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\nGunshot wounds are becoming more common at demonstrations. This is not to say you should panic—millions of people have participated in demonstrations over the past four months, while only dozens have been shot. Still, as political conflict escalates in the United States, it is important to think about how we can care for and protect each other. The good news is that even if you have no medical training, there are things you can do to maximize the likelihood that a person who is shot in your vicinity will survive—simple things like learning the location of the nearest trauma center. Though this subject can be stressful to contemplate, the following guide may equip you to help save lives.
\n\nWhile many demonstrators have learned how to prepare for tear gas, pepper spray, rubber bullets, LRADs, baton blows, and arrests, few are currently prepared to respond to gunshot wounds. This guide is drawn from the experiences of several people who have witnessed or treated gunshot wounds in the course of political and social conflict. In order to demystify the subject and help readers imagine how they might employ this information, we’ve included two personal narratives describing experiences with gunshot wounds at demonstrations.
\n\nAlthough this text draws on the practical knowledge of a number of people with both institutional training and street experience, it does not represent professional medical advice. It includes some information that will chiefly be useful to experienced street medics, but most of it is relevant to any reader. It is not intended to stand in for actual training in gunshot wound response or other medical interventions. We encourage readers to seek out additional training, skills, and life-saving critical response tools.
\n\nGunshot wounds involve traumatic injuries and serious puncture wounds. Their impact on the body varies according to the type of weapon, the distance of the shooter, and the location of the entry wound. Depending on the size and speed of the bullet, gunshots can inflict different types of harm—including severe bleeding, muscle and bone damage, and destruction of organs. They can damage bodies in unpredictable ways.
\n\nWhile some calibers of ammunition may pass directly through a person leaving easily identifiable entry and exit wounds, other calibers are more prone to “tumbling,” or ricocheting, inside the body. This can cause more internal damage and less predictable exits. Worse still, some types of “self-defense” ammunition for handguns are designed to “mushroom” out on impact, causing severe harm.
\n\nTreat any gunshot wound as a potentially life-threatening injury, regardless of the details. If an artery is compromised, a person can bleed out in as few as three minutes. Once a person loses half their blood, their chances of survival decrease dramatically. It is up to you to act quickly.
\n\n\nFirst and foremost, pay attention to what is going on around you. Street demonstrations can be chaotic and loud. Police may employ tear gas, flash-bang grenades, LRADs, and other noisy weaponry, while protestors sometimes set off fireworks—which can sound an awful lot like gunfire. When you are surprised by loud bangs in the streets, try to identify the source and what kind of risk it represents.
\n\nStay aware of the location of anyone who is openly carrying a firearm, as well as anyone you have reason to believe may be carrying a concealed weapon. People have been hit by friendly fire at demonstrations as well as hostile fire. If you are working with an affinity group, you could designate one person to keep an eye out for potential threats. Take turns occupying this role, so one person doesn’t become exhausted from being constantly vigilant. In any case, all parties should stay aware, as things can shift rapidly.
\n\nCommunicate clearly and concisely, especially when you are describing individuals with firearms. This can help others to make wise decisions rapidly in an emergency, without contributing to undue panic. Here are two communication models you can employ to convey what you see.
\n\nUse the mnemonic device “S.A.L.U.T.E.” (Size, Activity, Location, Unit, Time, Equipment) to identify potential threats. For example, rather than shouting “They’ve got a gun!” you might report, “I saw three men (S) guarding the convenience store (A) at the intersection of Main Street and City Avenue (L). Possibly militia (U). This was at 11:15 pm (T). Two had long guns, I don’t know about the third (E).”
\n\nIn emergencies, or when time is of the essence, you can use another tool called the “three Ds”: Direction, Distance, Disposition. For example, “Four unknown white men with rifles at my 1 o’clock, one block up, scanning the crowd with binoculars.”
\n\nMuch of what you can do to treat a gunshot wound takes place long before the shot is fired.
\n\nDepending on the type of event and where it is taking place, there may be medics around. You could investigate in advance whether there are street medics in your area, whether they will be attending, and where they will be positioned. During demonstrations, one often sees medics milling around in the crowd or stationed at the margins, carrying gear and wearing a red cross or a similar insignia identifying them as medics. If you believe it could become relevant, you can ask them whether they are prepared to deal with gunshot wounds and other severe injuries. Many medics have experience responding to tear gas, pepper spray, and rubber bullets, as well as exhaustion, dehydration, and panic. Currently, it is less likely that a medic who responds to a gunshot wound will possess the relevant skills and experience.
\n\nIf you are assessing the extent to which local medics are trained to deal with gunshot wounds and you learn that they are prepared to offer “first response” care, you can also inquire as to whether they have the capacity to offer prolonged care in the event that EMS services cannot reach an area. This can give you vital information about the potential risks you may be taking on if you remain in an escalating situation.
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/09/24/2.jpg\")
Street medics in the Bush era.
\nBefore going to a demonstration, assess the security and health needs of your comrades—including ability and willingness to call for emergency services, which are usually accompanied by police. Are there any needs that should be addressed before someone reaches the emergency room? Who would you like your friends to contact first in the event of an emergency or injury?
