the situation is safe, try to locate the entrance and
exit wounds. The entrance wound is often small
and is easy to overlook, especially when the exit
wound is large. BLEEDING CONTROLis critical; apply
direct pressure to stop or slow bleeding. Do not
move the injured person unless necessary for
safety, as movement may cause further damage
from a lodged bullet. SHOCK is likely; help the
injured person to remain calm, warm, and as
comfortable as possible.
Follow-through Gunshot wounds require
urgent treatment at a hospital emergency depart-
ment or trauma center.
See also MULTIPLE TRAUMA; RESPONDER SAFETY AND
PERSONAL PROTECTION; SITE AND SITUATION ASSESSMENT;
SYMPTOM ASSESSMENT AND CARE TRIAGE.
head and spinal cord injuries Trauma that may
cause BRAIN or neurologic damage. Common
causes of head and SPINAL CORDinjuries include
collisions and accidents involving motor vehicles,
motorcycles, bicycles, skiing, skateboarding, and
diving into water. Indications of such injuries may
include UNCONSCIOUSNESS, bleeding from the ears or
NOSE, bruises around the eyes or behind the ears,
HEADACHE, NAUSEA, and PARALYSIS.
Site and situation assessment Determine
whether the injured person is at risk for further
injury, such as from traffic or drowning. MOTOR
VEHICLE ACCIDENTSmay involve injuries to multiple
people.
Responder personal protection measures Latex
gloves, which the responder should put on before
approaching the injured person, are essential for
personal protection from bloodborne pathogens as
often there is moderate to heavy bleeding from
traumatic injuries of the head and spinal cord.
First response actions Do notmove a person
who may have a head or SPINAL CORD INJURY. Use
appropriate BLEEDING CONTROL when there are
bleeding injuries. Head wounds especially can
bleed profusely. To the best extent possible, brace
or splint the person to immobilize the head and
back. Discourage the person from attempting to
move, including the arms and legs. Do notremove
a helmet (bicycle, ski, motorcycle, football, horse-
back riding, or other type) unless the helmet
interferes with aid attempts or the injured person’s
ability to breathe.
Follow-through Head injuries require urgent
medical evaluation and treatment at a hospital
emergency department or trauma center.
See also ACCIDENTAL INJURIES; CONCUSSION; TRAU-
MATIC BRAIN INJURY(TBI); SITE AND SITUATION ASSESS-
MENT; SYMPTOM ASSESSMENT AND CARE TRIAGE.motor vehicle accidents Collisions between
motor vehicles or between motor vehicles and
objects. Accidental injuries are the fifth leading
cause of death in the United States; motor vehicle
accidents account for nearly half of those deaths.
Nearly three million people receive injuries in
motor vehicle accidents that require medical care.
Motor vehicle accidents often result in multiple
serious injuries affecting two or more people.
Site and situation assessment The situation the
first person on the scene of an accident often
encounters is chaotic and panicked. The responder
must remain calm and clear headed to appropri-
ately assess the circumstances and extent of
injuries. Factors to consider include- number of vehicles and people involved
- severity of injuries
- risks such as traffic, downed power lines, dan-
gerous terrain (woods, cliffs, water), fire, leak-
ing gasoline
Responder personal protection measures Latex
gloves, which the responder should put on before
approaching the scene, are essential for personal
protection from bloodborne pathogens as nearly
always there is moderate to heavy bleeding from
injuries.
First response actions The responder often
must act to concurrently provide a safer site and
aid to those who have injuries. Sometimes the
responder must help the injured out of the vehi-
cles. The first actions of the responder include:- Call 911 to summon rescue personnel.
- Turn off the ignitions of any vehicles that are
still running. - Kick dirt or gravel over any spilled gasoline to
reduce risk for fire or explosion. - Check for BREATHING; perform RESCUE BREATHING
or CARDIOPULMONARY RESUSCITATION (CPR) when
necessary.
378 Emergency and First Aid