First Aid/Gunshot Wound in Scapula
QUESTION: Hello, Marcus.
Please help me build a realistic scenario for a contemporary romance I'm writing. It's about a soldier getting grazed in the scapula by hostiles staging a hasty roadside ambush.
Here are my questions:
1) What kind of handgun bullet/s inflicts a non-life-threatening gunshot wound in the scapula?
2) What kind of non-life-threatening GSW requires the transfusion of whole blood for its clotting factors? Are "soft-tissue disruption" and "slight fracture of the bone" enough?
3) When does blood transfusion take place, before or after the surgery? How long does it take for a blood donor to undergo screening and extraction procedures?
4) How is the patient (the soldier slumped on the roadside and bleeding) prepared for MEDEVAC? Also, do responders rip the entire upper garment off and discard it? Can the soldier-patient's buddy keep it with other retrieved belongings?
5) How long will the surgery take? What kind of anesthesia can make the patient sleep for thirty or less hours?
6) How soon after the surgery can the soldier-patient be wheeled into the recovery area?
7) How do you wish your name to appear just in case the story gets published?
ANSWER: Hello Annette,
1) Starting with the pistol: probably a 9mm, and the type of gun depends where this is happening. In Afghanistan/ Middle East I would consider either a Russian MP-443 Grach or a Glock 19 from Israel. For Africa, the far east, central/ south America I’d have to look and see what is currently floating around in those regions. Also some information on who the shooter is would help firm up the type of weapon. Are they a covert operator (spy), civilian militia, elite forces? But as far as the 9mm round, that’s pretty standard for most military organizations and would give you the survivable shot you’re looking for.
2) Blood products (usually not whole blood) is given for severe bleeding which can be independent of a specific type of wound. If they lose more than 500 ml of blood they start to require transfusions. At a well equipped hospital or upper level field hospital they should have blood products healed and ready to administer… usually packed red blood cells (PRBC’s), plasma, and Cryo-precipitate (Cryo)
3) blood transfusion usually takes place as soon as possible, while the bleed is being controlled. Additional blood products (probably PRBC’s) are given after surgery and determined blood tests and how low the hematocrit level is.
The donation process takes about 25 minutes for a unit of whole blood, and processing that unit takes about 15 minutes.
4) A combat lifesaver (combat medic) pulls the patient to a safe area, body armor is removed and uniform is cut to expose the area of the wound (front and back) the patient is lifted to a folding stretcher, (places a “FAST 1” (Intraosseous infusion system) (“IO needle”) (look up FAST 1 IO on youtube.com). (Oxygen by mask if available),
5/ 6) the surgery should take between 2 and 4 hours. Servoflurane or Isoflurane gas would be used for anesthesia during surgery. After 45 min to 2 hours the patient should be released from “post-anesthesia recovery” and moved to the surgical unit to recover.
My full name : Marcus LaBarbera, EMT-P, CC-EMTP
Good luck with your story,
---------- FOLLOW-UP ----------
QUESTION: Hello, Marcus.
Thank you for the prompt and thorough reply.
The story is set in a fictional territory in western Africa. Our patient is a female soldier in charge of protecting a VIP. Their convoy is ambushed and she gets grazed in the left scapula from ten-or-so meters away. Here are the conditions:
1) She is airlifted by a MEDEVAC helicopter to the station hospital within minutes of being shot.
2) She needs to be transfused.
3) There are no blood stocks at hand.
4) The only donor available is the VIP.
Please let me know if this is a conceivable scenario, and how I can justify it.
Again, thank you for your kindness. Happy New Year!!
Hello again Annette, Happy new year,
The CZ-75 pistol in 9mm would be the best choice for the weapon used. The accuracy of a pistol drops dramatically after about 20 ft (7 meters I believe). Everything else sounds like you have a good handle on your story. Good luck writing.