How to roleplay being shot.

[Husky]

Hello! So as an avid medical roleplayer and someone who really enjoys medRP, I've encountered a lot of people who don't know how to roleplay getting shot or what medical terms or treatments mean. That's understandable and perfectly okay - though it can be frustrating for the EMS services. So I've decided to write a handy guide to run you through the basics of getting shot and what roleplay you may do after being shot, what happens when certain areas are shot, and how to accurately portray the wounds.

 

Warning; some people may find the detail of injury in this guide a little graphic, and I will include spoilers for each area - no graphic images or displays of real gunshots will be included in this guide, I'll keep it as PG as possible (There are some image diagrams of Arteries, blood in/surrounding the lungs - if you wish not to view them, the pictures including blood are in the Thorax section, i.e. the lungs).

 

Head:

Spoiler

Headshots are typically seen as the be-all end-all of gunshot wounds, however there are circumstances where you can survive. 'Grazing' shots are typically what's roleplayed when someone gets shot in the head and wants to RP surviving. There are lots of examples in real life of people surviving headshots as there are parts of the head that could soften or slow down a low calibre pistol shot or even present non-lethal areas. These can include the outer areas of the jaw, for example, or one case in Florida of a man being shot in the nose with a pistol round and surviving, or the case of the Pakistani boy shot 6 times with an AK to the head and surviving. It is possible, just extremely unlikely. 

 

The primary cause of instant death with gunshot wounds to the head is damage to the brain stem, once the brain stem is damaged - there is no recovery, no chance of survival and nothing that can be done at all. The brain stem is a part of the brain near the centre and connects the spinal column to the brain itself. Other parts of the brain can receive damage and still function - however typically with drastic changes, though when a bullet enters the brain, typically the shock from the kinetic energy of the bullet, combined with the caving of the skull and bleeding presents immediate death. 

 

When someone is shot to the head, what can sometimes happen in people who do not immediately die is the leakage of cerebrospinal flued (CSF). This is a clear liquid that surrounds the brain and spinal column to protect it from damage or concussions. When this layer of flued is broken, it will seep and flood the brain, this will then push the brain into the spinal cord and effectively kill someone within a few hours of its presentation. Signs this is happening are easy to spot; a clear liquid will run from the patients nose and ears. CSF leaks occur during severe brain injuries which may be present on someone who, for example, is shot in the head repeatedly while wearing a helmet.

 

Torso:

-Lungs

Spoiler

Lungs are a particularly dire place to be shot and can be easily fatal if left untreated. What can typically happen with a high velocity penetrating injury to the lungs is; 

First of all, there is going to be blood leaking into the lungs (hydrothorax)
Secondly, air can get trapped in the space between the lungs and ribcage, this puts pressure on the lungs and causes it to collapse, effectively stop working. (Pneumothorax)

Third, both of these happen at once, causing blood to leak into the lungs as well as air causing; hydropneumothorax. The lung collapses at this point however the other lung can still be operational; this is typically remedied with a plastic chest compress (Plastic to create an air-seal and subsequently an air-way that works outward, to draw air out of the lungs/the air surrounding them and helps seal bleeding.) And a decompression needle if needed (This further allows air to come out of the space.)

 

Ultimately, not immediately fatal, but can lead to some harsh consequences.

 

Below are diagrams of each of the listed above.

 

Spoiler

Spoiler

Spoiler

 

-Heart

Spoiler

Unfortunately, you won't survive a shot to the heart; but it is a great GSW to roleplay if you are killed. The reason being; when someone is shot in the heart, the organ quite literally explodes (depending on the calibre, but regardless, it's destroyed) and this sudden surge of pressure causes a large push of adrenaline and blood throughout the body, people who are shot in the heart will not realise they have been shot, it typically does not happen. They will, however, drop dead from blood loss roughly 30 seconds after being shot in the heart. Death occurs as the blood loses all its pressure after the initial burst and so just freely flows downward in the body - when you lose a certain amount of blood from circulation in your body, your brain runs out of enough blood to keep it conscious, resulting in the loss of consciousness after 30 seconds, after that, internal bleeding will cause death and organ failure. 

 

So, what this means is, if you're shot in the chest repeatedly but you're still shooting and eventually end up dead, you wouldn't feel a shot to the heart, it's fatal giving a reason for death, and how you managed to carry on fighting after having been shot. 

-Ribs

Spoiler

As you may image, a gunshot to the ribs is likely to fracture them entirely in two, refer to penetrating injuries to the lungs for more information, but this would result in the exacerbation of pneumothorax as well as sending a lot of splinters into your body. It's not going to be pleasant and would be extremely painful.

