G-MEDICINE: TREATING GUNSHOT WOUNDS IN GUERILLA FIGHTERS

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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About the Author: NC Scout

NC Scout is the nom de guerre of a former Infantry Scout and Sergeant in one of the Army’s best Reconnaissance Units. He has combat tours in both Iraq and Afghanistan. He teaches a series of courses focusing on small unit skills rarely if ever taught anywhere else in the prepping and survival field, including his RTO Course which focuses on small unit communications. In his free time he is an avid hunter, bushcrafter, writer, long range shooter, prepper, amateur radio operator and Libertarian activist. He can be contacted at [email protected] or via his blog at brushbeater.wordpress.com .

33 Comments

  1. Anonymous August 18, 2020 at 05:53

    5

  2. Matt August 18, 2020 at 06:07

    I’ve seen conflicting thoughts on the use of tampons for sealing wounds. There is the side that recommends them, as above.

    The other side’s thought process is that standard gauze soaks up the blood and gives it a place to begin forming a clot. Tampons on the other hand are designed to put blood away from the source and therefore inhibit the clotting process to a lessor or greater extent.

    Any validity to this or is it just internet malarky?

    Matt

    • NC Scout August 18, 2020 at 06:40

      Early in the GWOT they were used as a quick way to seal up gunshots. If that’s all you’ve got, it’s all you’ve got. But it’s far from ideal.

      Trauma gauze is the way to go, but again, you’ve got to have it to use it.

      • Matt August 18, 2020 at 10:23

        Thanks for the info. I’ll use this as a push to buy more hemostatic items.

        Matt

      • Johnny Paratrooper August 18, 2020 at 10:27

        Early in GWOT there were massive shortages of everything from medical supplies and even hand grenades if you can believe that.
        Hand Grenades… A shortage of hand grenades. Unbelievable…
        I hope we include some burn treatment in this series. Those 3 inch Mortar rounds and Molotov cocktails appear to be the Antifa special.

        The Super Silver Wound Gel by Infowars is absolutely incredible for burns. Buy some immediately and keep it with you. You will not regret it. It’s incredible stuff. I sliced my finger wide open this summer, and burned myself on a torch. That gel takes away all the pain as soon as it touches your wound. It’s some real deal 2020 science stuff. Truly awesome.

        • DVM August 18, 2020 at 12:04

          Thanks for your input Johnny Paratrooper, and thanks for everyone’s comments so far. You guys are awesome. Yes, a BURN treatment article is coming soon…and more…

          • Johnny Paratrooper August 18, 2020 at 13:41

            Excellent. And those new burn kits they provide, The blue “Burn Gel” kits they issue around the world is basically same product. Again, leaps and bounds ahead of the stuff we had even ten years ago. Incredible stuff. The medical system gets a lot of hate, and rightfully so. But the equipment and supplies they use in 2020 is second to none. To not buy a modern burn kit is simply ignorant. Imagine having to watch someone you love suffer in agony. Imagine knowing you could push the pain to the back of you mind without the effect of narcotic treatments. That new gel is AMAZING. Ask anyone who has used it.

            Works great on friction burns too.

            Source: Burning Steel, Welding, Medical Wards, and War.

        • Matt August 18, 2020 at 17:03

          Paratrooper,

          Things never change. During Desert Storm we almost ran out of bombs, less than a day’s supply was left at one point. The only thing left were some slick 500 pounders that were actually older than I was. You’d think that they could manage the basics better.

          Matt

          • Johnny Paratrooper August 18, 2020 at 18:06

            Yes. I ate PB&J Pop-Tart sandwiches and stale honey buns for two weeks in Sadr City. The T-Rats that we had delivered were moldy. Edible, but moldy. That was at the nice JSS. When we pushed out to Combat Outpost 762, the food got worse. Strictly requisitioned from local national forces. We were consistently sick, and had many parasites. It was awful.

            10th Mountain also burned up all the Mk262 in the AO before we arrived because they had the tallest building in the sector. Which is probably why I could never bring myself to buy any Mk262. We ALWAYS had trouble finding that stuff when we needed it.

            Logistics is the only metric of war that one should study. Everything else is matter of willpower and firepower.

