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Read the first of this two post series here

Being shot and having to treat yourself isn’t ideal. I went over the basics of what to do if you are shot in a previous TTAG post. The nice thing about treating yourself is that you don’t have many options, so you can focus on doing those few things really well. In this post, we’ll go over what to do if someone else is shot. I would recommend reading that first post for some specific treatment methods that we will gloss over here.

First things first…just like when you’ve been shot, if someone else is shot, your first order of business should be ending the threat. If the threat is ongoing, that means returning fire.

As I said the last article, the best medicine on any battlefield is fire superiority. You must limit the opponent’s ability to fire and maneuver. But once that’s done and you and the victim(s) are safe, it’s time to get to work. That’s the time you have more options and you may have a lot more work to do.

Before we get into how to treat a gun shot wound (GSW), we have to get into deciding who gets treated first. Obviously, if there’s only one person shot, get right on that. But what if there is more than one? Whether the attacker intended to shoot one person or not, there are often multiple victims. Getting to the right ones first is a skill set that only experience can really help you master, but there are a few techniques that will help.

The overriding rule of triage: help those that are in need of assistance and have the best chance of survival if you provide that assistance. That sounds simple, but emotionally, mentally, that can lead to some extremely difficult decisions.

If you think getting shot or blown up and driving on with the mission makes you hard, it does, but not compared to the decisions you have to make in triage. Trust me, I’ve done both. You will be able to make those decisions as well, and people will be better off for it when you do.

What kind of decisions? Well, for instance, I have had to step over breathing children and delay their care, knowing it would result in their death in order to work on a conscious adult. I did that more than once because I had a better chance of saving the adult’s life than I did the child’s. Nothing will get to you like dragging a breathing child away to die alone while you work on someone else, but you may have to do that. If you don’t, it’s possible that both the adult and the child will die.

Note that you aren’t trying to help the largest number of people…you are trying to help the people that you can do something about, to save life, limb, and eyesight. I have, in my career, had an event where I had six severe traumatic patients. I knew that if I did everything right — everything just perfectly — five of them would probably die. And they would die because I would have to ignore them to save the one who I thought I could do something about.

Just understand that those decisions will have to be made — very quickly and correctly — or everybody suffers and more will die. The worst possible thing is to wait. Waiting is tantamount to murder.

Also, once the threat is gone, everyone who is wounded is a patient. Everyone. That includes the aggressor. Yup, you have to treat the shooter. This isn’t a philosophical debate. If they’re no longer a threat and they are wounded, they are a patient and you have to treat them to the best of your ability. That means triaging them appropriately, too.

I have treated the enemy before myself. Try and avoid that scenario if possible.

There are many methods to triage, but here is an easy and effective one…once the scene is safe, stand up, use your loud grownup voice, and say “My name is (___).  People have been shot and I’m here to help. If you can hear the sound of my voice, get up and come to me.” Give that barely half a minute. The people that can get up and start to make it to you are your second priority.

The next thing you say is, “Okay, if you can hear the sound of my voice, raise your hand and yell, let me know where you are.” Those people are your first priority. Get to them right away. Because if they are conscious but can’t move, they are in bad shape, but not so bad you can’t do something about it.

The people who could not respond to you in any way are your last priority. You treat the responsive but immobile first, then the mobile, then the unresponsive. You are only treating them for life, limb, and eyesight. You treat everyone you have time to treat and none who you don’t.

If you are shot, treat yourself first, then get to work on everyone else. If that’s just one other person, great, but it might not be. Unlike before when it was just you getting shot, if there is anyone else conscious there, have them call 911 immediately, even if that’s the victim.

Getting the GSW victim to call 911 is a very good thing. It keeps them engaged and conscious while freeing you to work. If there’s no one else who is conscious, but you have more than one victim, call 911 now. The same rules for putting the phone on speaker phone mode apply. Never turn it off.

So the scene is safe and you have sorted the victims. Breath deep and smile, the hardest work is done. I mean it. Force yourself to take a deep breath. Force yourself to smile. The most important vital sign in any casualty event is YOUR pulse. So take a breath and get yours down a bit.