\n\nIn addition to learning whether trained medics will be around, make sure you know the location of the nearest emergency room—preferably one with a trauma center. Not all hospitals are equipped to deal with life-threatening wounds. If you will not be near a hospital with a trauma center, at least learn the location of the nearest hospital. With any luck, they should be able to stabilize a victim before transferring them to a hospital that is prepared to deal with mass physical trauma.
\n\nThere are several items you can carry with you that can be useful in the event of a shooting. Consider procuring or building an Individual First Aid Kit (IFAK) to carry with you. An IFAK is a trauma kit containing essential life-saving materials to help you control bleeding and treat major wounds. It is usually a small pouch containing items such as a gauze (regular or hemostatic), pressure dressing, personal protective equipment (gloves, face shield), and a tourniquet. An experienced medic has compiled a thorough list of what to put in an IFAK and where to obtain it, which is included in an appendix below. With the exception of PPE, which protects you and the person you are assisting from blood-borne pathogens or other communicable diseases, all of these intervention tools share the same purpose: to stop bleeding as quickly as possible.
\n\nGauze is a basic part of an IFAK, but a crucial one. It is used to absorb blood as you apply direct pressure to a wound. It can also be used to “pack” inside of a larger wound.1 Hemostatic gauze (often known by brand names such as QuickClot, Celox, and Hemcon) is gauze impregnated with a mineral agent that helps blood clot more quickly, which is critical in the case of a major bleed.
\n\nA pressure dressing (also referred to as an Israeli bandage, emergency bandage, or emergency trauma dressing) is an elastic wrap, similar to an ace bandage, with an attached non-adherent absorption pad and a Velcro or clip closure system. When holding pressure on the wound with your hands is not enough stop the bleed, a pressure bandage is used to apply stronger, constant pressure to a wound. There are many different models of pressure dressings; if you carry one, make sure you know exactly how it works. Online training or gear review videos are great for this.
\n\nA tourniquet is the cornerstone of an IFAK. If you carry only one intervention tool, invest in a quality tourniquet. When purchasing a tourniquet, it is ideal to acquire one approved by the Committee of Tactical Combat Casualty Care. These tourniquets have undergone rigorous pre-manufacturing testing and have been thoroughly vetted through field use. We recommend a CAT-7 Tourniquet. One can cost around $35; you and your comrades may be able to buy them in bulk to save money. Beware of fakes! Many cheaper versions are in circulation; these can fail under pressure. You can usually recognize a fake by the absence of a factory stamp by the red pull tab; a skinny windlass (i.e., the rotating rod) can also be a giveaway, instead of a beefier one with extrusions. Finally, and most obviously, no black CATs produced before 2009 have white “time” straps. Fakes notoriously have these white straps.
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/09/24/6.jpg\")
The one on the top is a cheap knockoff that could fail under pressure.
\n![](\"https://cdn.crimethinc.com/assets/articles/2020/09/24/9.jpg\")
The one on the right is a cheap knockoff that could fail under pressure.
\nIt is good practice to keep your tourniquet with the band already threaded through the buckle, creating a large loop you will then pass over the foot or hand, rather than attempting to thread the buckle in the heat of the moment if you need to use it.
\n\nFinally, carry sharpies to mark the time that a tourniquet was applied or any additional information that first responders—street medics or otherwise—may need to know. Black sharpies work for white people or lighter-skinned people of color, while silver sharpies work better for Black comrades.
\n\nEven if there is a trained and experienced medic collective local to you, carrying an IFAK, or even just a tourniquet, is a great idea. In the scope of emergency casualty care, many properly trained medics will seek to use the injured comrade’s equipment on them first, in order to save their specialized equipment for those who did not carry anything. Because of this, be sure to mark your IFAK or blowout kit clearly and carry it somewhere that is easily accessible. Failing this, make sure to have your tourniquet easily accessible, in a marked, visible location that is known to everyone in your affinity group. Normalize the practice of letting your trusted comrades know where your medical equipment is located.
\n\nSeveral things can happen in the immediate aftermath of a shooting. If police are nearby and intervene, it is possible that you will rapidly lose control of the situation. Despite their general lack of medical training, they will typically form a cordon around the victim and prevent a medic or anyone else from treating them. This does not necessarily mean they will act quickly in response to the injury. Put pressure on the police if they aren’t doing enough, or doing it fast enough. Demand they seek proper medical care for the injured.
\n\n\nhttps://twitter.com/crimethinc/status/1300285181530640391\n\n\n
The flip side of the scenario is just as possible—you and your comrades may have to make do without state intervention. If the situation is chaotic or deemed dangerous, even if you are willing to call emergency services, an ambulance may not enter an area. Police may spend an inordinate amount of time trying to clear the area with tear gas or other means before they bring in an ambulance—they might even simply prevent an ambulance from reaching you. In such a situation, depending on the severity of the wound, survival may depend on quick thinking and action. In that case, you will have no one to depend on except yourselves to care for the wounded and organize your evacuation.