 

Abdominal region:

-Liver

Spoiler

Gunshots to the liver are particularly dangerous as there's a large amount of blood circulating through the liver, it's where most things metabolise in your body and as such, getting shot here would result in a large amount of bleeding and potentially cause you to go into hypovolemic shock (refer to below) relatively quickly. The priority with these injuries is blood control and pain management, abdominal shots are by far the most painful of any place to be shot (alongside the kneecaps, both have rated the same on pain scales).

-Stomach

Spoiler

Depending on the calibre of the gun, the stomach can, similarly to the heart, explode when shot, however this typically only happens with much larger calibre bullets, usually something larger then 5.56. So, say, AK's, DMR's, sniper rifles - and again, the priority issue with these injuries is containment, stomach linings and stomach acids are very sensitive, and need to be contained when they have been shot. Anything larger then a 22. LR is going to pass straight through a stomach.

-Intestines

Spoiler

As you may imagine, the intestines are not a particularly vital place to be shot, however, they rank the same on pain scales as kneecappings, it's extremely painful and can be roleplayed as such. The largest issue present for medics treating intestinal damage is pain management, bleeding and infection. If the intestines are visible during treatment, this leaves the risk of infection excruciatingly high and requires immediate treatment at a trauma centre. Bleeding here is bound to be intense, but luckily - it's probably one of the most non-lethal areas you can be shot, it's just going to be extremely painful and there's going to be a lot of blood.

 

Legs:

Spoiler

Now, as mentioned previously, the most painful places to be shot include the intestines and kneecaps, they are by far the most painful place you can be shot - bear this in mind if you wish to roleplay that. Getting shot in the thighs is particularly dangerous due to the number of veins and arteries in the area. If an artery is shot, you have 30 seconds until you lose consciousness from blood loss, and one minute until death from the severing of the artery. Something simple such as a tightly wrapped bandage on the wound can prolong this time-period significantly and allow time for medics to arrive - it's interesting and satisfying to see this roleplayed, as it's something not often roleplayed, I will go more into this later. However, here to illustrate that point is a diagram of the arteries in the legs:

 

As you can see, the thigh is where the big femoral artery is, as it continues down and further to the outside of the leg, the arteries are smaller and thinner. 

 

Arms:

Spoiler

As you can imagine, arm gunshots are similar to legs in that there's major arteries in the area that can be damaged, these are pictured below; 

The main artery here to be aware of is the Brachial artery, it functions similarly to the Femoral artery in the leg, being the main provider of blood to smaller arteries and the largest in the area. 
 

Another problem occurring from shots to the arm and hands are nerve damage, there's a long set of nerves sending information back and forth to your fingers and arms - these can be damaged, sometimes causing a victim to be unable to fully grasp their hand, or move their arm appropriately, or put their hands behind their back fully. 

 

Complications:

-Hypovolemic shock, i.e. blood loss.

Spoiler

Hypovolemia, or more commonly knows as blood loss, is the body's shock reaction to a severe lack of blood in the body, this occurs in a few stages, compensated shock, decompensated shock and irreversible shock, I will go into each of these later.

 

Initially, the symptoms of hypovolemia are:

Severe loss of blood.

Cyanosis (This is where your skin or lips turns blue.)

Rapid, weak pulse. (Rapid pulse is known as tachycardia).

Low blood pressure

Altered Mental State (AMS) (Delirious, confused, not fully awake.)

Cold, clammy skin.

Sweating

Rapid breathing.

 

Onto the stages of shock you would experience:

Compensated shock - This is the initial stage of shock that would happen in the first stages of blood loss, symptoms include:

Agitation.

Anxiety.

AMS.

Shallow, rapid breathing.

Cyanosis around the lips.

Weak, rapid pulse.

Restlessness.

Nausea or vomiting.

Thirst.

Clammy/Cold skin.

 

Decompensated shock - This is where things start getting deadly, this is the later stages of shock in which blood pressure starts falling, and can have a rapid onset with hypovelemic shock due to the rapid loss of blood volume. Symptoms include:

Laboured irregular breathing.

Ashen (grey), mottled (patchy, irregular colour spots) or blue/purpleish skin.

Thready or absent peripheral pulses (typically, the carotid artery is best for assessing BPM and the Jugular vein can give a good indication of blood pressure.)

Poor urinary control (please don't roleplay this......)