If you have help, instruct them to start helping other people, but be willing to call them over if you need them. Until there’s a more competent medical provider there, you are in charge of helping the victims.

The first thing you’re looking for is bleeding. The way we do that is by asking people where they are shot, looking, and performing a rapid blood sweep. There’s no need to take clothes off or expose the wound at this point.

Wipe your hands off, put them on the patient, and then look at your hands again. If there is blood, check that area out and get to work. If there is no blood, move to the next part of the patient, checking your hands each time. It does no good to check the whole patient and then look at your hands. You won’t know where the blood came from.

Just like before, your go-to care for a GSW to an extremity is the tourniquet. If you need to make one, get someone else to hold pressure while you make it and apply it. But get on that fast because it’s relatively easy to remedy and will save a life quickly. By the way, a patient with a GSW to one arm can dial 911 with the other.

Injuries to the torso will require a dressing and pressure. Expose only the wound area you have to, but press down on that injury. Yes, you can stick your fingers inside of them to put pressure on the wound. No, don’t fish around. As in my earlier article, hemostatic agents such as QuickClot Guaze are preferred, but not required. Get that dressing on, pressed as hard as you have to, and tape it all down.

How do we know when the bleeding is controlled and it’s okay to move on to something else? Squeeze, squeeze, squeeze until the red blood stops.

Just like before, a patient with penetrating trauma to the upper torso may have a sucking chest wound. If the patient is conscious, they will tell you that it’s getting harder to breathe. If they are unconscious and unable to tell you that, you will eventually see the uneven rise and fall of their chest.

There are a few good telltale signs, but if you haven’t seen them before you will likely miss them. The general rule for you, if you aren’t medically trained, is to treat any open chest wound as if it were a sucking chest wound. Refer to my previous article for treatment.

Some of you wise guys may be asking about needle-chest-decompression. That’s where you shove a 14g needle into someone’s chest cavity to relieve the pressure. Unless you have been extensively trained with this in a hands-on setting by a qualified medical provider, do not attempt this. The majority of trained first responders get this technique wrong in one way or another and many cause more harm than good.

In the worst case scenarios, I’ve had combat life savers go under a rib instead of over it and cause more bleeding into the thoracic cavity. I’ve also seen patients that received a needle chest decompression that didn’t need one at all and now they need a thoracotomy. That’s not ideal. Skip it unless you really know what you’re doing.

As in my previous post, roll a patient with a thoracic GSW onto the side of the injury and make sure you treat any exit wound. Patients with any facial trauma should be rolled onto their side, or at least have their head turned to the side. Don’t put a pillow under a GSW patient’s head unless there’s an injury to the spine and you need to keep it from moving. I have seen a patient killed from a good Samaritan putting a makeshift pillow under her head, cutting off the flow of air down her windpipe and choking her to death. Don’t do that.

Now we can move to the patient’s airway. For the vast majority of GSW patients, simple positioning will protect their airway. That is, unless they are shot in the face and have teeth and blood loose in their mouth, just sitting them upright or laying them on their side will be good enough.

If they are shot in the face, you may have to perform a simple finger sweep of their mouth to get bone or teeth clear of their windpipe so that they can breathe well. Don’t just fish around. Look in first and see what’s wrong, then you can sweep a finger through their mouth to take out any obstructions you see. Positioning on their side is good for now if they’re not fully conscious. Be aware, you will likely have to do this more than once.

As in the earlier article, we aren’t going to worry about putting in an IV. Even in most combat situations, we don’t do that anymore unless we know that it’s going to be hours before they receive comprehensive medical treatment. For most people, training time spent learning to give an IV is far better spent learning to stop bleeding in the first place.

If you only have one other patient and they don’t have a pulse, control any bleeding and then move to CPR. There’s no need to perform CPR if you cannot control bleeding, or if there is another patient you can help. You will perform CPR unless and until help arrives. If you do it right, you will be exhausted in a matter of minutes.

