The time is here to push this out to all patriot groups, especially the medics in such groups. In writing this article I sought to take current best practices of gunshot wound (GSW) care and bring them against the additional ideas of NO SECONDARY MEDICAL FACILITIES and MEAGER SUPPLIES. This is most realistic for many scenarios going forward. The title is not a misspelling. Since we are still under Rule of Law in medicine in the USA I am writing this as a veterinarian theoretically treating a gorilla. This keeps me from getting in trouble legally. Readers will see the obvious application to your own groups and situations. I have been in direct communication with an MD about the content. I have treated several of these successfully as a vet. I am not giving medical advice nor am I responsible for any use you may make of this information. This is a thought exercise. I welcome medical folks to tweak this GSW strategy for the good of all of us by way of the comments. Please do not use the comments to tell us all about the fancy equipment that your group has. This must remain extremely practical. Think wilderness medicine with no hospital.

Were I to encounter a gunshot gorilla I would first make sure the scene was safe and secure. I wouldn’t want the person who shot the gorilla to shoot me or shoot the gorilla more times. Hopefully I would have friends that would be working with me on scene safety as well. Some people believe that it is best to move the gorilla if possible (if no spinal injury, if gorilla can assist) to a safer immediate location, but this is controversial. Make a decision at your scene.

As quickly and thoroughly as possible evaluate the injured gorilla. Where’s the wound? Is there more than one? What kind of gun made this? What kind of damage has occurred? What kind of shape is the gorilla in overall? In shock yet? Should I start IV fluids? Do I have IV fluids? Now work on any wounds.

Current best practices in human medicine generally follow three steps to GSW care: stop the bleeding, keep it clean (and from contamination), and get the subject to a higher medical center for further care. At the higher center a GSW will typically be reconstructed with more surgery immediately or at some future date. Various specialists will be brought in, like orthopedic surgeons or soft tissue surgeons. This last step is not going to happen in the G-war that’s coming.

Stopping the bleeding is something we can and must do on scene. In the military they use the soldier’s IFAK (you DO have one of these right?). Put on at least some nitrile exam gloves and get to it. Each GSW will be unique but put pressure on it with clean gauze or the Israeli bandage from the IFAK. Even if it is a very defined hole it is not a good idea to “probe around” and see where the path goes. Nor is it a good idea, as shown in hundreds of movies, to remove the bullet. In my squad medical bag I have forceps and gut suture material to clamp and tie off bleeders, but not everyone will have that capability. Pressure is the oldest, most intuitive, and most basic tactic in hemorrhage control. If the GSW is on an extremity you may have to use a tourniquet, or at least use one until you can figure out something better. Secure your pressure bandage with medical tape or other means. Pack deep wounds with sterile gauze (or regular gauze if that’s all you have) and secure with tape. Chest wounds may require sealing to reverse or prevent a sucking pneumothorax (sucking pneumothoraxes SUCK!!), but that is worthy of another article. Tampons work very well for defined holes. Every guy should have to buy some for his medical kit.

The next step is treatment and prevention of further infection. This is why wrapping as much of the GSW as possible is a good idea. The normal barrier of the skin has been breached and we don’t want continued contamination. I am blessed to have some antibiotics with me in my squad medical bag. If the gorilla is able to swallow and not allergic I’ll give him some oral or injectable antibiotics on scene. If he can be moved we will get to a safe location, safe house, etc. At the safe house we will try to clean the GSW better, possible under local anesthetic (this requires lidocaine). My plan is to spike a bag (or bags) of normal saline with some Betadine solution (not Betadine SCRUB, it has detergent in it) and use it for as much flushing and irrigation as possible, and using warmed fluids if possible. If I had no IV fluids I would use tapwater spiked with Betadine solution. At higher centers they perform debridement (surgical removal) of damaged tissue. I don’t think we are going to be able to do much of this but maybe you can. They also do fancy things like partial closure, reduction of dead space, and application of negative pressure bandages and other wound-healing devices. I don’t think we are going to have those either. In any case DO NOT SIMPLY SUTURE OVER OR COMPLETELY CLOSE GSWs. They are contaminated and must be left open to allow fluid out. If you close them you will be creating an abscess. A good way to think of it is GSWs must HEAL FROM THE INSIDE OUT. Keep a bandage over it until it heals. This may take weeks. Do you have enough bandage material?

The third stage is what may be called Reconstruction at a higher center. This can involve numerous follow-up surgeries and procedures. As I said earlier, this is something that I believe we will not have. GSWs are already reportable by hospital personnel now, in 2020. Imagine a gorilla coming to a (controlled) hospital in the future and trying to explain how he got injured. You will be hand-cuffed to the bed or worse.

Well, more articles are coming, but that is enough for now. One final thing, though. If the gorilla is terminally injured I am going to comfort him with words and by holding his hand or putting my arms around him until he slips peacefully into eternity. Should I be the recipient of a terminal GSW I ask you to do the same for me. Please listen to the modern hymn “The Mansions of the Lord.”

 

God bless,

DVM

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