ER Physicians using Military Trauma Techniques on Gunshot Victims

Gunshot InjuriesAs an experienced medical transcription company serving numerous specialties, we provide timely and accurate clinical reports for the two major players in the emergency room (ER), trauma surgeons and emergency room physicians. These medical specialists are specially trained to respond to emergency situations. Today, they have a new skill – using techniques honed by military doctors on battlefields to treat civilians injured in terror attacks and mass shootings. According to recent reports, firearm-related injuries are on the rise in ERs. Newswise reported that a new study by Johns Hopkins of over 704,000 people who arrived alive to a U.S. emergency department (ED) between 2006 and 2014 found that firearm-related injuries account for $2.8 billion in charges each year.

Fifty-eight people died and more than 500 were injured in the recent Las Vegas shooting. The ER team at Nevada’s University Medical Center (NUMC) could handle the massive influx of patients as they are now better equipped to provide trauma care. They treat people with disabling or life-threatening gunshot wounds using advanced techniques applied by military doctors in war zones like Iraq and Afghanistan.

Firearm-related wounds include chest injuries, cardiac tamponade, abdominal injuries, limb injuries and tissue damage. As part of their emergency preparedness plans, all trauma centers in the U.S. have been trained to handle such injuries. What’s particularly disturbing is that the types of injuries that physicians have seen in recent times are more severe and potentially fatal. For instance, Vox reports that the trauma team at Orlando Regional Medical Center saw “the gamut of wounds – from wounds to the extremities, the chest, abdomen, and pelvis area – as if they were shot from below…” They treated them successfully using “techniques from the battlefield”.

According to a report published in 2016, with a national trauma care strategy that translates military trauma care into the civilian sector across the US, an estimated 20 percent of those deaths could be prevented. The key trauma strategies that ER medical specialists are using to treat gunshot injuries are as follows:

  • Addressing breathing and bleeding problems: Basic maneuvers are first performed to open an airway and resolve breathing distress. Next, steps are taken to stem bleeding which can also occur internally. Massive brain injury and bleeding are the two most common causes of death from firearm injuries. Today, as in battlefields, tourniquets are recommended to control extremity bleeding. There is new evidence that battlefield tourniquet application increases survivability of patients.
  • Damage control surgery: ER surgeons treating gunshot victims will need to perform small stopgap surgeries before they do a conventional surgical procedure. These abbreviated surgeries help save lives. One example of a small, quick surgery for a patient with a minor blood vessel injury on the leg involves placing a “shunt” – a small piece of plastic – to maintain circulation. This damage control solution allows them to move on to addressing more critical conditions in the same patient or treating other patients with serious injuries.
  • Administering platelets and plasma first to aid clotting: Blood transfusions are critical for people who need surgery due to firearm injuries. The conventional response of administering saline solutions along with or followed by blood products has given way to the method recommended by military doctors – giving blood products immediately. Blood transfusions typically involve providing specific blood components like blood plasma, including red blood cells, which carry oxygen, or platelets, which are essential for blood clotting. Soldiers responded better to this tactic and it has saved many lives in recent wars. Vox reports Margaret Knudson, a professor of surgery at the University of California San Francisco as saying, “We learned from military experience that it’s really important to give clotting factors almost first, and in a better ratio.”

Gunshot InjuriesLow-velocity gunshot wounds can be safely managed with local wound care. However, high velocity gunshot injuries call for massive wound debridement. Non-trivial gunshot injuries require blood transfusions, fluid replacement, x-rays for investigation, monitoring and intensive care.

Chest wounds should be closed immediately. It is reported that 15% of deep chest injuries involve the heart. Pericardial effusion may be a life-saving treatment for patients with cardiac tamponade. It also buys time before definitive intervention. Abdominal injuries usually involve internal injury and full exploratory laparotomy will be required. Limb injuries caused by gunshots will endanger nerves, tendons and vessels and will require thorough investigation in good light. Damage will require formal surgical repair.

ERs are manned by different types of healthcare professionals. While ER physicians focus on the initial stabilization of the patient and can effectively manage minor trauma, ER surgeons perform operations. Regardless of the specialized training they receive, these medical specialists have one goal – to save lives and minimize the permanent effects of illness or trauma.

As they grapple with the increasing influx of patients with firearm injuries, medical transcription companies help ER medical specialists manage their electronic health records. A Kaiser Health News report published last year said that electronic record systems have led to a new category of patient safety errors in ERs where things happen fast. A reliable medical transcription service company that specializes in ER transcription can help physicians and nurses improve efficiency and patient safety by minimizing EHR-related documentation errors.

Julie Clements

About Julie Clements

Joined the MOS team in March of 2008. Julie Clements has background in the healthcare staffing arena; as well as 6 years as Director of Sales and Marketing at a 4 star resort. Julie was instrumental in the creation of the medical record review division (and new web site); and has especially grown this division along with data conversion of all kinds.