Treat all of the life-threatening injuries on one patient before moving to another.

Now it’s time to splint up injuries, bandage eyes, get patients out of the cold or extreme heat, and get them ready for the ambulance or other transportation. Unless you are way out in the woods, there’s no need for you to carry a patient. If the scene is safe and you find yourself picking someone up, you are doing it wrong.

If you must move them for the sake of safety or to get them out of extremes, drag them there. I don’t care if they only weigh  50 lbs. and you are a big strapping man. Unless they are an infant, drag them there. Don’t carry them.

Now is the time to start reassessing your patient(s). Your biggest concern is still the bleeding, doing another complete blood sweep and making sure nothing has come loose and is bleeding again. Check and see if it’s time to relieve pressure on that chest seal. Talk to your patients constantly, and keep them involved in their own care. This reassessment, treatment, and assurance will continue until more help arrives.

Good medical gear really helps, but most kits have more things than you will need or know how to use. If you’re on the range with other people or you can throw a bag in your home or vehicle, I would recommend at least the following to treat others:

At least 4 tourniquets

At least 4 sets of Quick Clot Gauze, and at least 6 rolls of Kerlix.

At least 4 chest seals

At least 3 Sam Splints

And buy more medical tape than you ever thought you’d need and a flashlight that you don’t have to hold down a button to keep on. That’s the minimum. Put it in any easy-to-get to bag. I prefer everything in clear Ziplock bags and put it all in one big compartment.

As I wrote before, for those of you who want to get into more medical training and would like a good guidebook, the Ranger Medic Handbook is the best single guide I’ve ever seen.

For more in-depth reading, I would recommend the US Army’s Emergency War Surgery, now published completely online as well as my constant field companion, Tintinalli’s Emergency Medicine Manual.


Read the first of this two post series here


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  1. Wow these articles are super great informative.
    Thank you JWT.
    Now on a lighter side.
    I just couldn’t help thinking of the man who was bitten on the end of his penus and ask his buddy to save him.
    ” Looks like your going to die” was the punch line.

  2. “That includes the aggressor. Yup, you have to treat the shooter. This isn’t a philosophical debate. If they’re no longer a threat and they are wounded, they are a patient and you have to treat them to the best of your ability. That means triaging them appropriately, too.”

    maybe on the battle field…but out here in the civilian world if you treat that bad guy you just had to shoot and they die anyway you are probably going to prison if you get prosecuted by an over zealous prosecutor who gets a jury that can be made sympathetic for the bad guy especially if there are racial biases among the jury.

    the second issue is …if the bad guy has a hidden weapon. when you get close enough to ‘treat’ them, because you may not think them still a threat or unable to be a threat does not mean they can’t sudden become a threat with you very close trying to treat them. remember, if they were threat enough for you to shoot they may not hesitate to continue to try to be that threat, for example, once you re-holster then kneel down next to them while both of your hands and your attention is on trying to stop their bleeding.

    yeah, it may sound cold and callous to say this, but …

    1. you have no legal requirement to try to save the life of or treat a bad guy who was a death or serious injury threat to you forcing you to shoot to stop that threat.

    2. treating them…if you cause or create further damage, or they die, while you are treating them you can be held legally responsible even though the self defense act was legal. Because, basically, its not immediate to the defense act because the threat ‘legally’ ended when the bad guy action that caused you to defend your self ended (e.g. you stopped the threat).

    3. if you are on the phone with 911 and the bad guy is screaming in the background then when police roll up and they had expired… you are already going to be asked to account for why they were alive on the 911 recording but dead when police arrived. if there is any trace of you trying to treat them an over zealous prosecutor is going to try to prosecute you for murder.

    3. if you had to shoot a bad guy, if you must then throw them a towel or a tourniquet but do not go near them to treat them yourself.

    is short, although it may sound cold and callous… but this is the world the anti-gun created with their over zealous prosecution legal environment where they grasp at anything at all trying to send you to prison for conducting a legal and necessary act of self defense.