            “War… War Never Changes”

            https://www.youtube.com/watch?v=EM3Y6uw6FtU

        • Coyyote August 18, 2020 at 18:23

          Is there a big difference between Silvadene Cream 1% and the newer super silver stuff. Silvadene was the goto at Brooks Army Med Ctr in their burn unit – but that was Namn time.

        • Berglander August 19, 2020 at 08:49

          Burn gel is tits. And as far as hand grenades…we had so many at the Basrah Palace in 05-06 that we were fishing with them. Crazy how there’s a shortage in some places, and an abundance elsewhere.

          • NC Scout August 19, 2020 at 09:07

            RGD-5s are fun.

          • Coyyote August 19, 2020 at 15:35

            Well I got off my lazy ass and researched the latest on exudative wound care (burns, etc). The medical reviews still list Silvadene ( silver sulfadiazine) 1% cream as #1 for moderate and severe burns (2nd and 3rd degree), but obviously could be used on first degree burns. It is however a prescription item made by Pfizer.

    • Johnny Paratrooper August 18, 2020 at 10:14

      Hell yeah on the tampons. But, if you have ever shot a deer before, it’s important to remember that one tampon might not be large enough. As tampons are quite small, but deceptively large at the same time. Also, there is no guarantee that you will receive a straight “Hollywood” through and through shot. Most likely you will receive a Hole and a “Zipper”. or the combination of the two. A zipper gunshot wound looks like a machete wound with trauma caused by impact, possibly crushing bone. Bullets do different things depending on the distance from the muzzle, and the angle of impact. It’s important to remember that most bullets cause AT LEAST two holes in the target, Or you could end up like by friend from Detroit and take an AK-47 round to both quads. Straight through the top with four holes the size of a clementine. He was sitting in the TC seat of a Humvee. Opened the door, and BANG. That dude was super messed up. But he took it like a CHAMP! Lucky for him, the bullet didn’t hit any bone.

      OH MY DARLING we ran out of medical so quick.

      Gauze is the way to go because you can use it in a variety of wounds. Which could be a slice, stab, arrow, pistol, shotgun, or rifle.

      I have both, but most importantly I have the knowledge and training to know that literally anything sterile is better than nothing.

      As mentioned rapping the treated area with a protective layer is also very important, mostly to protect it from flies. Flies NEVER go away. Plus the usual suspects with infections are dirt, debris, and dust.

      Stab wounds can behave like pistol wounds. I have seen people get stabbed 5-6 times and not bleed but a drop of blood. They usually seal themselves up and stop bleeding on their own within seconds. Especially with skinny people, and large obese people.

      The crushing effect bullets have on bones is the real problem. Crushing wounds are very common and difficult to treat.

      Slice, or filet cuts are like a hunting arrowhead. You are gonna BLEED my friends. You are gonna bleed SO MUCH.

      Source: Baltimore and Baghdad.

  3. Green Mountain Shooter August 18, 2020 at 09:25

    having been and EMT for eleven years I say thank you for writing this and we all should be looking forward to future articles. Seeking training in pre-hospital medical care now, such as free CPR courses or basic first aid from the American Red Cross, would be a smart move.

    • Johnny Paratrooper August 18, 2020 at 10:53

      On average they offer free medical training at their firehouses once a month. The wealth of knowledge they have is vast.

  4. Cavguy August 18, 2020 at 09:49

    If one plans to play with guns, one needs to play doctor too. Those 5.56 holes get big really fast.

    Cavguy

    • Johnny Paratrooper August 18, 2020 at 13:23

      “If you play with guns long enough, you are gonna shoot yourself, or get shot” MOH recipient and Delta Cadre at Range 37 standing next to another cadre who had shot himself in the hand with a 9mm the week prior.

      The 9mm point blank GSW blew his carpel OUT of his hand.

    • Boat Guy August 22, 2020 at 09:35

      Recently took an advanced course from John Murphy of FPF. The “Stop The Bleeding” content included trainer ankle kits with IBD’s and CAT’s. Periodically Murph would call out something like ” pressure dressing, left leg! ” ( usually when your focus was elsewhere) and it was off to the races. I’m still good with an IB D but my CAT skills have atrophied significantly. Have taken heed.
      Those of us not wearing tight trou can easily move with an ankle kit (North American Rescue has pouches) or two.