And finally: A blood pressure of on or below 90/60 (this is called hypotension)

 

Irreversible shock is, as said, irreversible. This is indicative of organs beginning to shut down, such as the lungs fail to breath, the heart stops, the patient becomes completely unresponsive. Blood pressure on the externals of the body (Arms, legs, etc) will be next to nothing as, in a last ditch attempt to preserve itself, focuses all blood circulation to just the heart and brain at this stage.

 

-Arteries

Spoiler

As mentioned before, Arteries are a very nasty area to be shot in. Once an artery is severed, bright red squirting blood will exit from the wound - that's due to the large blood pressure in these arteries and their oxygenation.

 

So, when you are shot in the artery, it's a very critical time sensitive matter, you have 30 seconds until you lose consciousness, 30 more seconds until you're dead. When shot in the artery you need to immediately put pressure on the wound, get a tourniquet or some sort of bandage/dressing on it to slow the flow of blood. Roleplaying this could create some tense medical roleplay for yourself and others and bring some risk or action to your roleplay. Arterial shots are something not often roleplayed, and I'm sure others would appreciate the interaction.

 

-Veins

Spoiler

Bleeding veins, or venous bleeding, is when a vein (like an artery but they're slow and carry de-oxygenated blood, blood that's already been used and is sent back to the heart to be recycled) is ruptured. This can even happen from blunt force trauma, such as a kevlar shot. When Veins rupture, they ooze a dark red, almost black liquid that oozes out with your heartbeat. This isn't so critical or exciting, but it can add some flavour and realism to your injury. 

 

Any other type of bleeding that is so often roleplayed is called Capillary, this is just your body pushing blood on a wound to try to clot it and prevent infection, it's just regular bleeding, nothing special; it's also what causes bruising and typically isn't life threatening.

 

 

Blood pressure, blood oxygen, beats per minute, what do they mean and how do I roleplay them?

-BP

Spoiler

Blood pressure, as the name implies, is the pressure of the flowing blood in your body. When you push more water through a hose the water gets stronger, right? Same thing with blood. This is just a way to measure how strong the blood is flowing through your body. Typical measurements will be between 90/60 to 120/80. (Quick tip, Hypo = Less, Hyper = More) Anything below the normal standards is Hypotension, anything above is hypertension. When you're under a lot of stress, you might be hypertensive. When you're bleeding out, you will by hypotensive. Simple!

-02

Spoiler

Blood 02 is measured to give a sense of how much oxygen is in your blood, normally this is 100% and will read at 98% (the monitors have a +/- of 2%). When your body starts to lose oxygenated blood (capillary and arterial) it's blood 02 will decrease as the volume of non-oxygenated blood increases, or alternatively, this can happen during pneumothorax, where a lung has shut down and the body is yet to compensate. Anything below 90% is concerning, at 85-80% the brains function starts to get affected due to a lack of oxygen, at 67% you start to get Cyanosis (refresher, that's when your lips and skin start to turn blue). That last reading should give you an idea of how quickly blood oxygen starts to drop when you're in hypovolemic shock.

-BPM

Spoiler

This is just how fast your heart is beating, is it slow? Fast? Normal? A fast heart-rate would be inclusive of any stressful scenario, and in hypovolemic shock. A normal heart-rate is between 60-80BPM resting. A tachycardic (really fast) heart-rate is anything above 100BPM, some people put the bar at 120BPM for extremely concerning heart-rates. In irreversible shock, the heart rate starts dropping rapidly (a low heart rate is called Bradycardia), and in decompensated and compensated shock it's Tachycardic (high heart rate). A low heart rate is anything below 60 BPM.

 

I've tried to keep this guide as simple as possible, and if there are any mistakes or corrections you'd like to point out, please do put a comment.

 

I hope this guide helps some people who perhaps didn't understand some things paramedics were throwing at them, or wanted to roleplay their gunshots a bit better, hope you all have fun, and take care. 

 

 

TL;DR: Bullet ouchie

[Biography]

Well done, thank you!

[afrosamurai]

Very informative and will definitely come in handy for the aftermath of those zesty gun battles!

[Heinrich]

Great guide. 

[Blade]

I don't plan to get shot but it's definitely helpful! Great guide. 

[Brando]

Absolutely phenomenal guide. Great work. 

[Katja]

Husky is an extremely useful source for medical rp

Great stuff

[Brett]

Great job on this guide! It clearly took a lot of work to put together, and is pretty detailed. 

[Macares]

A very well written guide! Good job!

[Michaud]

Nice stuff! Love the guide!