Lifesaving Skills Every Gun Owner Should Know
With regard to home or personal defense, everyone knows the line: “When seconds matter, help is minutes away.” Such logic is the reason many of us carry daily or keep a firearm bedside. But what about those moments outside the home, perhaps in a remote location? We are indeed our first responder but it remains important to understand the term “first responder” applies to more than just those personnel carrying a sidearm.
A critical situation — when emergency medical services are necessary — can happen anywhere, and it may occur when no threat is present. It could be a rural range, when you and friends are stretching the rifle out to a mile.
Or in the backcountry, chasing elk. Accidental discharges — whether user or equipment error — are a scary reality. They happen.
In these moments, that line we can recite like the Pledge of the Allegiance becomes: “When seconds matter, help is hours away.”
OVER 50 YEARS OF TRAUMA AND LIFESAVING EXPERIENCE
Dr. David Acuna, 62, has been a trauma surgeon for 30 years and serves as the Trauma Director at Wesley Medical Center, a Level I trauma center in Wichita, Kansas.
A first-generation American with a father from Argentina, Acuna grew up a farmer in Ohio but at a young age became fascinated with the world of trauma and surgery. He trained in the early ’90s in Dayton, Ohio, which, at the time, was the number-one dual-homicide city in the nation (meaning two people died during the incident).
“Dayton is at the crossroads between I -70, which crosses the country, and 75, which goes from Detroit down to Miami,” he said. “Right in the middle of cocaine central. So I’ve taken care of so many gunshot wounds. Sometimes they got shot in the hospital parking lot. It was that crazy. Just a crazy time to train. There was almost not a day that I was not in the operating room tending to a gunshot wound.
“I trained in the glory days of trauma,” he said. “The only place that you could go now to get that kind of volume is probably Chicago, Detroit, DC. I’m sure LA is the same way. You’d have to go to some huge city now to get the kind of volume that we had when we trained.”
Escorted by local police, Dr. Acuna shared the tragic news with the family and was attacked. Police intervened immediately. The next day, his wife was carjacked by gunpoint in an unrelated event.
“That changed our world,” Acuna said. “Our house immediately became a gun house. I had to re-teach my dog how to bark, because we’d tell him how to not bark. And I changed the way I was raising my boys.
“Now it’s not just a need, but it’s become kind of almost a lifestyle,” Acuna said. “I’m very familiar with, professionally, the consequence of firearm activity, but I also understand the need to have them.”
THE 7 LIFESAVING SKILLS YOU SHOULD KNOW IN ORDER OF PRIORITY
1. Apply immediate and proper pressure.
“It literally takes one, at most two, fingers to stop the hemorrhage,” Acuna said. “You don’t want to get on the phone to call 911 when the patient’s lifeforce is going into the ground.”
Find where the injury is, and then if there’s an active hemorrhage, put two fingers on it and stop it. Once you’ve done that, you can take a couple of breaths, get yourself re-oriented, calm yourself down so you can think, and determine, “OK, and you should be able to feel with just your fingers, is it arterial or is it not arterial?”
If it’s an arterial hemorrhage, you’re going feel it. If it’s venous, you likely aren’t. Venous has such low pressure that you can literally not feel the pulsation on your finger with the pressure gradient so low. Nevertheless, treat every bleed as if it’s arterial until you can verify otherwise. Use a finger or two immediately.
2. Secure a tourniquet.
If the patient is experiencing arterial hemorrhage on a limb, fastening a tourniquet may be your best option. Because an artery can retract 4 to 5 inches, it is advisable to secure a tourniquet 4 to 5 inches up from the wound, between the torso and the wound.
Applying a tourniquet should also hurt like hell for the patient. “I tell my patients, ‘This going to be the worst pain of your life,’” said Sutton, “‘But it’s going to save your life.’”
