Amputation for gunshot accident © 2025

Gunshot wounds are always a medical emergency

The extent of injuries depends on many factors, such as where somebody is shot, the size of the bullets, and the type of gun. Unfortunately, gun-related injuries are not rare in the world. If someone’s been shot, it’s critical to go to emergency services as soon as it’s safe to do so. Administering first aid can save a person’s life while you wait for an ambulance to arrive. Acting quickly can help slow bleeding and prevent life-threatening complications. Keep reading to learn essential information about first aid, medical treatment, and recovery from gunshot wounds.

First aid for a gunshot wound

More people experience nonfatal gunshot wounds than fatal ones. It’s crucial to identify where someone’s been shot and begin first aid while waiting on emergency services.

The first 10 minutes after the injury are often referred to as the platinum 10 minutes. During this time, the person who was shot is at risk of life-threatening complications, such as:

— Airway obstruction

— Tension pneumothorax (collapsed lung)

— Bleeding

The leading cause of death in gunshot wounds is bleeding, a person can die from severe bleeding in fewer than 5 minutes if untreated. Here’s what you can do if you’re with somebody who is shot.

If you’re with somebody who has been shot, it’s crucial that you and the person get to a safe place away from the threat. In the case of an accidental shooting, this might mean making sure the gun’s safety is on and that the gun is secured. In the case of an intentional shooting, this might mean evacuating the scene. If you are with an injured person during an active shooter situation, evacuation may not be an option. In this case, recommends that you attempt to:

Hide in a place that’s out of the shooter’s view
Silence your phone to avoid detection and remain as quiet as possible
Seek an area with a barrier for protection (such as behind a locked office door or a large object)
Block a shooter’s potential entry with a barricade, such as stacking furniture
Avoid restricting your ability to move in case you need to run or confront
Gunshot wounds always need medical attention to assess their severity and begin treatment.

Managing bleeding

Bleeding is the leading cause of death in people with gunshot wounds. It’s important to apply firm pressure to the wound if the person is bleeding profusely. If they have a large wound, cover the area with any clean cloth available, such as a piece of clothing. Press down as hard as you can until arrive to relieve you. It may also be necessary to use a tourniquet to limit blood loss while waiting to get someone to a hospital.

While research is still preliminary, it suggests commercially made tourniquets may be able to better control hemorrhage from appendages (arms or legs), reduce the chance of the person needing a blood transfusion, and increase overall likelihood of survival.

These types of tourniquets are pre-made, widely available to order (especially online), and can be added to emergency preparedness kits. If you are with someone who has been shot and do not have access to a ready-made tourniquet, you can still improvise one. Tourniquets should be used as a first resort when an arm or leg wound is bleeding so much that direct pressure does not stop blood flow.

Wrap and tie a long piece of fabric (such as a shirt or necktie) several inches above the wound as tightly as possible. This is intended to limit arterial blood flow and reduce blood loss. A homemade tourniquet will never be as effective as a commercially made one, but it can still be a significant first aid tool.

Decision to amputate

The extent of the “zone of injury” is dependent upon the mechanism of injury (i.e., blast, gunshot, and crush injuries), as well as the co-morbidities and physiologic status of the casualty. Factors such as severe blood loss with massive resuscitation, burns, compartment syndrome, tourniquet use, and contamination load often extend the actual amount of tissue damage beyond that which is apparent on initial visual inspection.

Amputation terminology includes traumatic amputations, which are immediate extremity amputations caused by the wounding mechanism itself. Primary amputations are those performed by a surgical team after evaluation of the mangled extremity, with the decision not to pursue limb salvage for whatever reason. Secondary amputations can occur early (within 90 days) or late (after 90 days), with the latter referring to those amputations occurring after an initial attempt at limb salvage has been undertaken. Most commonly, primary and early secondary amputations are performed for vascular injuries not amenable to repair or resulting in prolonged limb ischaemia, nerve injuries not compatible with a functional extremity, or extensive nonviable tissue with potential for uncontrolled sepsis. Late secondary amputations are generally performed due to patient preference or major complications (e.g., flap failure, recurrent osteomyelitis, persistent poor function or pain) of attempted limb salvage. Current consensus regarding extremity amputation following battle injury is to preserve limb length and vascularity, facilitate adequate wound drainage, and achieve eventual coverage and closure of the amputation wound.

Although a number of scoring systems to predict the need for amputation exist, none is widely accepted or validated in the combat trauma population. Intact or the potential to restore perfusion (by vascular repair or shunt) may be the first determinant. If perfusion can be restored, any decision regarding amputation for nerve or bone loss can potentially be deferred until later, with the structurally unstable limb stabilized for transport by splinting or external fixation. Given the time sometimes required to restore perfusion, amputation may be necessary as a damage control procedure in a massively injured patient.