    • You have to treat the attacker!!! Straight up bull5hit. Never attempt to treat someone who just attacked you. They may well again do so. Call 911 and remain clear of the scene. Mentally and if possible physically document the position of all pertinent evidence. Perps weapon(s), shell casings, witnesses and any vehicles involved. Victims have zero responsibility to help their attacker. Your only responsibility is to yourself and any loved ones involved.

      • correct, this thing in the article of some type of obligation to treat the attacker is flat out wrong. there is no such obligation, its dangerous to do and can put you in prison.

        so you shot a bad guy who was trying to kill you or loved ones or other innocents…your obligation was to that defense and to stopping the threat…not to take a chance to only be injurered or killed after your defense by trying to treat the very bad guy who’s intent was to seriously injure or kill you nor to take the chance of being prosecuted and sent to prison because you tried to treat them.

        it may have been that way in the military where the rules are different for enemy combatants where you must treat their wounded, and if your wounded enemy dies while being treated you have a protection of a ‘qualified immunity’ concept due to your military service. But out here in the civilian world there is no such legal obligation and its dangerous and you can end up being prosecuted for causing further harm in some way or murder if they die while you are treating the bad guy who you had to shoot.

        • Just to clarify…all my above reply was in reference to treating the bad guy.

          Of course if there are innocents injured then if you are capable then treat them if you can or get them the help they need. For example (simple basic examples), just about everyone can press a towel against a wound or elevate a wounded limb above heart level and tie off some sort of bandage around a wound, and a lot of people know how to administer CPR or apply a tourniquet.

          But treating the bad guy? Nope, don’t do it. There are simply too many pitfalls involved (some I posted above) that can get you or others injured or killed or send you through a hellish legal environment that can financially ruin you and take away everything you have or send you to prison.

          What I wrote is no way intended to say or imply that I would want a bad guy to die or be injured or that I actually seek to do such. To the contrary I do not want to shoot anyone but I have trained and I do practice and I am prepared and I’ve had to actually do it several times because I had no other choice, and without that DGU my wife and I would not be alive today.

          So, if you do not already realize it, and surprisingly most people do not especially left wing people (until it happens to them) – I’m here to tell you the reality is that there are bad people in this world, around you every day out in public, that actually do want to injure or kill others (e.g. you or family or others around you) by their actions either directly (e.g. criminals) or ‘actively but indirectly’ (e.g. anti-gun and democrat politicians and left-wing idiots by trying to disarm you while at the same time facilitating and emboldening violent criminals who want to injure/kill, and my personal experience is that some of those anti-gun people will become physically violent and want to injure/kill you so keep away from them because every one of them are confirmation biased and full of misconceptions and false beliefs and emotionally driven on the subject of guns and that emotion can drive them in a heartbeat to a time of violence against you).

    • Agreed. This might be valid as part of the laws of war but it is not true in the civilian world, except in the actual practice of medicine, by professionals.

      Also, the concept of ending the threat is an interesting one in the context of responding to a mass casualty event. If the bad guy is alive, he is a threat until you can make sure he is restrained and disarmed. He may have a second gun or even an explosive on his person. How much time do you want to spend trying to figure that out? What if there’s another shooter down the hall? Do you want to be trying to search the wounded guy when he walks in? How are you going to restrain him while trying to render aid to, say, a critically wounded child?

      There are example of school or other active shootings (like in TN) where you can see the police continue to fire until a suspect is very clearly dead. This isn’t just an impulse to mag-dump; it allows a full determination that the threat from that person is ended, because they can no longer take any conscious action. In that case, there is also no need to worry about treating the suspect.

      • After watching literally hundreds of officer involved shooting incidents. Mag dumps are far more common, than not. Even during after action questioning, It’s common for the officer to not know exactly how many rounds they fired.

        • There are mag-dumps, but I’m talking about something less indiscriminate that fits within the mass\school shooter training regime- focused, aggressive violence of action. Not in the textual training material, but described verbally, was the rough adage that “there’s still a threat until you see brain matter.”

