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.