Target Audience

“I will report the patient to the trauma center,” the Attack One crew leader advises. “Clear on red category, bullet strikes to the vest but no torso injury, and a tourniquet on the left leg for a severely bleeding wound.”

The Attack One Crew transports the child victim and organizes the transport operation. All victims are transported to the two hospitals, and no further victims are reported through the liaison officer to metro police.

Hospital Course

The victims arrive at the emergency department over about 20 minutes. The child’s wound is examined by the trauma surgeon, and a rapid x-ray confirms it is not a bullet wound. It is a piece of brick or cement block, no doubt kicked up by a bullet, and has damaged the femoral artery. The child is stable, but will undergo vascular surgery at some point.

The police officer has a significant injury to his left leg, and will be moved immediately to the operating room. Bullets hitting his protective vest caused contusions to his chest wall and abdomen, but no internal injury.

One of the victims with a gunshot wound to the shoulder is treated in the ICU due to bullet entering his chest. A victim with bullets to the buttocks and upper leg and arm is also taken immediately to the OR. This man had a bullet strike his buttock as he ran from the shooter. The bullet entered his abdominal cavity, and his condition worsened while in transport. On arrival at the trauma center, he began to complain of abdominal pain, and his abdomen became very tender.

All victims survive their gunshot wounds and are ultimately discharged from hospital.

The event occurred as a result of a fight at the bar that extended out across the city. The shooters were eventually found and chased until they crashed their vehicle. Another multiple-victim incident occurred as a result of that accident.

Case Discussion

Gunshot wound victims are difficult to assess in the prehospital environment. The wounds may appear to be very minor, with little bleeding, when in fact there are devastating internal injuries that will end the victim’s life. There are also victims who appear to have significant external injury but have little or no damage to important internal organs. The victim with a gunshot wound to the lower back and buttocks, like the one in this incident, will often have penetration of the bullet into the abdominal cavity. When you look at yourself in the mirror next, notice that your abdominal cavity extends from your nipple line to the bottom of your buttocks. Penetrating wounds of any type in that zone can enter the abdominal cavity.

It is also critical to note that bullets do not pass through the body in a straight line, and have essentially an unlimited ability to bounce around inside the body once they enter. A full assessment is needed of each area of a GSW victim’s body.

When violence involves multiple victims and the incident is scattered across a wide area, EMS crew safety is at particular risk. There have even been incidents where rescuers were targeted. Multiple-victim incidents with significant trauma require timely response, on-scene treatment and rapid transport to the closest appropriate trauma center, but rescuers must also use a cautious and integrated approach to scene safety with local law enforcement.

This incident clearly illustrates the need for cooperation with law enforcement and an integrated command function. The battalion chief was in face-to-face contact with the lead police official as they coordinated where police officers had secured scenes and where EMS crews were needed. There was one individual suspected to be a shooter, and he had to be subdued by officers and then secured before EMS could transport. The officers wanted to interview him quickly in an attempt to identify the other shooters, so after his initial triage EMS providers let the officers do their work prior to transport. Law enforcement officers are responsible for escorting a criminal suspect to the hospital, to avoid a situation where that individual becomes uncooperative and EMS providers do not have law enforcement powers to restrain.