\n\nContinually assess what’s going on around you. Are there still gunshots being fired? Is there traffic in the area? Are people running past you fleeing from a shooter, police, or fascists? Don’t let panic, haste, or inattentiveness cause additional misfortunes.
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/09/24/5.jpg\")
A small Individual First Aid Kit (IFAK) containing a tourniquet and trauma dressings.
\nNothing you could read here can substitute for proper medical training. However, if you own an IFAK or tourniquet and possess a basic understanding of how to stop a bleed on an arm or leg, some action may be better than nothing.
\n\nIf gunshots ring out, try not to panic. First, get to a safer place. In the system of Tactical Emergency Casualty Care, the first step is to maintain scene safety, so you do not become a casualty as well. Find cover from which to assess the situation. “Cover” designates anything that can stop the rounds you are facing, which depends on the situation and the caliber of weapon. Consider a brick wall or the engine block of a car.
\n\nIf you determine that someone has been shot and you are equipped to provide aid, make sure the scene is relatively secure. If you can determine this, communicate to your friends that you intend to move to the person who has been hit. While moving, ask the person questions to determine how to care for them: “Where were you shot?” or simply, “What is your name?” If they answer these questions before you reach them, this will indicate that their airway is open and they are conscious, and you may obtain enough information to start preparing your equipment and mindset.
\n\nYour first thought will likely be, “That’s a lot of blood!” Initially, you may have a difficult time identifying exactly where the wound is, especially if the individual is wearing long-sleeved dark clothing. Quickly expose the injury, using trauma shears (special scissors designed to cut quickly through clothing) if you have them. In general, it is important to expose an injury at skin layer to understand the exact scope and extent of the wound.
\n\nImmediately apply direct pressure to the wound. Ideally, you would use a gloved hand and a gauze pad (preferably hemostatic gauze), but in an emergency, you can use a t-shirt, scarf, or extra mask. If blood soaks through the gauze, add more gauze or another cloth layer and apply more pressure. If holding direct pressure with your hands does not stop the bleeding, apply a pressure dressing. Place the sterile absorption pad over the wound, and over any gauze that has already been applied (never remove gauze—this could disrupt any clotting that may have started). Wrap the elastic bandage firmly around the injured part of the body. It should apply a lot of pressure, but not enough to cut off circulation.
\n\nWith a life-threatening bleed, time is of the essence. If the wound is clearly on an arm or a leg and you can see a lot of blood, you may choose to apply a tourniquet immediately. Unlike holding direct pressure with gauze or using a pressure dressing, which stops bleeding from a specific wound, a tourniquet cuts off all distal circulation to the limb, meaning that it should stop all bleeding that is further away from center body than where the tourniquet has been applied. If applying a tourniquet over clothes, quickly check to ensure that you are not fitting it over items in a pocket or anything else that could obstruct the pressure.
\n\nMany people have been taught that using a tourniquet is likely to result in the loss of the patient’s limb, due to complications from cutting off circulation; in fact, this is still commonly taught within many wilderness/remote medicine and street medic frameworks. Data garnered from combat zones across the globe, however, has shifted the understanding of tourniquet safety. Certified tourniquets such as the CAT-7 are now understood to be highly effective and safe live-saving devices, rarely resulting in long-term damage or side effects. Used correctly, they are considered an appropriate first line of intervention, rather than solely as a “last resort.” As the everyday demonstrator’s threat model changes—especially if the streets increasingly take on the contours of a combat zone—models of intervention based on armed conflict scenarios, such as the Tactical Combat Casualty Care framework, will gain increasing relevance.
\n\nFor a succinct step-by-step guide to using a tourniquet, see Appendix III.
\n\nTo apply a tourniquet, open your CAT-7 and make sure that the band is passed through the single routing buckle and the red tip is pointed towards the heart. Then slide the tourniquet up the extremity as high as you can possibly go, while taking the individual’s genitals into consideration if applicable. If the wound is clearly below the knee or elbow, and you can easily see there are no wounds higher on that limb, you can place the tourniquet just above those joints. Once you have it in position, make sure the strap is as tight as you can make it—think “ratchet strap.” If you can stick even one of your fingers beneath the strap, it is not tight enough. Turn the windlass until the flow of blood stops. Pull the “strap” closed through the windlass clip and mark the time applied on the time strap. This process will hurt your comrade immensely, though likely less than the initial wound, depending on its location. Talk to them while you are applying the tourniquet and afterwards as you are able.
\n\nPrior to ever using a tourniquet, you should get a sense of how tight it has to be to be effective. Try placing it on yourself briefly just above the elbow before the demonstration and tightening it until you no longer feel the pulse at your wrist. This is a good exercise in empathy, to know what kind of experience a person you treat will endure. Never leave a tourniquet in place for more than a few seconds except when treating an actual wound.
