This call definitely resulted in an outcome I was not expecting. Working the ambulance we were dispatched to the report of a gunshot wound nearly 30 miles away next to an elk refuge. Elk season was only a couple days old so we assumed we had a hunter getting shot. Now elk in Oregon will weigh in about 1,000 pounds so large caliber rifles are the norm. Most calls I had been on during hunting season, aside from the occasional hand injury, were mortal wounds. The bigger calibers are literally overkill for humans.

After running code for almost 20 minutes we got an update that an Oregon State Police trooper was on scene and our patient would be in a vehicle about 10 minutes up the road. This told us two things. First law enforcement was on scene and that we still had a patient versus a body. My partner was an EMT-I so we had already agreed I would handle the patient, being an EMT-P.

We got on scene and I noticed my patient was sitting behind the wheel and I got my first surprise. I was expecting a 100 kg guy in a pick-up dressed in camo with a hunters vest on. Instead my patient was a 20 year old female, looked to be Native American, maybe 45 kgs, dressed in normal clothes in a little sedan. She was conscious, alert with a good radial pulse and no complaint of trouble breathing. I asked where she was shot and she said her left shoulder/chest area. As I started to cut her clothing off to see what was going on I asked what had happened. I told her she was not the burly patient I was expecting and she laughed.

It turns out she had been at the elk viewing area of the refuge when a young man pulled into the parking lot. They got to talking and he asked if she wanted to smoke a joint with him. She declined and feeling uncomfortable began driving away down the viewing area access road. Maybe a mile down the road she said her back window shattered and she felt a pain in her shoulder. She had no idea what happened. It turns out the young man followed her and as she drove away, took aim and fired with his rifle. I have no idea what he was aiming at. To hit the car was easy, to miss her entirely would have been easy. To have a bullet travel through the back window, her seat-back, through her and lodge in the dash without killing her. Not so easy.

As I cut away the clothing to expose the wound I could see a smaller entrance wound between her spine and shoulder blade, missing both. The exit wound was a little larger again exiting high in her chest and it seemed to have missed her ribs leaving her body.  Neither wound was bleeding much but I covered each with an occlusive dressing and bandaged the shoulder. Pulse, sensation and movement were all good distal to the injuries and lung sounds were intact bilaterally. My partner helped me package her up and we headed for the hospital about 40 minutes away. I started a line, placed her on oxygen and monitored her the rest of the way.

Turns out she was from Alaska, Native American and was on a break from school. She was a delightful patient and we were having a great time talking and even joking. As we wheeled her into the ED, my partner, patient and myself were all laughing about something. The doctor got a quizzical look on his face and asked, “Is this the gunshot patient?” We all assured him it was and he said it was the first time he had a gunshot wound patient come in laughing. My partner ended up going back to visit her during her hospital stay and after she was released. They ended up dating and about a year later were married and still are decades later.

Lesson to Learn: Go into any gunshot call ready for a nasty trauma but take the lucky ones anytime you get them. The other lesson is don’t discount the value of laughter. I didn’t make it a habit to joke with patients but I usually did engage them in conversation designed to take their mind off of their condition or injuries. No reason to dwell on the negative if you can help to lighten their spirit and prepare them for what will occur once they hit the ED door. I’d love to hear some of your strategies to help patients get their minds off their problems.