Stopping the bleed with a tourniquet leaves you able to do other things, such as call 911 or work toward transporting the patient, if necessary. However, if the wound is too close to the torso, or on the torso or on the neck or above, a tourniquet isn’t an option, and you must begin packing the wound.
Note: Practicing with a tourniquet is crucial, but also understand once a tourniquet is used once, it’ll no longer function at the necessary life-saving level. “Once a practice tourniquet, always a practice tourniquet.”
3. Pack a wound.
Start with QuikClot combat gauze, if you have it. If not, 2×2 gauze may work. Compressed gauze is another option for deep wounds where direct pressure alone will not stop the bleeding.
Once you’re certain, you can wrap the wound with emergency trauma dressing and address other logistics. But also remember, when dressing a wound, just because you can’t see bleeding, doesn’t mean the wound isn’t bleeding, so be careful with dressing too early.
“As a paramedic student, we ran a call just south of here,” Sutton said. “Fire responded and the ambulance responded. Fire responded and because it was a dialysis patient near their fistula they were bleeding horribly. Firefighters put huge bulky dressing on, and we were so close to Wesley we were like, ‘Fine, let’s go.’ When we get to Wesley and that bulky dressing was pulled off, it was clear we hadn’t stopped anything.
“The doctor kind of put us in our place, held up two fingers. But also a valuable lesson that day: do not assume another health care worker did the right thing.”
4. Communicate with 911.
Note how this doesn’t read “Call 911.” You need to be able to communicate your location and the condition of your patient. Are they conscious? Can they talk? If they can’t respond to your questions or talk, that means they’ve likely lost 30 to 40 percent of their blood.
Communicating with 911 could also serve the purpose of calming down you or someone in your party, as dispatchers are trained in being able to mitigate stress of callers. If the person next to you is freaking out, have them talk with 911 while you use your hands to work.
Knowing your location in relation to the nearest medical facility is also crucial and should, ideally, occur ahead of travel. Example: If you anticipate spending the morning at a long-distance range, mark the closest facilities ahead of arrival. If medical services are farther than a half hour out, you may need to move the patient.
“Sometimes the best resuscitation fluid is diesel fuel,” Acuna said. “You just need to get them from point A to point B as fast as you can. Get them to where they can get the help.” That could also mean meeting paramedics halfway, as paramedics will have the necessary IVs and likely O-negative blood to administer.
Communication is paramount. The more concise, pertinent info that can be exchanged, the better. It’s more than just a phone call.
5. Prevent body-heat loss.
“So we’re going to go back to chemistry 101,” Acuna aid. “Catalysts. Our body is a chemical thing, and catalysts are also driven by temperature.”
Within the coagulation cascade, those catalysts work at an optimal temperature range. And outside of that optimal temperature range, those catalysts won’t work as effectively. So when a patient gets cold, they tend not to clot, which is why it’s so important to keep the patient warm.
“In fact, our trauma bays are hot,” Acuna said. “People hate working in there. It’s just like 85 to 86 degrees in there. Because we don’t want the patient to get hypothermic and cold.
“So even in the summertime, let’s say it’s 75 degrees out and a patient is lying on the ground — guess what? They’re getting cold. That ground is a massive heat sink. And 96.8 degrees is slowly dropping, because you’re sitting on a ground that may have a temperature of 75 degrees.
So it may not seem cold to you, but a patient who’s in stress is all of a sudden starting to get colder and colder and colder, especially when their life force is poured out on the ground. Now your heart rate’s going up, and you’re going to cool off even faster.”
What this means: Have a thermal blanket on hand. It could be something as simple as those cheap aluminum foil blankets that you can purchased neatly and tightly packed into little squares.
We also lose the majority of body heat through our heads. Though it may be summertime, it may make sense to include a quality winter hat in your med kit, because the bottom line is: A cold body will not clot. And regardless of how much pressure you apply, you will not stop the bleeding.
6. Perform CPR (cardiopulmonary resuscitation).
When the heart stops beating, effective CPR can jumpstart and help save a life during cardiac arrest. The same as stopping bleeding, once you stop performing CPR, you’re starting from zero.