\n\nAs soon as you have stopped the bleeding—by using direct pressure, a pressure dressing, or a tourniquet—immediately being to look for other wounds. Sweep underneath all parts of the body with gloved hands. Check your hands for blood regularly during the sweep so you can immediately identify which part of the body is injured. If the injured person is wearing waterproof clothing, make sure to remove or sweep inside of those layers, as a rain jacket or rain pants can keep blood next to the body, concealing a major bleed. Do not wait to apply a tourniquet if you find a major bleed on an arm or leg. Pause the sweep, apply direct pressure, a pressure dressing, or a tourniquet, and resume sweeping once that bleed is controlled.
\n\nBleeds that are in junctional areas (i.e., the groin proximal to the inguinal ligament, the buttocks, the gluteal and pelvic areas, the area under where the arm connects to the shoulder, the shoulder girdle, and the base of the neck) can be controlled by “packing” the wound, which applies direct pressure to the severed artery or vein. If you are in an unsafe area, or if you are not equipped with wound packing material, direct pressure on the wound, ideally with a gauze pad, can do for the time being.
\n\nIf you are not equipped with an IFAK or tourniquet, call loudly for a medic. Call out landmarks to guide them quickly to you, as well as crucial information such as whether the casualty is bleeding considerably: for example, “I need a medic! I’m behind the red sedan—someone has been shot in the leg!”
\n\nWhile you wait for them to arrive, use direct pressure to slow the bleeding. If the bleed is capillary (slow and even flow, bright red in color) or venous (steady flow, dark red in color), you may be able to control the bleed with direct pressure. If the bleed is arterial (spurting or pulsing flow, bright red in color), direct pressure won’t be enough—you will have to apply pressure at an arterial pressure point. If the wound is in the leg, consider applying pressure in the upper thigh, near the pelvic region—but be careful. If there is a wound in this area, try applying pressure in the lower right abdomen. If the wound is in the arm, try applying pressure underneath the armpit. If the bleeding is on the neck, try applying pressure on the side of the neck generally underneath the point of the jawline, keeping in mind to apply pressure only on one side. Only do this in an extreme emergency, as it is of limited value for bleed control.
\n\nRegardless of where the wound is, once you apply pressure, do not remove pressure to check if the wound is still bleeding. Continue to apply pressure until a medic can place a pressure dressing or other hemostatic intervention.
\n\nIf the wound is in the chest, it is acceptable to cover the wound with your gloved hand, but applying too much pressure can potentially inhibit their respiratory system. Chest wounds generally present with less bleeding, but run a high risk of air entering the chest cavity, leading to a buildup of pressure that can cause a lung to collapse. Some medics carry vented chest seals in their kits, which serve the same general purpose as a gloved hand over the wound: preventing air from entering the chest cavity. If the wound is in the trunk—i.e., between the chest and the navel—there is probably little you can do to help besides notifying a medic or other higher care immediately.
\n\nIf you can control the bleed, you or a friend should prepare the victim for a possible ER visit or another situation in which they may have their possessions confiscated. Remove any potentially incriminating items from their backpack, pockets, and person. Dispose of these or give them to a trusted friend who can remove them from the scene.
\n\nWhen higher care arrives, whether that is EMS or street medics, give them a report to the best of your ability, using the MIST acronym: the Mechanism of injury (M), the Injuries sustained (I), the Symptoms (S), and any Treatments (T) given. For example, “They were shot with a rifle from about two blocks away, they received two bullet wounds in their left leg. Their skin is cool to the touch, and their breathing seems slower than normal. I applied a tourniquet high and tight and the bleeding seems to have stopped.”
\n\nIf it takes a while for medical care to arrive, consider writing symptoms or other things you notice on the patient’s arm with your marker.
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/09/24/4.jpg\")
A small IFAK that can be worn on a belt, marked with a cross for easy identification.
\nKnow your options for evacuation. Are you behind a police line that an ambulance cannot pass through? Does the local medic collective offer transport to hospitals? You can try calling for an ambulance if you think you are in an area they can enter. When you place a 911 call for an ambulance, you can request that they do not send police in tandem, but they may well ignore your request. If you do decide to call EMS while you are in a group actively trying to assist someone who has been wounded, designate one person to make the 911 call and report the wound and location while the rest of you stay focused on assisting the victim. It is possible—but not guaranteed—that a 911 dispatcher can walk you through basic trauma response until you receive help or can transport the wounded.
\n\nIf you or your comrades have driven to the demonstration, it can help if a car is parked nearby with immediate access to the road. Make sure the location of the keys is known and accessible to more than one person. Other people will likely wish to assist in the event of a shooting. If you cannot transport the patient yourself, seek aid from those around you.
\n\nIn some cities, hospitals place shooting victims in protective custody to eliminate the threat of violence against them.2 If that occurs, you will not be able to locate your friend inside the hospital system. If the person is unconscious and unable to tell healthcare workers who to contact, the workers will try to contact a family member. If you are entering a situation in which it is possible that you will be severely injured, you could write an emergency number in sharpie on your skin with the instruction “call in case of emergency.”
\n\nWhile this may not be uppermost in your thoughts in the event of a shooting, it is important to know that most large hospital systems offer programs via which you can apply for aid to reduce or forgive your bills. If someone’s life is on the line, you can work out the financial details later.