      • NC Scout August 22, 2020 at 09:45

        Its been my experience that when members of my team needed a tourniquet, indexing it from the leg was out of the question.

        • Boat Guy August 24, 2020 at 08:24

          The ankle kit is intended as EDC for concealed carriers. If the choice is ankle carry or none, I’ll go with ankle.

  5. Al Davidson August 18, 2020 at 12:57

    Great information, but one glaring error. We have the rule of constitutional law, of the people, by the people, for the people! The exact opposite of the rule of law, which is of the elite, for the elite, by the elite. RoL is a very successful communist “lawfare” term. There is no -we the people- component in RoL. Example- Afghanistan is a fully functional, complete, rule of law government, set up by our communist democrat friends in D.O.S., and the U.N.

  6. Ralph k August 18, 2020 at 13:05

    Some other concepts to consider. Dakins solution, developed during WW1 by two doctors in an effort to combat sepsis as a result of traumatic injury from weapons of war. Its use markedly reduced sepsis, death, amputations etc. A combination of sodium hypochlorite (bleach), baking soda and water. Made to different strengths depending upon the injury and severity of contamination and infection in the wound. I refer you to this link for the formulation. And remember, widespread us of antibiotics at this juncture in human history had not yet begun.

    :https://www.nursingcenter.com/journalarticle?Article_ID=1585988

    Excellent read on the history and development of the process. Caveat: do not practice medicine without a license. And, read the directions of the preparation. No full strength sodium hypochlorite EVER on or in the human body, and do not use the scented variety. Meticulous cleansing of the wound ASAP is paramount, ie dead tissue, clothing, dirt, etc. Think: the solution to pollution is dilution, meaning copious irrigation of the wound and use of aseptic technique.

    Another preparation that is easily formulated with commonly obtained chemicals is oral rehydration salts. Very useful especially for
    cases of prolonged loss of body fluids because of emesis or diarrhea, think cholera and other diseases that produce similar symptoms. Constituents are water, sugar, salt, baking soda. An internet search will provide links to the formula.

    I will close with an interesting story relayed to me by a French physician who was involved in the French Indochina War. Think Vietnam. They were there before we got entangled in it. His story was the use of the lytic cocktail, a combination of demerol, phenergan and thorazine, 100mg each in a liter IV fluid, very slow drip rate of infusion. As a battle would unfold the casualties would increase far beyond the capacity of surgical teams to work on the wounded. The soldiers who did not require immediate lifesaving procedures were basically ‘warehoused’ until the teams could attend to them. Sometimes they would be in a somnolent
    state for up to 10 days. Their pain was abated, their metabolism basically slowed down and interestingly, the infection rates also slowed. Remember that most of the injured were young healthy males, the most resilient of the population.

    Also, to Johnny Paratrooper, I worked in a major urban center ER, typical knife and gun club environment. I saw at least twice the deaths from knives vs GSW. Yes, with a knife wound, sometimes the reaction of the blood vessels is immediate contraction and cessation of blood loss, I have seen it, but it is not the common result from such injuries, exsanguination after severing of major vessels is a more common result as you probably know. I didn’t want prospective victims to get a unrealistic expectations from such encounters.

    As always, due diligence is always required and none of the above constitutes medical advice, and do not practice medicine without a license. I hope everyone finds this informative and fascinating.

    • NC Scout August 18, 2020 at 14:38

      What an excellent comment. Thank you so much!!

    • Johnny Paratrooper August 18, 2020 at 18:40

      Excellent comment. WAY ABOVE MY PAY GRADE.
      And in response to your comment about Knife wounds. A knife is very dangerous because it is silent, and a criminal is more likely to use a knife than a gun because a gun is loud and they believe they will get tracked down using Hollywood CSI magic Fedboi super spy systems. That contributes to the higher rates of use relative to a firearm.

      Another factor is that knife victims usually get stabbed multiple times before they even realize a knife is being used on them. Seen it with my own eyes in broad daylight. Poor guy got tuned up ten times before he realized what was happening to him. He survived only because a top hospital, with an open surgical ward, was 5 minutes away. A firearm usually results in the victim running for their lives cause guns are loud and scary and obvious in the hand of the user. This makes critical hits harder to achieve. Pistol bullets also induce massive bruising, which can close up a wound. Resulting in less immediate trauma than one would anticipate from a firearm. I remember reading that this “low velocity pistol cartridge effect” lasts JUST long enough to get to a hospital. Which contributes to the higher rates of survival. Even if a vital organ is damaged.

