Sorry it has taken me so long to get this out, I was back to work after recovery and was simply too worn out to catch up. Anyways…

As previously stated, the 30.06 round entered at the jawline. Regardless, he was still alive after taking the hit.

ALS treatment for wound management of this magnitude largely focuses on bleeding control and shock prevention. In the golden days, not much was done to stop the bleeding and airway management was atrocious.

Many of the answers focused on survivability, while most likely fatal, there are treatment points that should be considered on any penetrating trauma patient:

Stopping the bleeding and preventing shock are probably the best things we can do. If we can’t stop the bleeding, eventually there will be a cardiac arrest we can’t reverse.

After that, airway management should take a next highest priority.  Gunshots to the face and neck are troublesome for airway and shock management because it is a literal choke point, as everything vital to running the brain and body passes through there.

My personal treatment plan was scene safety and rapid extrication of the patient from the area to some place with more cover. Then, bleeding and airway management, most likely I would capture the airway using intubation and gain circulatory access using an IO drill. Since there was no trauma to the lower extremities, an IO is indicated.

It would be difficult to manage the wound AND immobilize the patient for spinal injuries, so full immobilization would be left off my list of things to do.

In transporting to the hospital, a larger IV would probably be started along with a bolus of lactated ringer’s.

Do I think the wound was survivable? Probably not. It severed the spinal cord and a major blood vessel, and it is very likely that a bleed out would have occurred despite our best efforts.


Category: Case Studies

About the Author

Russell Stine is a firefighter/paramedic in a large urban system. He has been employed for 6 years as a street level provider and has delivered care as an EMT and a paramedic across the urban, suburban, and rural settings. He has been in emergency services for 15 years.

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  • Too Old To Work

    Bleeding control and airway would be primary, but neither would be more important than the other. It would be a tough case either way. Volume replacement wouldn’t be high on my list, especially if it delayed transport. If the patient had any chance of survival, then it would be by getting to the OR as quickly as possible. Except for airway control and hemorrhage control anything that delayed that would be counter productive.


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