Gunshot Wound First Aid: What to Do in the First 5 Minutes

A gunshot wound kills in two main ways: rapid blood loss and damage to the chest that stops breathing. Both are treatable in the field with the right gear and a clear priority order — and both kill in minutes, which means the person on the scene, not EMS, is the one who decides the outcome. This is the reasoning behind carrying a trauma kit at all.

This guide walks the first five minutes of gunshot wound care, following the MARCH protocol. The tools referenced — a tourniquet, wound packing gauze, and a chest seal — are the core of any serious kit like the AID-PAK Gen-2. None of this replaces calling 911 and getting trained; it is the bridge until professionals arrive.

Before you touch the patient: scene safety and 911

If there was a shooting, the scene may not be safe. Do not become a second casualty — ensure the threat is gone before you approach. Then call 911 (or direct someone else to) and start care. Glove up before contact with blood.

The first 5 minutes, in MARCH order

M — Massive hemorrhage

Uncontrolled bleeding is the leading preventable cause of death from gunshot wounds. Find the source fast.

• Extremity bleed: apply a CAT Gen-7 tourniquet high and tight above the wound, and tighten until bleeding stops. Note the time.
• Junctional bleed (groin, armpit, neck): where a tourniquet cannot reach, pack the wound with wound packing gauze and hold firm pressure.

A — Airway

If the casualty is unconscious, make sure their airway is open. Position them to protect the airway and, if trained, use a nasopharyngeal airway.

R — Respiration

Check the entire torso for penetrating wounds. A gunshot to the chest can collapse a lung. Seal any penetrating chest wound with a vented chest seal, and check for exit wounds to seal as well.

C — Circulation

Reassess all bleeding control. Make sure tourniquets are still tight and packing is holding. Watch for signs of shock — pale, cool, clammy skin and rising heart rate.

H — Hypothermia

Keep the casualty warm. Cold worsens bleeding by impairing clotting. Cover them with a blanket or jacket even in mild weather.

What not to do

• Do not remove an impaled object or dig for a bullet. Stabilize and wait for EMS.
• Do not give food or water.
• Do not remove a tourniquet once applied — leave that decision to EMS.
• Do not delay hemorrhage control to look for the exit wound first — stop the worst bleed, then survey.

Related trauma skills

Each step above has its own deep-dive: our tourniquet application guide, wound packing 101, and sealing a sucking chest wound. For the overall framework, see the complete trauma first aid guide. Shop hemorrhage-control gear in the Massive Hemorrhage collection, and find training at our education hub.

Frequently asked questions

Should I look for the exit wound first?

Control the most obvious life-threatening bleed first, then do a full-body sweep for other wounds including the exit. Do not delay stopping a spurting bleed to hunt for a second hole.

Can a tourniquet be used on a gunshot wound?

Yes — for a gunshot to an arm or leg with severe bleeding, a tourniquet applied high and tight is the fastest way to stop it. It does not work on the torso, neck, or junctional areas, where you pack instead.

What if the gunshot wound is to the chest?

Seal it with a vented chest seal and check for an exit wound to seal as well. Monitor breathing closely and get EMS — chest wounds can worsen quickly.

Do I move the casualty?

Only if the scene is unsafe. Otherwise, treat them where they are, keep them still and warm, and wait for EMS unless you must move them to safety.

What kit do I need to be ready for this?

At minimum a tourniquet, wound packing gauze, and a chest seal — the contents of a proper IFAK. See our IFAK contents list to build or check yours.

Disclaimer: This article is for educational purposes only and is not a substitute for professional medical care or certified training. Seek qualified instruction (e.g., Stop the Bleed, TCCC) before relying on any trauma equipment.