controlling bleeding that a pressure bandage cannot. But if bleeding can be controlled by pressure(95% can be) then why go there? Even the worse arterial bleeds I’ve delt with were controlled and perfectly stable with just pressure bandage and gauze for the one hour transport time we had.
Nice write-up, Nick.
There are cases to take the reshoot. Last month I had an interchangeable front sight leave my 686 SSR during a stage. Had to shoot the last 6 targets without the sight, my score was really bad. Then it turned out the stage was set up with an extra target and a missing non-threat so we got to reshoot because we were the first squad. My second time was better by a mile (with the sight found and reaffixed).
Only thing I would add is to be aware of the nearest hospital, always, but especially when you’re at a gun range. For some of the larger outdoor ranges, cell service could be spotty and addresses can be tricky. Sometimes country roads go by several names, officially or unofficially, and the most common may not be the official name.
For those reasons and others, you may have to drive to the hospital yourself, so you should know the way.
This is a great reminder that accidents can happen at any time. Get a first aid kit and keep it close by at all times!
Great job, my friend!
Next time we’re in the same place and adult beverages are involved, ask me about crawling around in the pea gravel on a range, looking for a thumb.
Michael B
No issues with your response.
Two points however on holsters and holstering:
1. When practicing from the holster, I ALWAYS holster slowly after visually confirming no fabric is near the opening, visually checking the muzzle entering the holster and visually confirming the exaggerated straight trigger finger being away from gun and holster as it goes in. Did I say slowly?
2. I do not appendix carry. Just imagine this same accident with the discharge down and into the femoral artery. Much better to just gouge a small piece of my right buttocks out if I ever fail to do #1 above.
I knew something was missing from my emergency first aid kit!
Note to self: add clotting agent!
And more gauze.
As a full time paramedic, reading this article makes me smile. Not for the unfortunate fact that someone got injured, I’m never happy someone got injured(not that much of a trauma junkie). But to see its still drilled in your head even after being “rusty”. If your teachers were anything like mine(I haven’t met many that arn’t), the skills and knowledge were pounded so hard in your head you’ll still be able to do a trauma assessment in your sleep 20 years from now. But this is the exact reason a jump bag stays in my truck all the time and at least a small drop leg kit travels with me else where. But out of those kits I would say my most used item is a tube of super glue, it works great for lacerations.
Well written and an excellent, logical step-by-step presentation.
I always have a pressure dressing in my range bag, as well as a basic first aid kit. Having spent time in the military and in a couple of active conflict zones, I’ve seen and dealt with quite a range of trauma injuries. The guidance in this article is spot on, especially the advice to stay calm and think clearly.
Have been at 2 steel challenge type pistol matches now where while reholstering hot, the shooter shot himself in the leg just like the guy in Nick’s picture. Thankfully both times it was not me and I was not in that squad to see it happen. Kuddos to Nick for responding. Be careful out there boys and girls.
As the match director at a Steel Plates match years ago, I had to deal with a fellow who wasn’t even the shooter being struck by a jacket fragment on ricochet. Problem was, this tiny wound happened to someone on a high level of blood thinners due to high BP. By time I got to the scene, the guy was sitting and blood was dripping off the hem of his soaked t-shirt.
Thanks to heaven above, there was an EMT shooting the match that day and knew what was going on and what to do.
The paperwork for the “gunshot wound” ran to pages. The transport and ER visit cost upwards of $3000. Luckily, the victim was a muckey-muck at a big insurance company and they paid.
The fragment was so small they left it in his pectoral area and it grew out about 9 months later.
A wake up call for this match director.
At the indoor range we instruct at, I get to do the safety talk of our Holster & Handgun Skills class before my partner takes over on the technique of the holster.
I stand on the fading remnant of a six-foot blood stain in the concrete floor and point it out during the Four Rules portion- a copper re-holstering a 92 drilled a bad one that almost resulted in bleeding out during a PD training session.
It’s a very effective learning aid.
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