\n\nWhen bringing someone home from the hospital, evaluate their home situation. Do they live alone? With friends or family? Is their bedroom up a flight of stairs? Depending on the severity of the injury and the forecasted length of their recovery, they may need to change their living situation.
\n\nBecause there is very little semblance of a public health system in this country, people are often released from the hospital very rapidly—sometimes before they are ready to go home. This can be intimidating, but the good news is that home is usually a better recovery environment than an institution. You can rent a hospital bed from a hospital or home-care equipment rental company—they are surprisingly inexpensive and can be enormously helpful in the case of a long-term recovery.
\n\nIf necessary, organize community care so people are present or available around the clock. Even if that is not necessary, try to organize a caregiver schedule involving a rotating cast of friends and loved ones to ensure that care does not fall solely or mostly on a partner. In addition, you can create a meal schedule for people to drop off food and groceries or cook for the wounded and the caregivers.
\n\nWhile it should go without being said, being shot—or responding to someone getting shot, or witnessing someone getting shot, or having someone you love get shot even if you weren’t there—is a traumatic event. You may experience a range of responses including nightmares, anxiety, flight/freeze/fight responses, self doubt, jumpiness, fear, and depression. Seek help! Form a community care circle and meet weekly to process the pain, confusion, and trauma.
\n\nIf many people in your community were affected by the event, you can seek out a friend or loved one from outside your circle to help you process what happened. Find a therapist in your town to help you work through your feelings. While therapy can often seem cost prohibitive, there may be a non-profit, a clinic system, or a university where counselors in training can offer services for free or a reduced price. If there are ongoing protests in your city, local non-profits may offer counseling specifically for those affected. This guide written in response to the COVID-19 pandemic offers some tools you can apply to coping with trauma.
\n\nThere has been a longstanding tendency in anarchist milieus to emulate tough attitudes and bravado. Analyzing and overcoming these cultural norms and eschewing a dichotomy between “passivity” and “militancy” can help us to build sustainable long-term movements. Remember, we want a thoroughgoing social revolution, not just periodic street violence.
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/09/24/3.jpg\")
\nThere is a long history of state-sanctioned violence in the United States, against both ordinary people and movements for social change. Alongside this extends an equally long history of extra-state violence, from the lynchings of the not-so-distant past to contemporary equivalents like the murders of Trayvon Martin and Ahmaud Arbery. Since before the American Revolution, extra-state forces have worked in tandem with the state to uphold patriarchal white supremacy. It is well documented that police continue to cooperate with white supremacists. They are two sides of the same coin.
\n\nThe current clashes between white supremacists and anti-fascists are reminiscent of the rise of Nazism in Germany. In the early 1930s, when the Reichstag election campaigns were in full swing, fascists repeatedly baited their adversaries into street fights, injuring many while framing themselves as “victims in a lawless country.” They used this violence to bolster their campaign for “law and order,” a pretext to impose a dictatorship. Sound familiar?
\n\nThere have now been many instances of lethal violence during demonstrations, including the murders of Heather Heyer in Charlottesville, David McAtee in Louisville, Garrett Foster in Austin, and Anthony Huber and Joseph Rosenbaum in Kenosha. It is vital that we learn how to navigate these increasingly violent and contested spaces. If we are to sustain a culture of resistance, we’ll have to be prepared to respond to a wide array of scenarios. We can learn to deal with violence and mitigate its effects while refusing to glorify or romanticize it.
\n\nAs social conflict deepens, more and more people are becoming familiar with the violence that the state has long meted out overseas and against Black and Indigenous communities inside the United States. This must not deter us from action—it is better for us to confront these threats together, head on, than to try to hide from them until they reach each of us in isolation. Generalizing care and aid is an essential part of staying safer in the streets, which, in turn, is part of creating safer communities and, ultimately, a safer world for all of us.
\n\nAs frightening as this situation is, you are not alone. The same dynamics that are destabilizing our lives and our society offer us the opportunity to connect with each other and reinvent our lives on a new basis. Thank you for everything you have done to become part of the momentum towards a better world.
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/09/24/1.jpg\")
On May 15, 1970, policemen in riot gear fired more than a hundred and fifty rounds in twenty-eight seconds, murdering two young Black men at Jackson State campus in Mississippi and injuring a dozen more. While the murders at Kent State a few days earlier remain widely known, the subsequent murders of young Black demonstrators in Jackson and Augusta, Georgia are often forgotten.
\nThe following accounts may help you to visualize how you would conduct yourself in similar circumstances.
\n\nIt is a dark and stormy night, the first night it has rained all week. People are milling around under the awning of a barbecue joint, hanging back from the police line, waiting to see what will happen. More than a few folks have guns tucked in their waistbands. Some people scuffle with the police, some break up chunks of concrete to throw at the tanks; others listen to heated arguments about whether we should go home, stop violating the curfew, and leave the fight for another day. Then, out of the blue, a lone cop car comes squealing in from behind, sirens blaring.
