AboutStephen Bernhard Expertise I can assist with answering or finding the answers to questions involving first aid, CPR, emergency first response, and general procedures of the emergency medical services (not specific to any specific organization, but I may be able to shed some light on why they do the things they do).
Experience I am a former EMT-Basic, Police Officer whose duties included medical first response,Basic Life Support and Automated External Defibrillator instructor, Bloodborne pathogens instructor, and I have taught hundreds of students, including hospital, fire and rescue, and police personnel.
Education/Credentials EMT- Basic certification, American Safety & Health Institute (ASHI) and Emergency Care and Safety Institute (ECSI) certified Basic Life Support (BLS) Instructor-Trainer, Ohio Peace Officers Training Academy certified. I also own and direct HSTA LLC, a BLS instruction company in Southwest Ohio, which also serves as a certified training center through ASHI and an educational center through ECSI.
Question QUESTION: I am writing a story about hikers miles away from EMS. A man gets shot in the shoulder by a Browning 9MM. His friends apply proper 1st aid field dressing and stop bleeding (clean exit hole). In a best case scenario what might his symptoms be? Might he be able to walk on his own? If so, for how many miles?
ANSWER: Hi Lonnie,
Besides the obvious signs and symptoms (pain, bleeding, deformity), a gunshot wound (GSW) can also produce symptoms of shock and respiratory impairment.
signs of shock (hypovolemic shock, in this case) would include any or all of the following:
Depending on whether there was injury to a lung, he might also show symptoms of either a hemo/pneumothorax (where either air, blood, or both, leak around the lungs and cause severe respiratory distress by not allowing the lungs to expand... typically leads to a "collapsed lung").
Symptoms are usually:
-Pain
-Increased difficulty with breathing which continually gets worse, and worse case scenario deviation of the trachea
-Cyanosis (bluing of the skin)
-Weakness
-Thready pulse
-decreased blood pressure
-Rapid breathing
As far as the victim's ability to hike: That would depend on factors such as the severity and location of GSW, the victim's overall health, amount of blood loss, the amount of effort that the victim has to put forth and numerous other factors. However, it is possible that the victim may be able to traverse the terrain for several miles with the assistance of his fellow hikers. This would, ultimately depend on the exact scenario that you put him in.
I hope that this helps!
Stephen
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QUESTION: Let's say the gunshot wound only passed through the shoulder and the man is in excellent health. Would his companions want to cleans it with alcohal? (or to make things interesting, only a flask of whiskey is available). Would it be far fetched for him to make it 24 hours and 10 miles without professional medical care? (obviously he can't carry a backpack).
ANSWER: Theoretically, it would be possible for him to travel as described. There is another thing to put into account, though. A clean shot through the shoulder would inherently mean the the projectile would have passed through some bone. This could cause the slug to deviate, break up inside the body, or splinter the bone and thus cause more injury. However, there is the remote chance that it somehow missed a rib, clavicle, scapula, or shoulder socket....
I think that pouring alcohol of any sort on the wound would actually be detrimental. Whether it's isopropyl, Jack Daniels, or a refreshing mojito garnished nicely with a twist of lime, the alcohol can wash debris further into the wound can still cause an infection. Alcohol can also kill the tissue around the wound, as well.... However, in your scenario, I would think that they would act as most people would (who learn a lot from watching movies etc.).
Can he make it 24 hours and 10 miles? Yes, he very well could, in my opinion. He will also probably be severely weak, dehydrated, and consequently in the ICU for a spell while hooked to some very good IV antibiotics.
Thanks,
Stephen
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QUESTION: One last question: Let's say another hiker possessed some antibiotics. Would that buy more time for the gun shot victim? (assuming he's not allergic to it) If so, what type of antibiotic would work best?
Answer Hi, again, Lonnie,
Now, I must admit that this question is actually out of my expertise. As a first aid provider, EMT, and BLS instructor, I have never received the pharmacological training regarding antibiotics.
Now, I know from my own personal experiences, that other than the penicillin based antibiotics, more powerful ones exist such as Bactrim and Vancocin. Both kill the Staph A. bug, which commonly cause infection of the skin and wounds.
As far as buying any time... that would probably be doubtful. If it were a matter of days, it might help. Otherwise, in a 24 hour period, the antibiotics would most likely not have taken any effect yet.
If I were with the GSW victim, here is what I would do (assuming that I have no first aid equipment to speak of):
1. Calm and reassure the victim
2. Treat the wounds by applying pressure
3. Immobilize the arm on the affected shoulder using any spare cloth, such as a ripped shirt, to make a sling and swath. This will also allow to more easily apply a pressure bandage to the wounds.
4. Monitor victim for shock, and treat accordingly
5. Since help is many hours away, I would personally allow the victim to drink small amounts of water to help with dehydration.
6. If moving the victim is necessary, I would either attempt to carry the victim or drag him on a makeshift sled (if materials were available). Otherwise, I would attempt to assist him to minimize his effort.
The name of the game is to "adapt and improvise" to the situation. A bunch of sticks and some strong twine can make a drag sled. If the terrain is flat, a blanket or sleeping bag may work, as well. Multiple rescuers means that they can take turns in assisting the victim to minimize exhaustion....
