EMS Emergency Protocols for pre-Hospital Treatment of Gunshot Wounds Vary from every State in the United States, this is a general description of priority actions as designated by the NAEMS team. All EMS professionals must be Certified and Licensed to be eligible to serve patients in their state.
EMT Basic Treatments Protocols – “The purpose of these protocols is to provide a uniform treatment standard through-out a designated E.M.S. Region of the U.S., for certified pre-hospital care providers and first responders.”
While this is the typical overview of what to expect from your EMS response team, proper gun safety should always be practiced and many gun related incidents would be prevented if more individuals were responsible enough to lock up their firearms securely.
First on the scene pre-hospital care providers or EMT’s provide on-the-scene recognition and treatment of life conditions that risk mortality or morbidity should treatment be delayed. Enter the patient into the E.M.S. system and begin immediate meaningful interventions.
For patients not immediately in life or limb threatening conditions, provide entry into the E.M.S. System, provide initial stabilization, safely transport to an emergency facility.
A third goal of protocol, for patients requiring immediate hospital stabilization, using only minimal on-site delay: examples like gunshot wounds, pre-mature infant, chest or stab wounds, deteriorating neurological status, or severe pulmonary edema.
In the case of multiple casualty incidents (MCI), the fourth goal protocol is on-scene triage. To achieve goal protocols of pre-hospital care, the EMT must quickly recognize the need for on-scene intervention using rapid patient assessment. At primary survey identifying needed interventions needed to be acted on immediately will interrupt the survey procedure then upon stabilization, survey is continued.
Examples of survey interruption:
- deal immediately with airway problems
- treat sucking chest wounds
- provide oxygen and immediate treatment if patient is having a MI
Once life and limb threat is stabilized continue primary and secondary surveys.
A base hospital physician will give medical direction to Not Give C.P.R. to a pulseless, apneic patient.
- Red – immediate (first transport and treat)
- Respiration over 30
- Pulse – no radial pulse
- Mental status – unable to follow simple commands
- Yellow – Delayed transport and treat
- Other more seriously wounded cannot walk on their own
- Green – Minor (Transport for treatment)
- Patients can walk without assistance
- Black – Dead or Dying – no respiration after head tilt and OPA
Priorities: ABC’s, Scene Safety, Get needed Assistance en-route to Scene. If there are 5 or more critically injured patients needing immediate treatment, contact base hospital to call an MCI. Some agency approved assistance upon an MCI call:
- Aircraft Assistance
- Special Needs such as Haz-Mat, Buses, etc.
- Mutual Aid
- Constant updates to Base Hospital
Additional resources will assign: Triage, Staging, Scene Safety and Security
The most obvious trauma may not be the worst risk of death, some trauma victims have died of mechanical airway obstruction while more dramatic injuries were being treated. EMT’s should continue primary and secondary surveys as soon as they are able during treatment.
In the event of a firearm wound, first responders perform the initial rapid assessment, then time permitting do the detailed head-to-toe assessment, visually then hands on. Check the following signs of trauma: Head, Neck-including major blood vessels, Chest, Abdomen, Pelvis, Extremities, watch for wounds, hemorrhage, crepitus, deformity and mobility. Note any potential circulatory compromise or hypotension from hemorrhagic shock.
Symptoms of gunshot wounds are influenced by many factors, including type of firearm, type of bullet, location of wounds, organs involved, patient health and condition. As preparation for transport, apply cardiac monitoring and pulse oximetry. Keep contact with base hospital regarding administering bolus fluids and any changes in vital signs.
When immediate interventions are indicated, such as chest wound with interval thoracic injuries, EMS may be required to perform chest decompression with needle thoracostomy before transport. All protocol regarding blood pressure in a gunshot wound victim is subject to local protocols, EMT level and base hospital physicians’ orders.
Depending on locations of wounds, treatments will vary from bandaging, application of pressure, immobilization, intravenous lines, blood and fluid replacement, pre-warmed blankets to avoid shock. Once the patient has been stabilized for transport, some of these procedures can be provided en route.
Monitoring in Transit:
- Score the following:
- Eye opening
- Verbal Response
- Motor Response
- Abdominal rigidity
- External Bleeding
- Deformity of head or extremities
- Fluid secretions, eyes, ears, etc.
- Decreased Breath Sounds
- Pulse Deficits
- Reduced or Absent Sensation
- Skin Color
Accompany Patient into emergency room to update physician in charge.
While this has been a good overview, please remember that the #1 thing you can do to prevent firearms accidents is to ensure that you are proactive in your approach to firearms. There is nothing worse than having one of these situations as a result of recklessness and carelessness when it comes to how someone handles a gun. Make sure you find a way to keep your firearms secure at all times, and dial 911 immediately in the event of an emergency.