\n\nThe crowd scatters, people panic, running in all directions, as tear gas canisters skitter across the street and flash-bang grenades explode from the police lines. Choking smoke and chaos and fear everywhere. Gunshots ring out as people fire through the crowd at the lone cruiser, which has turned around to retreat. I dive to the ground by a blue mailbox, confused and separated from my friends. A tide of people flows down the street away from the police lines, as the cops start to push the crowd forward, hoping to clear it. Swept up in the sea of people, I take perhaps twenty steps down the sidewalk before I come upon a knot of people gathered around a figure on the ground.
\n\nTime slows down. Two of my close friends are clustered around a body on the sidewalk. That body is one of my oldest and dearest friends. Someone is screaming, “He’s been shot, he’s been shot!” One of my friends is shouting for people to back up, pushing people back, when he looks up and sees me. I look from him to my friend on the ground, who has been shot in the leg. But the light is fading in his eyes as he clutches his torso and moans. Getting shot in the leg isn’t enough of an explanation as to why my friend is crashing. We’re so confused—there’s no blood, there’s no blood. What the fuck happened? Where else is he hurt? There’s no blood, just a stumbling, haunting groan from his mouth. I am a mother, I have birthed a small person into this world. I know what it sounds like at the line between life and death, and all I know in this moment of despair and confusion is that this person I love so much is straddling that line before my eyes.
\n\nI still don’t know what the fuck is happening, but I do know that we have to get him out of there ASAP. No one is coming to help us and no one is coming to save him. I run to my car—thank goodness I parked only a few blocks away. I speed around screeching cars that are doing donuts in the street. When I get back, I find people lifting my friend’s body into an already packed car. I scream and scream that he is coming with me as my friends wrest his body away from the well-intentioned strangers. We race down the street into a rabbit warren of loopy suburban streets. I know what hospital I want to go to, but it’s dark and I’m confused. Riot angels pull up next to us and ask if we need to be led to the hospital.
\n\nWhen we arrive at the hospital and pull my friend from the car, his shirt slides up and there it is: an entry wound with no exit wound. He is immediately transferred to a trauma hospital. Over the following days, we hear over and over the words “should have died.”
\n\nBefore this, I didn’t know that I didn’t know what it meant to get shot. What getting shot means is that a bullet rips through muscle, maybe through bone, maybe destroys some organs—quite possibly some that are essential. It could destroy the left kidney or the spleen; it could collapse both lungs, clip the esophagus, fill up the inner cavities with blood as the body bleeds out internally. A bullet could end up in the heart. You could find yourself in a hospital in the middle of the night, being coaxed through a series of legal documents by a very patient and very kind cardiologist who is preparing to do a second open heart surgery on someone you love to fish out the bullet that is lodged in his heart.
\n\nLuck was on our side that night, absolutely. But we responded to the situation quickly. I found out later that many different friends had passed by, that I wasn’t the only one running for a car—I just got there first. And well-intentioned strangers were trying to evacuate my friend on their own—so many people get shot in this city that people recognized what they were looking at and how important it was to respond.
\n\nWhat happened to my friend hasn’t stopped me from returning to the streets, and it hasn’t stopped him or other people in my community. Because the hospital placed my friend in protective custody, only one other friend and I could be there with him. Many of my friends sought comfort in the street battles that continued to rage, glad to have an opportunity to turn their grief, fear, despair, and anger into action.
\n\nI’m thankful that I happened to be parked close that night. I’m thankful that so many people around us wanted to help. I’m so thankful that people realized we needed them to lead us to the hospital. I’m thankful that the transfer to the trauma center happened quickly enough and I’m thankful for adept and willing surgeons. I’m thankful that my friend’s inner will was strong enough that he survived. I’m so thankful he lived. I’m thankful that there are things you can all do, too, to make it likely that things will turn out as well as possible if you ever find yourself in a similar situation.
\n\nAnd I am thankful for riot angels. May they be by your side if you ever need them.
\n\nWe all heard it. A single pop. It rang through the night, oddly out of place after hours and hours of hushed scuffles and the rustling of an agitated crowd. Hundreds of people were in the square—many lined up to get inside the event, and possibly an equal number trying to stop them. Red hats sailed above the crowd like short-range fireworks as people snatched and threw them. It was a mess, the conflicts impossible to follow; eggs, paint bombs, pepper spray, and punches coming at odd angles and from all directions. The few police that were on hand didn’t intervene. Stepping back from the square into the dark campus streets, the entire situation looked like a poorly directed fight scene in a low budget play.
\n\nBut we all heard the pop. Just the one. Instinctively, the black-clad crowd dispersed throughout, the red hats all looked up. Given our knowledge up to that point of what happens at demonstrations, we assumed it was a flash-bang grenade. That was the only thing we thought could make that noise. But there was no second bang. Everyone’s eyes refocused on the stalemate around them. Pushing and shoving, some reinforced banners and phones being snatched, but a relative calm.
\n\nLooking up across the square, I caught a glimpse of something out of place. It was someone I recognized, someone I knew was in trouble. He had been trying to ensure that no one would get hurt, mixing distraction and de-escalation. Now something was wrong, but it was impossible to tell what it was.
