Understanding Gunshot Wounds and Their Severity

Gunshot wounds are high-energy puncture injuries that cause rapid, extensive tissue damage. Unlike ordinary lacerations, bullet wounds carry a compounded risk of internal bleeding, organ perforation, infection, and shock — all of which can be fatal within minutes if left untreated. Understanding the factors that determine severity is the first step toward effective emergency response.

Three Key Factors That Determine Wound Severity

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Location of Injury

Head, chest, and abdominal wounds carry the highest fatality risk.

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Projectile Size

Larger calibre bullets displace more tissue and cause wider wound channels.

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Projectile Velocity

Speed has the greatest impact — doubling velocity quadruples the kinetic energy transferred to tissue.

💡 Clinical Note Rifle rounds travel at significantly higher velocities than handgun rounds, meaning they cause substantially more internal damage even when entry wounds appear similar. However, any gunshot wound should be treated as life-threatening.

Step-by-Step: How to Treat a Gunshot Wound

Difficulty Level: High — requires composure under extreme stress
Critical Time Window: Aim to have the victim in ambulance transport within 10 minutes of injury.

  1. Ensure Scene Safety First
    Before approaching a gunshot victim, confirm the threat has been neutralised and the scene is safe. If you are not the victim, apply universal precautions — use gloves and personal protective equipment (PPE) if available. A rescuer who becomes a second casualty is unable to help anyone. Do not enter an active shooting scene.
  2. Call 112 Immediately
    Call emergency services the moment a firearm is involved — even before you reach the victim. Rapid ambulance transport is the single most critical factor in gunshot wound survival. Provide the dispatcher with your exact location, the number of victims, and the nature of injuries.
  3. Do Not Move the Victim — Unless Necessary
    Moving a gunshot victim risks worsening internal injuries and destabilising spinal damage. Only relocate the victim if remaining in place poses an immediate, ongoing threat to life (e.g., fire, active shooter).
  4. Assess and Maintain the Airway
    Follow the ABC framework: Airway, Breathing, Circulation. If the victim is unconscious but breathing, position them to keep the airway open and unobstructed. If there is no breathing and no pulse, begin CPR immediately. Learn how to perform adult CPR →
  5. Control Bleeding Aggressively
    Apply firm, direct pressure to the wound using a clean cloth, sterile dressing, or folded clothing. Do not lift the dressing to check the wound — add more material on top if blood soaks through. For limb wounds, a tourniquet applied 5–7 cm above the wound is appropriate when direct pressure fails to control haemorrhage. See our complete guide on controlling severe bleeding →
  6. Seal Chest Wounds to Prevent Pneumothorax
    A gunshot wound to the chest can allow air to enter the pleural cavity, causing a collapsed lung (pneumothorax) — a rapidly fatal complication. Seal chest wounds on three sides using plastic wrap, a chest seal, or a non-porous material to create a flutter valve effect. If the victim's breathing worsens or becomes more laboured, remove the seal temporarily to allow trapped air to escape.
  7. Position the Victim Appropriately
    Position is critical and depends on wound location:
    • Allow conscious victims to adopt the position most comfortable for breathing.
    • Place unconscious but breathing victims in the recovery (lateral) position.
    • Do not elevate the legs for shock if the wound is to the chest or abdomen — this increases bleeding rate and impairs breathing.
  8. Withhold Food, Water, and Medications
    Do not give the victim anything to eat or drink, including water. The victim may require emergency surgery, and an empty stomach reduces anaesthetic risk. Do not administer any medications, including over-the-counter pain relief, without medical direction.
  9. Monitor, Reassure, and Stay With the Victim
    Continuously monitor the victim's breathing, consciousness level, and circulation until emergency services arrive. Speak calmly to keep them alert and reduce panic. Note any changes to report to paramedics on arrival.

Expert First Aid Tips for Gunshot Wounds

🔍 Entry vs Exit Wounds Do not attempt to differentiate between entry and exit wounds. There is no reliable field method to distinguish them and it does not alter your first aid response. Treat all visible wounds.
↔ Bullet Path Is Unpredictable Bullets can ricochet, fragment, or change direction inside the body. A wound on one side does not mean the projectile exited the other side. Never assume the bullet's path or final location.
⚡ Velocity = Damage Tissue damage equals mass × velocity². Doubling bullet speed quadruples destructive energy. This is why high-velocity rifle wounds require immediate surgical intervention.
🩸 Shock Awareness Watch for signs of haemorrhagic shock: rapid or weak pulse, pale/cold/clammy skin, confusion, or loss of consciousness. Report all signs to paramedics immediately.

Critical Mistakes to Avoid

⛔ Never Do the Following:
  • Do not remove objects embedded in the wound — stabilise them in place instead.
  • Do not attempt to probe or clean the wound cavity.
  • Do not apply a tourniquet to the neck, chest, or abdomen.
  • Do not elevate the legs if the wound is above the waist (except arm wounds).
  • Do not leave the victim unattended once you begin care.
Related Articles: Remove a Tick Gunshot Wounds Treat a Seizure Chemical Exposure

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