Bleeding on the Guard-Room Floor
15:20, the guard room of a school. A 24-year-old guard is changing over at the end of his shift and handling his pistol at his open locker when a single shot fires. The bullet entered the front of his right thigh, mid-thigh, and exited the back. He is on the floor, conscious and answering questions, pale and sweating. Blood is coming from the entry wound in bright red jets that match his pulse, and the floor around his leg is wet. His pistol lies about a metre from his right hand, slide locked back, magazine still in it; a spare magazine is in his trouser pocket. Two other guards and the caretaker arrive within seconds. School finished at 14:00 and the building is empty of children. The nearest ambulance station is 12 minutes away; the nearest hospital is 18 minutes by road.
1. Set the order of the first sixty seconds and justify each step, including why the weapon comes before the bleeding.
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1. The weapon. There is already one casualty; there must not be a second. The slide is locked back and the magazine is still in the pistol, so the weapon is not inert. Remove the magazine, place the pistol and the magazine out of the casualty's reach and away from the working area, and say out loud who has taken control of it. This takes seconds, which is why it comes first - not because the gun matters more than the leg, but because it is the only thing in the room that can create a new emergency while the leg is being treated.
2. The call. Point at a specific person - 'you, call 101 now' - give the address, the entrance to use, 'gunshot wound, heavy bleeding from the thigh, patient conscious', and stay on the line. Have a second person call 100 for police. Specific instructions to named people, because a crowd shouting 'call an ambulance' often produces no call at all.
3. The bleeding. Begin control immediately, in parallel with the call, not after it. Arterial bleeding kills in minutes.
4. Everything else. Do not move him except for a safety reason, do not give food or drink in case surgery is needed, keep monitoring breathing and consciousness, and keep the scene otherwise untouched.
2. Describe the haemorrhage control in detail, with the reasoning behind each choice, and state what must be recorded and what must never be done.
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The wound is arterial: bright red, pulsatile, mid-thigh - the femoral artery territory, and a wound that can exsanguinate in a very short time.
Tourniquet first, applied as high on the limb as possible, above the wound and above the knee if needed, over clothing if that is faster. Tighten until the bleeding stops - not until it hurts, but until the jet stops. Distal pulse loss is expected. Pain is expected and is not a reason to loosen it. If bleeding continues, apply a second tourniquet above the first; do not stack pads under a tourniquet.
Record the time on the tourniquet itself or on the casualty's skin, in writing, and tell the ambulance crew the time and the number of tourniquets. The receiving team needs that time to make decisions.
Never loosen or remove the tourniquet, never cover it, and never conceal it under a blanket. The exit wound needs no separate tourniquet - one tourniquet proximal to both controls the limb.
If no tourniquet is available, pack the wound with gauze and press hard with body weight, or use a knee high in the groin for a junctional wound.
Shock: lay him flat, keep him warm, monitor breathing and consciousness continuously, and reassess the wound for continued bleeding. Report every change to the ambulance crew on arrival.
3. Police arrive while the ambulance is still en route and want the weapon and the guard's account. What do you hand over, what do you say, and what must not be done?
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Hand over the weapon - magazine removed and separated, slide locked back, with a short written note of who secured it, when, and where it was lying. Hand it to the police officer directly, not to a supervisor, not into the locker, not into a bag. Do not clean it, do not wipe it, do not function-test it, do not reload it. Do not let anyone handle it for interest.
Preserve the scene to the extent medicine allows. The tourniquet and the casualty's clothing are part of the casualty's treatment; move them only for medical necessity, and photograph the guard room and the floor as it is before anything is tidied. Hold the guard-room CCTV before it is overwritten.
The account. He is conscious but injured, in pain, possibly in shock, and has just shot himself. A brief initial account is appropriate - who he is, what he was doing, that it was a single shot - and a full statement later, after treatment, when he has had a chance to consider legal advice. Do not put words in his mouth, do not prompt him toward a version of events, and do not let colleagues summarise it for him.
Must not: discuss the incident with media, parents or social media; speculate on the cause in your own report; sign a log that misstates the round count. Report observations, not theories, and notify the employer and the licensing authority in accordance with procedure.