\n\nA comrade and I pushed our way through the crowd to where he was. To get there, I walked through something hanging in the air—my brain wouldn’t put it all together for a while. It wasn’t a smell, it was more of a taste, a cloud in the air that had a tang of metal. Once we reached him, the look on his face told me that I was in over my head. That, and the sound. He was making a sound that you just don’t make. A scream and a gurgle mixed into one. I don’t know how he was still standing. I got to him first and he leaned into me, all dead weight. The smell of his leather jacket and the press of him onto my smaller frame in that moment of desperation is one of the things that would enter my dreams and wake me for years after. It was as if I was carrying a dead but still living body.
\n\nHe stared right at me, but looking past me. I realized he was dying. But I had no idea why. Reasons flashed through my head; there was almost no blood and I couldn’t find anything. We didn’t walk that far—twenty feet at very most—and the best I could come up with was that he must have hit his head, only a head injury would make him incoherent like that.
\n\nAnd then as quickly as I had taken his weight, the medics took him. His weight left mine and we were uncoupled from that moment. I stared at the medic, who I thankfully trusted, and all I could get out was “He’s hurt, I don’t know,” or something like that. Besides walking him out of the danger of the immediate moment, I felt totally useless. The medics began doing their part, on the ground where there was a fair amount of blood now, trying to run through what their training had taught them. I heard the crowd as a low din—that thing that happens when you’re about to pass out and the audio goes to the end of a tunnel. But that was when I finally put it together: pop, metal, gurgle.
\n\nSomeone had shot him.
\n\nThe police swooped in and took him, pulling the trained trauma medics away by force as we all screamed from the other side of a police line. Now everyone knew he was dying, that something had gone wrong. I wanted to scream that he had been shot; I started to, but then I realized that it might cause people to panic. I was just barely aware that I was already panicking. I found one of the medics; they confirmed that someone had shot him.
\n\nThe police loaded him into the back of some kind of open-air vehicle—campus cops with a golf cart. And the demonstration continued. I panicked openly at that point, finding my crew and demanding that we leave, that “they” were shooting at us and we had to go. But at that point, I didn’t even know where the threat was coming from or if leaving was safer. So we pushed back along the line of people trying to see Milo talk, well after the event had been closed off. The police never moved in, the “active shooter on campus” alert was never activated, and we stayed in that crime scene—for hours.
\n\nLive Like the World is Dying podcast recently aired an interview with an experienced street medic who gives detailed instructions about responding to gunshot wounds at demonstrations.
\nIn this podcast, Hex, who survived a shooting attack by a fascist at a demonstration on January 20, 2017, discusses justice, violence, patriarchy, and compassion, the critical importance of healing, and how to redefine resistance.
\nProtocols for Common Injuries from Police Weapons—A guide for street medics responding to non-lethal police munitions and chemical weapons
\nKeep talking to the person you are treating.
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/09/24/7.jpg\")
\n IFAK Build—Current lowest price per kit: $95.25, not including tax, shipping, or a bag or pouch for the kit. Here are the recommended contents, with links to sources:
\n\n“Packing” means applying internal direct pressure to a severed vessel by creating pressure on that vessel with gauze, filling the wound with more gauze, holding direct pressure when the wound is filled, and finishing it with a pressure dressing. ↩
\nIn this case, if someone has been shot, the hospital assumes that they may still be a target and aims to reduce the possibility of continued harm. ↩
\nThe following guidelines are intended to equip street medics and health professionals to respond to some of the common injuries inflicted by police violence. They are drawn from experience in the struggle against an airport that the French government tried—and failed—to build in Notre-Dame-des-Landes. It can be difficult to find solid information about how to treat such injuries based on real-life experience. Most mainstream health professionals have little experience treating injuries caused by police weapons; this guide shares the knowledge that medics gained in repeatedly responding to these injuries, in hopes of saving others the trouble of having to learn by trial and error. Being medically trained does not qualify you to be a street medic, as the Do No Harm Coalition elegantly states. Street medics gain from sharing information about what works and what doesn’t in a constantly evolving discussion. The red flags listed here can also help injured people identify when their symptoms are serious and when they should seek professional medical attention.
\n\nThese guidelines are non-exhaustive; there are many things that are not included here. For instance, the police deployed thousands of tear gas canisters and flash-bang grenades on the ZAD during April and May 2018, but relatively little pepper spray. The focus here is on the protocols have been tested extensively. We prepared this translation in solidarity with the current uprising, sharing this information in hopes that it will be useful to street medics in the US.
\n\nWhat follows is not a do-it-yourself guide. Your local area or nearby large city likely has a street medic collective—find them! Medic collectives sometimes do trainings for new medics. Many of the practices detailed here require extensive knowledge and experience—and can really hurt someone if done wrong. Please don’t jeopardize the health of others by claiming experience you don’t have or trying to practice outside of your scope.
\n\nThe title photograph is from Ujimaa Medics. Founded by Black women in Chicago, they train communities for urban emergency first response.
