Managing Gunshot Wounds in Combat

Gunshot wounds (GSWs) remain one of the most common and life-threatening injuries in combat. Unlike controlled civilian trauma environments, battlefield GSWs occur in dynamic, resource-limited settings where providers must act swiftly and decisively under hostile conditions. This chapter explores the tactical, clinical, and logistical aspects of managing GSWs using the MARCH framework, with emphasis on rapid hemorrhage control, airway assessment, shock prevention, and thermal protection. It outlines key mechanisms of injury, field-level decision-making for tourniquet use, fluid resuscitation strategies, pain control, and evacuation prioritization. Special attention is given to recognizing vascular compromise, junctional injuries, and complications like tension pneumothorax or infection. Using a realistic case scenario, the chapter highlights the life-preserving role of combat medics and the critical importance of early interventions in determining outcomes. Structured protocols, rapid improvisation, and situational awareness are the foundation of effective care when managing gunshot wounds in the field.