ThrillWriting: EMTs and Gunshot Wound Information for Thriller Writers

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When I learned CPR, it was on a dummy like the one strapped to the gurney in my EMS photo on the right. It was okay training. In the back of my mind, I think that what I learned on the dummy might not translate so well when and if I were actually doing those chest compression and singing, “Ah ah ah ah Staying alive. Staying alive…” that ironically provides the perfect tempo for CPR.

English: A paramedic preparing a intra-venous ...

Image via Wikipedia

It was a real treat to have the second year paramedic students role-play for us. Mainly it was relieving to know they practice on each other. If I were lying out on a road somewhere and the first responders were practicing on me as a human - instead of me as a disembodied plastic torso - for the first time…well, I’d be grateful, no doubt, that someone was willing to show up - but I’d be hopeful that their hands had been on real people.

Real people indeed. A girl stumbled into the room in a daze, gasping for breath, collapsing on the cold tile floor in the ambulance bay where we perched to watch and learn. An ambulance pulled up and the work began.

Paramedic work, like all field medicine, requires a little MacGyver-esque ingenuity. For example, the victim had two open wounds. These were not referred to as gunshot wounds. The paramedics I spoke with are not allowed to diagnose - though I have had paramedics write and tell me they can so check the locality of your book's setting.

In order to apply pressure and seal the wounds, front and back, they used the pads from a defibrillator. Very effective. They discovered that the victim had a deviation between her right and left lungs. Her wound must have caused a tear in the lung causing it to collapse. That’s life or death. But Kent Sears and his crew went methodically forward. They used an intravenous needle taped (any foreign object that has entered the body either by design or accident, and is sticking out, needs to be taped) to the victim’s chest balancing the lungs.

When the lungs collapsed the victim passed out. Splat. They needed to get an IV line in. How do you do that if the vein has collapsed? They used an Intraosseous or IO machine. It looks like a hand held drill. They screwed on a drilling attachment that had a spoon like bit. They have this enter into the flat portion of the fibula (in the leg), or if this is unavailable they can use the humeral bone (at the shoulder). This process is very quick and is usually done on someone who is unconscious. If it is done on someone who is aware, they give a quick burst of Lidocaine before they introduce the fluids.

WARNING Trigger alert Video Quick Study

Pain ratings for the IO
Entry drill 3
Pain with drip (no Lidocaine) 8
Pain with drip (Lidocaine) 1
Pain pulling out apparatus 1-2

How do the first responders know what to ask? They use a mnemonic.

O - onset - when did this start?
P - provocation - how did this start? Ex. With a heart attack victim
where you doing something strenuous?
Q - quality - Is it sharp? Is it dull? Does it throb? And so forth.
R - Radiation - where do you feel the pain?
S - Severity - This is the famous 1-10 scale. 10 being your head is
about to explode.
T - Time- are there any changes over time.

And

S - signs and symptoms
A- allergies
M -medications. What medications are you taking?
P - pertinent - What pertinent medical information do we need to
know? Ex Are you pregnant?
L - last - When is the last time you ate or drank? Important for
surgeons.
E - events - What events lead up to the medical issues?

Here’s some interesting shot related information:
Once the bullet enters the body it can bounce around and go anywhere. The physics of the ammunition entering the body at any spot can cause hydrostatic shock. Basically a shock wave that runs through the body and can injure the brain. This is why gunshot victims wear a c-collar and are on a backboards.

The victim’s health comes first. The EMTs are trained to cut away from the cloth where the bullet was introduced. They try their best to preserve evidence. Of course, all that goes out the window when a life is on the line.

The EMTs appreciate people who can help. The will often give hysterical family members something to do. Sort the old “go boil water, Dad!” scenario. They need to be careful though. They’ve had it happen that someone is hanging around looking like they want to be helpful, but they are really just there to make sure that the job got done and the victim dies- especially with gangs.

There is something called a Tactical Medic. This is someone who was trained as an EMT and trains with the sheriff or police though they do not do police work per se. And this job might be an interesting one about which to write. Especially in a situation that goes very, very wrong.

I hope you find this information helpful. Please let me know if you have any questions.