How to Treat a Gunshot Wound to the Leg

A gunshot injury to the leg is always a medical emergency and can be fatal in as little as five minutes if the bullet hits a major artery, causing traumatic blood loss. And whether the wound is the result of an accident or gun violence, knowing how to treat a gunshot wound to the leg can keep you or a gunshot victim alive until emergency medical assistance arrives.

Step 1: Assess the Situation and Call 9-1-1

First, make sure it's safe to approach. 

If the gunshot wound was the result of an accident at home or while hunting, quickly:

1. Make sure everyone's guns are pointing away from them.
2. Remove the bullets from the gun(s).
3. Secure the gun(s).

In the case of an active shooter, check to ensure that it’s safe before attempting to treat the victims. If you become injured, you won't be able to help anyone else.

As soon as it's safe to make noise, call 9-1-1 on a landline or cell phone. If calling from a cell phone, provide your location so that emergency services can find you.

Step 2: Find the Source(s) of Bleeding

As soon as you and the victim are safe from any immediate threats, check that the victim is responsive and check him or her over for bullet wounds. Sometimes, blast injuries can cause blood to spatter, making it difficult to locate the wound. Be sure to look for entrance and exit wounds as both can cause traumatic bleeding—the exit wound will often appear larger and more severe than the entrance. 

Step 3: Apply Direct Pressure

After locating the bullet wound, put on gloves if available. You can also cover your hands with clean plastic bags. Leave any bullet that's lodged in the wound alone (removing it may worsen the bleeding) and apply direct pressure with a bandage, pressure dressing, hemostatic gauze, or clean clothing, pressing down as hard as you can. 

Step 4: Apply a Tourniquet

If the blood flow doesn't stop with a few moments of direct pressure or blood is literally squirting out, the bullet has hit one of the victim's major blood vessels and you'll need to apply a tourniquet. 

1. Yell for a bleeding control kit or locate your own personal commercial tourniquet if you carry one on you (we strongly recommend that everyone carries at least one commercial tourniquet).
2. Slip the tourniquet around a high point of the victim's leg—preferably at the top of the thigh but definitely at least 2-4 inches above the gunshot wound and above the knee if the wound is below the knee.
3. Tighten the tourniquet and wind the windlass until the blood flow stops.
4. Secure the windlass with the strap or buckle (if using the C-A-T® tourniquet or SAM-XT tourniquet by SAM®) or tuck in the end if using the SWAT-T stretch tourniquet.
5. If blood flow continues, apply a second tourniquet below the first.
6. Write down the time the tourniquet was applied—on the tourniquet itself or on the victim's forehead: T = TIME.

If you don't have access to a commercial tourniquet, you can also treat a gunshot wound with household items. However, we strongly recommend that everyone complete bleeding control training and have a commercial tourniquet on hand, as improvised tourniquets are often ineffective or even dangerous when applied improperly. If there is no tourniquet, locate the femoral artery (between the thigh and the groin) or popliteal artery (behind the knee)—whichever is above the wound—and press down HARD.

Step 5: Collect the Victim's Basic Information and Provide Reassurance

Once the blood flow has stopped or slowed to a slow trickle, cover the victim with a blanket to help them maintain their body heat and prevent them from going into shock. If there may be a gunshot wound to the torso, avoid elevating the victim's legs.

While you wait for emergency medical assistance to arrive, ask the victim a few questions to help out the EMS personnel when they arrive and to distract the victim from the wound. Ask these questions early on while the victim is still responsive and be sure to write their answers down.

• The victim's name, address, and contact number.
• The victim's close contacts and their telephone numbers, if known.
• Any allergies, medications, and medical conditions that the victim has.

After collecting the victim's basic information, provide reassurance and stay by his or her side. If there is still any blood flow from the wound, keep applying direct pressure.

Step 6: Hand Over the Patient's Care

When the ambulance and paramedics arrive, give them the information you have and let them know that the victim has a tourniquet and the time that it was applied. In the hospital, an emergency medicine physician will remove the tourniquet when it's safe to do so.

At this point, you can go ahead and wash any blood off your hands. If you had cuts on your hands that may have come into contact with the victim’s blood, talk with your doctor about preventing and treating any potential infections.

Step 7: Hospital Treatment

Once in the hospital, treatments for gunshot wounds to the leg could include:

• Surgery to remove the bullet and repair damage to the muscles, blood vessels, and tissues. If removing the bullet is too risky, it may be left in place. Eventually, scar tissue will form around the bullet.
• The insertion of catheters to drain body fluids if there is swelling or infection in the wound
• Medications to prevent or treat infection and reduce pain

In contrast to gunshot wounds to the torso, leg wounds don't require surgeons to partially or completely remove organs. Gunshot wounds to the leg—however—can still fracture or break bones and complications can make it necessary to amputate all or part of the limb.

Step 8: Recover, Debrief, and Seek Psychological Support

After a traumatic event like a mass shooting or gun accident, anxiety, fear, confusion, and stress are completely normal feelings. Whether you were the victim, the witness, the rescuer, or a combination of the above, it can be helpful to seek psychological support to help you process the event. 

It Pays to Be Prepared 

A gunshot wound is something you hope you’ll never encounter, but everyone should know what to do in this type of emergency. 

So keep the right life-saving essentials on hand, understand the protocols involved in blood loss prevention, and—most importantly—remember to keep a cool head. If an emergency does occur, you’ll be ready.

Article written by

Brian Graddon

Brian is a former Firefighter Paramedic who also worked as a SWAT Medic, Engineer, and Captain over a 15-year career. Brian is devoted to providing life-saving information based on his first hand experience in life-saving application of tourniquets, hemostatic gauze, chest seals and other bleeding control products.