OK, this is the first time I've posted here. I am not a medical professional, so excuse the cluelessness.

In the Army you carry a bandage.  In training they show you a wounded soldier, usually your buddy.  They show where he got shot, such as the arm or leg or stomach.  You are supposed to put the dressing on without touching the sterile part.  

The question I have, is it hit me that they have you dress where the entry wound is.  What about the exit wound? It is bigger?

How should you really dress a gunshot wound it combat?

If there's an exit wound you dress it too.  Depends where it is and what bandage you use.  Size isn't consistent betwren entry and exit, esp if it's shrapnel.

Keep dressing as clean as possible. There is no sterile in the field. Wrap it tight, stem the blood flow. Same for exit wound.


Process varies depending on GSW location.

Stop bleeding by any means necessary!  Maintain airway, evac when tactical situation allows.



18Z50.....

Agreed.

Plugging it up and stopping the bleeding is more of a priority than keeping it clean.
Do what you can but don't get worked up over dirt. It's always dirty in the field.

But where does the second dressing come from? When I was in, we only carried one.  Do the new IFAKs routinely carry two?

Tag for info

If it's your job to dress wounds, you have more than one...of everything.

Keep in mind that there’s nothing magic about a pressure dressing. You should have compressed gauze or kerlix of some variety in your kit so you’d be able to pack or directly apply that to one side and still have the pressure dressing pad for the other side if it’s an area amenable to bandaging like that.

If you don’t have a pressure dressing packing or putting gauze on both sides and applying an ace wrap is essentially the same thing. The nice pressure dressings are just two things in one for convenience.

I'm talking more about the individual soldiers.  Back when I was in, we only carried one bandage on our LBE.  You don't give your bandage up in case you need it.  So it seems to leave one side open. I was wondering if the new IFAK that the soldiers today carry includes two bandages.  I've seen some of the other things they carry, like that green tube that goes up the nose of a burn victim, and my generation of soldier just shakes their head with confusion.

It sounds like you should attend a TCCC class.

All this is good info. If you seem a little confused by the matter, maybe you should take a simple class. Wilderness first aid or TCCC, TECC. People can tell you how to do it all day long, but you may need some instruction to see the big picture and grasp the concept. Good Luck.

Uuhhmm... yeah.

Get to a TCCC class asap.

I really like the OLAES bandage because theres separate gauze packed inside for packing the exit wound.

I've never served but it sounds like the typical .mil bs of not giving people the gear and training that they really need and hoping for the best.

Typically, an IFAK will have one dressing, some gauze, combat gauze, TQ, tape.

Units will add other things...Also, there are CLS bags that are distributed throughout the squads/platoons and people carry extra medical stuff all the time.

Now to answer your question.

If you only have one bandage, you will cover the large wound if possible. Hopefully, you have the 6 inch dressing. I prefer the 6 inch dressing for just about everything. A 4 inch is rarely good enough. Assuming the wounds are straight through, your bandage will cover both holes. You could use gauze in both and use the bandage as the pressure. You could also just put the bandage over it and hope for the best(not recommended).

I have treated different gunshot wounds. I once had an Afghan come in who received a 9mm wound to his leg. The Afghan police were "interviewing" him and he wouldn't talk. They decided to shoot him in the leg.

The bullet went straight through the tissue in his calf IIRC. Minimal bleeding and very small entrance and exit. I couldn't get any gauze in the hole, it was that tiny. I just put some gauze on top of each hole and used one bandage to cover up/put pressure on it.

To the sterility, that is not a huge concern in the field. Of course, you don't want to stuff mud/dirt into the wound..but this is field medicine. Anything put on this guy is going to get removed when he gets evac'd to the rear. You keep what you can clean, but is assumed he is going to get pumped up with some antibiotics and everything is going to get cleaned later on when he gets to higher echelons of care.

Torso wounds(below the diaphragm) have two schools of thought. Some docs want you to put stuff back in, some docs want you put the guts on the top of the body and just cover them up. Either way, the guy is probably going to surgery, have everything pulled out, cleaned, sewn up, whatever. So it just depends on what your SOP says when it comes to belly wounds. Anything in the chest, is an occlusive dressing. I recommend taping all 4 side of the dressing. Its going to be an ass pain to get the fucker to stick sometimes, so getting as much down as you can is important. Also, you may not need to do a NCD (Needle chest decompression) immediately. It takes time for the chest to fill with air. We would train like it happens instantly, but that isn't always true. You have to monitor your vitals, look for the red flags and anticipate that the soldier will need the needle eventually if he isn't evac'd quickly enough. The gold standard is a chest tube/occlusive dressing..but chest tubes aren't always recommended in the field. (plus its a lot to carry).

What's fun about medicine is all the different points of view. There are multiple ways to treat a single issue. Find what works best for you and what has the evidence to back up your claim.

eta: The exit wound isn't always bigger, it depends on what happened. The reason it can be bigger has to do with the tumbling of the projectile and amount of force the fucker puts through the body. Physics, math, magic.

The second dressing can come from multiple places(as I pointed out in my first post.)

The medic's bag
Another soldier.
The CLS(Combat lifesaver) bag.
IFAK modification.
Unit SOP to carry extra medical gear.
Truck medical bags

It's amazing the amount of equipment a platoon will carry with them, especially when using trucks. Guys would always talk about needing more. I never saw it that way. We carried fucking everything and the kitchen sink. There is so much medical gear in a platoon/squad. The problem I see is usually lack of knowledge, poor implementation, and poor critical thinking skills.

OP, when were you in?

Bagofcrabs broke it down well.

But might I add to please seek training before you stick someone with a decompression needle.

The roll of kerlix answer brings back some memories. Held one in a guy's lower abd wound until it clotted in the ER.   As stated, doesn't have to be a purpose designed bandage. If you have something that will stop bleeding, put it in and hold pressure.  Keep the blood on the inside of the vessels by any means necessary. They can sort out the infection later, if the guy lives.