          Some international responses to terrorist acts seem to have resulted in similar outcomes.

  3. Good stuff. Morally, innocent victims should get priority over attackers, in my opinion. On a battlefield this changes because all combatants are assumed to just be doing their jobs, thus receiving the same moral value.

  4. The comment about passing over children in an MCI hurt but it’s true. Kids will be great and then when they decompensate they go over the cliff 🙁

    The “walking wounded” field triage method is a good practical way to sort folks when you have a lot of injured and scant resources. Thank goodness I only had to do that once in my pre-hospital care time.

    Thank you for these articles and for your service both overseas and domestic

  5. Folks, there’s a lot of amateurs giving really bad jail-house legal advice above. Take it for what it is, the ignorant and inexperienced running their mouth, and nothing more.
    Most states have good Samaritan laws that protect you from civil and criminal statutes if you are rendering aide to your best efforts. Those statutes do not shield you from surviviors or their family members suing you for not providing aide when it is determined you could have safely done so. In addition some states do have a duty to render aide law, if it is determined you safely could have.
    But again, the attacker(s) can’t if they are dead, which is also a very sure way to end their aggressive action.

    • That’s crap, in 1999 I stood back and watched letting a crack-dealer bleed from the two slugs in his thigh for forty-five minutes, seems NYC NYFD/EMS & NYPD were on a shift change when I made the first of my three calls to 911, the last thing I told them was “If you don’t get this piece of sh** off our lot I’m wrapping a chain around his ankles and dragging him out into the middle of Forest Ave (Staten Island/he had crawled under our fence after getting capped). The 911 operator asked if I knew how to stop the bleeding I said “sure I do but I ain’t getting no AIDS”. Lol! Those were good times my friends, good times.

      Oh I almost forgot the best part, the dude’s beeper kept going of the whole time, he kept wanting to use the phone, told him nope it ain’t happening but the cops and ambulance are coming that’s when he said ” Cops!?” and began swallowing the THIRTY-TWO vials of crack he had in his pocket, “dry” with no water. Told the NYPD plainclothes guys about that, they had the docs pump his stomach in the emergency room, one of our drivers was one of the EMS crew he told me later that weekend the dude survived and got charged for slinging/posessing the rocks. Yay!

    • “Most states have good Samaritan laws that protect you from civil and criminal statutes if you are rendering aide to your best efforts.”

      That’s a myth when it comes to self defense. And in context with, since we are a gun blog, defensive gun use its because when you shoot someone in ‘self defense’ its actually an act in a category of ‘crimes’ broadly called ‘homicide’ and under that category is ‘justified homicide’ (e.g. ‘self defense’) and ‘homicide’ events are required to be investigated under criminal statutes.

      There is no state that has “good Samaritan laws” that protect you from civil and criminal statutes in rendering aid to the bad guy if you inflicted the damage on the bad guy due to a self defense.

      I’ve been through this several times.

      No Jon, its not “bad jail-house legal advice above”. It may not be like that everywhere for every situation, and sure there can be cases where no one says anything about it – but do not mistake ‘chance’ in not suffering some legal nightmare as a result of treating the bad guy as a ‘protection’ for doing such under some ‘good Samaritan law’ concept because it actually does not exist for self defense cases.

      Do not attempt to treat the bad guy you had to shoot. Yeah, it sounds cold and callous and goes against the grain for some – but the consequences of you doing so is just too great in today’s world. It would do you no good to, say, defend you family against an attacker to only go to prison because the attacker died while you were trying to treat them and save their life …. an over-zelous prosecutor will use your treatment efforts against you.

      Is there a “good samaritan law” concept that will help protect you if you do render aid to the bad guy you just shot in self defense? The short answer is NO. Once you say or act as ‘self defense’ and pull that trigger it and every action you took or did becomes categorized under ‘homicide’ and investigated as a crime until proven/determined to not be a crime (e.g. found to have been ‘justified’, ‘justified homicide’ AKA ‘self-defense’).

