What Happens When You Are Shot?

Most of what we learn about gunshot wounds, we learn from watching television. A small sliver of this programming is actually educational, like the ballistics tests performed on Mythbusters. (Some lessons: Bullets fired into liquids will stop or disintegrate rather than slice through seawater a la Saving Private Ryan, and a weapon that would blow a victim backwards would also blow the shooter back.) But these examples are outliers. Depictions of gun violence in fictional shows and movies are routine, and often wildly imaginative. Those depictions are distorting understanding of what bullets can—or can’t—do to bodies.



As a combat medic in Afghanistan, I treated a variety of gunshot wounds. And as the husband of an emergency room provider at Johns Hopkins Hospital in Baltimore, gun violence has remained—at least peripherally—a significant part of my life. This year, murder rates in Baltimore are on track to surpass death tolls generated by the crack epidemic. Through conversations I’ve had with ER doctors at Johns Hopkins, in addition to my own combat experience, I can offer a few tips you won’t learn at the movie theater. This isn’t just about exposing Hollywood sophistry: It’s about knowing what to do if you ever find yourself near or among the 297 or so people in America who are shot each day in homicides, assaults, suicides, suicide attempts, accidental shootings, and police interventions.

Lavery sustained his wounds at close range, the fateful round fired from a Soviet-designed PKM 7.62 mm machine gun. Lavery had quickly positioned himself between the shooter and a younger American infantryman, an instinctive decision for which he would receive the Silver Star. “I have no doubt that he saved my life,” the infantryman said later in a sworn statement. Nick seemed indestructible. Earlier, during the same deployment, a grazing round scarred his face, and shrapnel from an exploding RPG injured his shoulder. On this day, his ‘good luck’ ran out.



The femoral artery runs down the thigh, using the femur as a backstop. It supplies oxygenated blood to the leg, and in healthy adults is between 5 and 10 mm in diameter. The relatively small but powerful projectile that hit Lavery’s massive leg barely could have followed a deadlier trajectory: It struck and shattered his femur, severing his femoral artery in the process. Unaware of the arterial damage, his powerful heart continued pumping large quantities of blood toward the oxygen-starved muscles in his right leg, causing valuable blood cells to accumulate uselessly in the expanding interstitial space. Without immediate medical intervention, the wound would have killed him. He survived, but lost his leg above the knee.



The threat of blood loss is not unique to Lavery: It’s the number one preventable cause of death on the battlefield. Ruptures to the body’s arterial thoroughfares—including brachial arteries in each arm, bilateral inguinal arteries in the groin, and the thick subclavian arteries sitting unnoticed beneath each clavicle—can potentially result in massive hemorrhaging. It isn’t uncommon to see heroes on the silver screen fighting courageously through their extremity wounds, when in fact the disruption of peripheral or junctional arteries can cause irreparable harm within minutes.


The human body does possess certain defense mechanisms in the event of rapid blood loss. The vascular system will “shunt” blood from the extremities into the core to maintain perfusion to vital organs, but that’s really only effective once the hole gets plugged. Sudden amputations, in particular, will cause the surrounding musculature to tense and contract. A complete amputation doesn’t look like the busted fire hydrants in Kill Bill—instead, it may take minutes or hours before they bleed heavily. Combat medics in training are reminded repeatedly of failures by their predecessors to properly identify and treat “clean” amputations, injuries that resulted in delayed but sudden exsanguination en route to a higher echelon of care.