      I am curious, were these stab wounds? or slices? or both? I have NEVER seen a slice stop bleeding on it’s own. I did see a guy get tuned up in the belly, he danced around like a king after knocking his assailant out, then he turned ghost white, and passed out. He survived, but his thorax was full of blood. Took maybe 3 minutes before his eyes glassed over and he lost color. He was down on the ground a minute later, and out like a light within another minute. Where did he get hit do you think? It was around the belly button. Kidneys? I never saw the knife. I do know that the thorax/solar plexus can compress quite a bit from a direct blow(3-4 inches right?) which can make a small knife very dangerous if you take a hard hit. I don’t think the guy even knew his opponent had a knife. There was practically no blood to speak of on his clothing.

      Slice wounds disable so much tissue and blood immediately pours out of you. It’s horrible to watch. I would rather treat a pistol wound.

      The old saying goes “Never bring a knife to a gun fight”
      Obviously, whoever said that never visited Baltimore or Baghdad. Or Londonstan apparently…

      • Ralph k August 18, 2020 at 21:25

        I always carry a knife. And as you say it is silent. More importantly, can be drawn and used immediately with devastating effect without drawing much attention from others. Strikes to the correct areas, ie neck, groin, arms and legs at the joints, the chest of course. But the most important factor when confronted with a knife wielding opponent is this: very few people have ever been subject to GSW. Almost universally everyone has suffered a cut, severe or just a paper cut. It is indelibly impressed upon the brain and to be avoided. Fantastic weapon, and the best part is you get to look in to their eyes up close and personal.

        • Johnny Paratrooper August 19, 2020 at 10:21

          I have pulled a knife multiple times in my life. The effect it had on my would be assaliants was a mixed bag.
          Sometimes they follow you, while calling their friends on the phone, and giving up your location in real time.
          Be careful drawing a knife on real criminals. They are not afraid of us. There are hundreds of hours of video of people with knives on the net. Rarely does the knife scare them away, which is similar to my experience. Being ready to use it is very important.

          • NC Scout August 19, 2020 at 10:26

            Brandishing a weapon is about the best way I know to get killed.

            Don’t draw until you’re ready to use it. When you use it, follow through to the end.

          • Ralph k August 19, 2020 at 10:59

            I wasn’t advocating scaring someone or brandishing a knife, but putting it to use immediately, as NC Scout alluded to.

  7. Coyyote August 18, 2020 at 13:52

    Back in the time as a resident in a trauma hospital we saw lots of GSWs thanks to the San Antonio Knife and Gun Club. Occasionally while inside a victim in the OR trying to stem bleeding or run the bowel for holes we would come across the bullet. This initiated THE ritual with the surgeon loudly exclaiming. ” Nurse, a stainless steel pan STAT!”. Upon production of the steel pan the bullet was seized by forceps, held a minimum of 12-18″ over the pan and released, producing a resounding ping which echoed from the walls of the OR. We had disposable plastic pans on the surgical tray, BUT only a steel pan would do – just as in the westerns. Alas some of the patients we recovered bullets from did not fare as well as those in the movies that are miraculously cured with removal of the bullets.

  8. David Lawrence August 18, 2020 at 15:48

    I think a Wilderness First Responder Course would be about perfect preparation for a medical emergency, bullet and knife wound included, where advanced medical intervention is a half day or more away. A lot of material on shock, it’s various signs and mitigation. Also a really specific SOP on victim evaluation. I took a course 10 years ago when doing extensive backpacking and to this day haven’t heard of a better program.

  9. Alan Burquist August 19, 2020 at 09:06

    Question.. How many of you, “have your affairs in order”???
    Legal and binding wills, power of attorney, titles and deeds, etc..
    Might want to think about transferring your tangible wealth..

    Because if any of us end up “Wanted” by the Statists, they WILL
    go after your assets, and your family.. If they can no longer punish
    you, because you are dead, they will punish your family instead!

    Don’t leave your family holding the bag!

  10. Anonymous September 4, 2020 at 20:27

    3

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