For this reason, medical professionals today don’t recommend mouth-to-mouth. Continue compressions until the patient has a heartbeat. For this skillset — and for everything listed here, really — it’s recommended that you take a course and practice.
7. Properly pack a med kit.
The order in which you can access necessary items in your med kit could be the difference between life and death.
“It is important to pack your kit in a way that doesn’t make everything fall out when you open it,” Sutton said. “I utilize small plastic bags to keep Band-Aids and smaller items together. I like to have my pressure dressing, tourniquet, and trauma dressings on top ready to be grabbed at a moment’s notice. I find it important to go through my kit at least once a month and keep it organized. The more things you have in your kit the more stuff you forget about. Not much of my trauma stuff goes bad, but I check it for out-dates once a year.”
Here are the must-have items in Sutton’s med kit and why:
1. Medical Gloves. Gloves reduce the risk of infection and cross-contamination. “I keep a couple pairs in my kit in case I need to put on a new pair before rendering aid to a different person,” Sutton said.
2. 2×2 Gauze Pads. “Like a great trauma surgeon told me once, the vast amount of bleeding can be stopped with a 2×2 and two fingers applying direct pressure.”
3. Emergency Trauma Dressing. This combination of an ACE bandage and dressing will allow you to apply constant pressure to a bleeding injury without you having to hold the pressure manually.
4. Compressed Gauze. Wound packing is required for penetrating wounds where bleeding cannot be controlled using direct pressure alone. This is for injuries to junctional areas of the body, including the groin and armpits, where tourniquets cannot be applied, and direct pressure can be difficult to maintain. You can substitute other cloth items if you don’t have compressed gauze or run out.
5. Trauma Shears. Sometimes the hardest part of treating a bleeding penetrating injury is finding it. Trauma sheers will help you quickly and safely remove clothing while searching for the wound.
6. Tourniquet. They’re extremely effective at stopping bleeding in arms and legs. The risks associated with them are outweighed by their benefits. They can be kept in place for hours at a time with minimal risk to the limb.
7. Band-Aids. While your kit may be ready for a gun fight, more times than not a simple Band-Aid will fix most injuries that you’re confronted with.
SUPPLEMENTARY SKILLS TO CONSIDER
Identify type and number of bullet holes. A .22 gunshot may just be a flap of skin with a bit of yellow fat underneath versus the noticeable red crevice from a 9mm. It’s important to be mindful of the number of holes created by a gunshot. Someone shot in the arm at a certain angle could have three holes (two in arm, on in body).
You can’t stop the bleed if you can’t find all the holes.
Prevent a collapsed lung (tension pneumothorax). While fairly rare with a gunshot wound, there’s a reason chest seals are included in medical kits.
“The air leaves the lung,” Acuna explained, “the lung collapses and then, with each subsequent breath, what can happen — doesn’t happen all the time, most times actually doesn’t — is if the wound is big enough, the lung will then slowly start to collapse as more and more air goes out. The pressure outside the lung ends up becoming higher than the pressure inside, so it just pushes it over. That process, depending on the size of the hole, is typically slow.”
Know your blood type and display an identifier on you somewhere if that type is rare. While O negative is a universal blood type, ambulances and trauma centers stock only a limited supply.
Once it’s gone, they’ll need to start a transfusion with your blood type. If that blood type is rare like AB positive (read: hard to source), the sooner they know they will need it, the better. (Again, this goes back to being able to communicate with 911 and other emergency personnel.)
Educate those in your household and with whom you keep company and practice. “Everyone has a plan until they get punched in the mouth.”
If you’re the one punched in the mouth, it may be easier for someone else to remain calm, especially if they’re trained, and act to save your life. Or if the plan is so well-rehearsed among you, your friends and family, it won’t matter who gets punched in the mouth. Training will take over and muscle memory will kick in.