      Is there a “good samaritan law” concept that will help protect you if you do render aid to someone you shot unintentionally? The short answer is Yes and in some cases no.

      “In addition some states do have a duty to render aide law, if it is determined you safely could have.”

      What you are talking about is the “duty to rescue” law concept.

      There are zero states that impose a duty for you to physically render aid to a bad guy you had to shoot in self defense. But if you call 911 and report the incident, that is rendering aid and if there is some weird interpretation some place well you did render aid by calling 911.

      There are three categories under which you may be required to render aid to another. These are:

      1. You created the peril: If you had to absolutely shoot in self defense YOU DID NOT create the peril but rather the bad guy created the peril to their self via their actions. If you unintentionally shot someone then you created the peril.

      2. There is a special relationship: For example, a parent-child relationship, student-teacher relationship, inmate-correctional officer, police officer for suspect in their custody, etc… (but see #1)

      3. You undertook an action to render aid: This does not apply to self defense situations where you had to shoot the bad guy. But instead for others, if you start an action to render aid you have a duty to carry out that aid. For example, if you start trying to control the bleeding then you must continue to try to control the bleeding — but also, if you say you are going to call 911 well that’s aid too but if you intentionally delay in calling 911 or do not do it then you can be held liable for any further injury to or the death of the person needing aid.

      Everything else for the individual outside of those three is a personal moral ethics decision.

      • There is a difference between ‘aid’ and ‘treatment’. Although ‘treatment’ of injuries could be said to be ‘aid’ the two are not the same thing.

        “aid” is: To provide assistance, support, or relief to, or the act or result of helping (e.g. assistance). For example, calling 911 or carrying/leading an injured person away from a ‘danger’ is ‘aid’.

        “treatment” is: The use of an agent, procedure, or regimen, such as a drug, surgery, or exercise (e.g. applying a tourniquet to control bleeding), in an attempt to cure or mitigate a disease, condition, or injury. For example, applying pressure to a wound or applying a clotting agent is treatment.

        “aid” under law (broadly in all 50 states) doesn’t imply a certain amount or type of ‘qualification’ or ‘expertise’ or ‘competency’

        “treatment” under law (broadly in all 50 states) implies a certain amount or type of ‘qualification’ or ‘expertise’ or ‘competency’. Simply because you have a first aid/trauma kit does not mean you are now ‘qualified’ or ‘expert’ or ‘competent’ to provide treatment so get some actual training – but sure, if its innocents then until medical personnel arrive and take over then provide the necessary treatment if you are capable of doing so.

        But providing treatment for the bad guy you had to shoot is a very bad idea – as a civilian you do not not have a ‘qualified immunity’ concept applied to you, you do not have a “good samaritan law” concept applied because every action you take when and after pulling that trigger to shoot that bad guy is going to be classed under ‘homicide investigation’, and if that bad guy dies while you were ‘treating’ them then that’s also going to count against you by an over-zelous prosecutor. That over-zelous prosecutor is going to try to make it look like your ‘treatment’ was a continuation of an intent to ‘kill’, plus you take the chance that the bad guy even though they may look like not much of a threat any longer you take the chance they have a hidden weapon or can still injure you or disarm you when you get hands on trying to treat them. You have no legal obligation, in any state, to ‘treat’ the injuries of the bad guy you had to shoot in self defense – you did not create that peril to them and they created that peril their self by their actions that prompted the need for self-defense. If you want to provide the shot bad guy “aid” then call 911 so ‘legally’ qualified medical personnel can take care of it when they arrive, and in the interim while waiting for that medical help to arrive if you want to do so (but you don’t have to) you could toss them a towel (or other ‘bandage’ type thing) and tell them to apply pressure – but treating their wounds/injuries, nope.

  6. There is zero medical, scientific, or anecdotal evidence that quick clot has any effect on wound healing or slowing exsanguination. We have twenty years of empirical evidence in Afghanistan backing this up.

    Why are you recommending it?

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