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The Multiple Roles of a Nurse During a GSW Emergency

Gun shot wound

Nurses working in emergency room and surgery settings are exposed to the devastation a single bullet can have on a human body. Gunshot wounds are unpredictable, and quick decisive care is needed in order to ensure that they don’t become fatal.

Adding to the medical chaos that a bullet causes is the possible need to help collect evidence for law enforcement. There is an exception in the HIPAA laws that require certain information to be shared with law enforcement agencies, particularly in cases of violence. Nurses, and the entire medical community, have helped prevent 6,000 guns from getting into the wrong hands since the 2012 Sandy Hook Elementary shooting. This is attributed simply to them taking the time to report suspected issues to the FBI.

Earlier this year, President Obama expanded that expectation to include patients undergoing treatment for mental health conditions. This has the potential to prevent hundreds of thousands of senseless injuries and death due to firearms being purchased and used by individuals who are not of the right mind to use them safely.

In order to keep the momentum going, it is of vital importance that nurses understand the importance of their role in helping curb gun violence in the United States. To be an active part of this positive movement they need to be adept in recognizing a gunshot wound, identifying certain characteristics, and preserving important evidence.

Developing a Nursing Plan For Gunshot Wounds

A gunshot wound (GSW) is a penetrating trauma to any part of the body. The injury must be evaluated in order to determine the type of weapon used, the range at which it was fired, and the amount of time that has elapsed since the injury occurred. You must quickly evaluate whether the wound is perforating – where the bullet has left the body – or penetrating – where the body retained the bullet.  

All of this information is vital for the patient as it gives medical staff a better understanding of what is going on inside the body. For example, a perforating gunshot wound from a close range could indicate that the bullet “bounced” around once it penetrated the body. This could mean that various organs were injured in the process. So even though a nurse notes the entry site at the abdomen, he or she can’t rule out damage to the heart or lungs until further evaluation has been done.

This information could also be important to police investigating the incident. Not only is the bullet left inside of the body important forensic evidence, knowing that it never exited could give the police an idea of the type of gun used in the shooting, or the range from which it was fired.

In order to serve your patient in their best interest, and help the police, a nursing plan should be in place for when a GSW patient enters your facility. Start with these basic tips, and expand on them to fit in seamlessly with your workplace:

  • A nurse’s initial evaluation is going to focus on checking for breathing, circulation, and the neurological state of the patient.
  • Next is a head to toe assessment, where you examine the surface of the skin looking for the wound source, any residue from gunpowder, bruising and abrasions.
  • Clothing should be removed with care when possible, and placed immediately inside of a separate plastic bag to turn over to the police for evidence.
  • It is prudent to work with another nurse who can take notes while you call out your observations. What you see in those first few minutes could be vital not only to saving the patient’s life, but in helping the police understand how the gunshot wound occurred.

Always remember that no matter what the circumstances were that led to your patient being shot, they are hurt, and it is your responsibility to provide them with the best possible care.  Collecting evidence comes second to keeping your patient alive.

The violent nature of this type of injury should also be of concern to you. Your thorough assessment is helpful in determining whether the patient is at risk of harm to themselves or others. No matter what your initial findings or thoughts are, you are legally obligated to report the incident to the police as rapidly as you can. Even an accidental shooting that occurred with a firearm that was purchased and owned legally could lead to the discovery that the patient does not have the mental capacity necessary to own a dangerous weapon.

 

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Scrubs Staff


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One Response to The Multiple Roles of a Nurse During a GSW Emergency

  1. the_trauma_guy

    Primary survey is key in these situations. I deal with this mechanism every shift in my trauma center. Unfortunately, here in Miami we have one of the highest rates for GSW’S in the country, with a large amount being children/teens. Sucks!!!! We use xrays earlier than usual for “ballistic searching” in these cases. Normally x-rays are apart of our secondary survey but in these cases those “sneaky” bullets need to be identified to emergently treat the patient. #showmeyourshears

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