First Aid/Impact and treatment of multiple gunshot wounds
QUESTION: Hi Marcus,
Grateful for your advice on this one please. I am writing a story about a female soldier (early-20s). She gets shot multiple times at short range (8-10 feet) by an assailant with an AK-47. He is lifting the gun up from under a bench and shoots on full auto. I'm assuming the shots stitch across her from upper left thigh to right shoulder, and she gets hit in upper left thigh, three times across her torso and in her right shoulder. Two of the shots on the torso would penetrate her body armour, and I'm thinking probably stomach and right side of abdomen.
In my story she has patchy first aid initially then emergency medical treatment from a trauma team (and a blood transfusion) within 30 mins of the injuries and medevac to a full hospital. I have her arresting on the ground and in the heli.
I'm trying to get some idea of likely injuries (would/could there be organ damage?), risks in the near term, treatment and duration of treatment (ie how long would she be immobilised, how long would she likely to be critical, how long for recovery back to full mobility?). I'd like her to make a full recovery and be able to continue in the army.
V. grateful for any help/advice.
ANSWER: Hello Matt,
Iím assuming the body armor stopped 2 of the bullets (steel plated or ceramic plates definitely would stop the rounds, a soft Kevlar armor probably would as well). The wound in the upper left high is probably the most serious with the greatest chance for major bleeding and the hardest to control. A shot in the lower stomach is possible especially if a bullet gets under the plate carrier, or it could bounce off the pelvis and deflect up into the abdomen?
A description of injuries: left leg- the bullet enters, tears the left femoral vein, fractures the left femur and leaves the body. Abdomen- enters, tears through the small bowel (because the muzzle was so close the bullet hasnít had time to start tumbling and makes a single, small hole straight through and exits through the back and is caught by the body armor (the bullet is quite hot and may actually burn the skin if this happens). Bullet to the right shoulder- enters, fractures the clavicle, tears the subclavian vein and artery and exits through the back.
Treatment: tourniquet to the left leg if you can place one above the wound. Legs are tied together with cravats to splint the left femur fracture. Dressing over the abdominal wound. Dressing and direct pressure over the shoulder (though this may not stop the bleeding completely, and 1 guy will probably have to stay at the shoulder to hold pressure until surgery. An IO (Intraosseous) needle is set in the upper sternum with the body armor still in place. 1000 ml saline and 500 ml Hespan are given IV for blood loss. A fentanyl lozenge is taped to her finger so she can self administer pain medication orally through transport.
At the Forward Surgical Team: her leg is splinted, femoral vein is tied off, abdomen is opened and torn bowel is stapled off temporarily. Right shoulder is opened and torn blood vessels are tied off. She receives blood and arrangements are made for a flight to a hospital for surgical restoration.
Recovery: she will need 3-4 weeks before she starts using her left leg, maybe 3 months before she is able to walk on it well. By that time her other injuries have healed pretty well. She could have right arm nerve damage from the shoulder wound (numbness, nerve pain down the armÖ your option on this). After 6-8 months she could possibly pass her PT to return to duty.
I hope this answers your questions well enough, good luck with your story.
---------- FOLLOW-UP ----------
Thanks very much for your advice on this - very helpful. Two follow up questions:
1) If I wanted her to have complications post treatment by the forward surgical team what could I have and how serious would it be (I'm looking for something to flare up - maybe an infection or something)?
2) If I only went with a flesh wound in the left thigh how would that impact healing time?
Thanks very much for your help.
Hello again Matt,
1) she is at high risk for an abdominal infection (peritonitis), which would be treated prophylacticly as soon as she arrived at the forward surgical unit with 2 grams of Cefoxitin IV. the infection may become an issue as soon as 3-6 hours after treatment. Or she could develop compartment syndrome in her upper left leg (where pressure builds within the fascia which covers the muscles). She would start to complain of severe pain in the muscles of her leg and a full feeling inside her leg. The surgeons can preform a fasciotomy to open the tough tissue around the muscle revealing the pressure and pain but the procedure has a 3-6 week recovery time with proper physical therapy.
2) if there were no femoral fracture and no blood vessel damage the recovery time with be less, maybe 2 months? but to re-qualify for combat I would say she would need 6 months to build up strength and stamina.
Good luck with your writing again.