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/06/08/9.jpg\")
\nWhile the best way to learn how to be a street medic is from street medics themselves, here are some sources for more information about the history and practice of street medicine—from its inception as a self-defense tool during the Civil Rights Movement to its use in the recent uprising in response to the deaths of Black people at the hands of a system of brutal, racist policing.
\n\nAlways prioritize sources that are up to date and use evidence-based practice.
\n\nA recent video training by a coalition of medics about how to stay safe and healthy in the streets.
\nThe following protocols were written by the ZAD healers group, an interdisciplinary team of nurses, doctors, street medics, herbalists, psychologists, naturopaths, and energy workers who were part of a larger network of healthcare workers involved in the struggle to defend the ZAD (Zone à Défendre, “Zone to Defend”) at Notre-Dame-des-Landes.
\n\nIn their words:
\n\n\n\n\nDuring the evictions of autumn 2012, a number of healthcare professionals came to support the medics on the ground. Over the years, we have worked together to prepare logistical and communications strategies, and to have the materials necessary in the case of eviction attempts or other police intervention. We also have regular discussions, and regular reciprocal trainings.
\n
\n\n\nAs soon as we turn our dissent into concrete action, or block the smooth functioning of the corporate economy, repression quickly follows. Whether for the duration of a protest or because we live in the wrong neighborhood or because of the color of our skin, when we are labeled “undesirable” or “radicals,” the State hurts and kills us via its law enforcement.
\n\nConscious of these risks, in many countries revolutionary groups and activist movements have developed their own medical support networks for demonstrations or direct actions. This practice differs from humanitarian groups like the Red Cross, because we don’t pretend to be neutral. We take a clear political stance and an active role in the conflict and in the support that we bring to our comrades in struggle.
\n\nIn a demonstration, street medic teams try to be present on the scene as early as possible to be able to provide emergency care to people who ask for it, and to evaluate the needs of the situation before an ambulance arrives, which is sometimes blocked or delayed by the police. There is also an assessment of the legal risks involved in resorting to official emergency care: for example, the risk of identity checks and arrests inside hospitals targeting those who are undocumented, who have outstanding warrants, or simply because the fact of being wounded makes someone a suspect.
\n\nThe police regularly update their equipment dedicated to repression with new chemical, electrical and physical weapons. As street medics, we try to respond by spreading defense techniques developed on the ground and shared across the world for prevention, protection, and healing.
\n\nFor us, medical knowledge comes with a political reflection on how we put it into practice, to avoid reproducing the relationships of domination, management, and dispossession that characterize the medical institution. As street medics, we want to make the consent of injured people a priority and give them the information they need to make clear and informed choices for themselves.
\n
-Excerpt from a declaration of the ZAD street medics, 2015. (Published in print; not available online.)
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/06/08/13.jpg\")
A tear gas canister.
\nThe following protocols were written after the most recent eviction of the ZAD in 2018, during which medics set up a parallel system of emergency care as police blocked ambulances with tanks. These protocols were based in access to specific resources and skills and knowledge; they have been edited for clarity and context. Many of these protocols presume the ability to access medical care and transfer to a hospital as a backup option. The US does not have universal healthcare (yet). If you lack health insurance but have relationships with healthcare workers in your community, please reach out to them for resources or work with the people around you to find other ways to get the care you need.
\n\nThese guidelines are written for trained street medics and healthcare workers to respond to police violence. They are not a substitute for medical treatment or diagnosis. Please do not practice outside your scope!
\n\nAlso called CS, CN, or CR gas, tear gas is an aerosol that acts as a respiratory system irritant. Pepper spray is a red oil-based substance containing capsacin, derived from peppers, that is sprayed directly onto the skin and eyes.
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/06/08/10.jpg\")
\n—Symptoms: skin and eye irritations and burns
\n—Treatment: Rinse as much as possible, with water pressure or gentle friction.
—Tear gas can cause trouble breathing or provoke asthma attacks. For people with asthma, employ Albuterol, or even oral prednisone (by an experienced medic) if they are out of breath. Avoid tear gas for several days afterwards.
\n\n—Can result in disability or other neurological symptoms: nausea, vomiting, intense headache, confusion. In these presentations:
\n\n—For pain: Ibuprofen
\n—For moderate nausea and vomiting: oral or suppository anti-nausea medications such as Metoclopromide (Ondansetron and Promethazine are more widely available in the US). Ginger chews and peppermint or chamomile tea also help.
\n—For severe vomiting and inability to keep liquids or medicines down (risk of dehydration): refer to hospital for IV fluids and observation.
\n—For intense confusion: Nothing by mouth. Place injured person in the recovery position and call for an ambulance.
Make sure people know to wear thick leather or specifically heat resistant gloves (such as barbecue gloves) before picking up or touching tear gas canisters to avoid burns.
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/06/08/12.jpg\")
Concussion grenade exploding.
\nBlast wounds mainly damage the ears.
\n\n—Occurs infrequently in our experience. Not an emergency.
\n—Symptoms : pain, bleeding from the ear, temporary reduction in hearing.
\n—Treatment: Examine the ear with an otoscope, ideally within 24 hours. A torn eardrum heals itself in 2 weeks.
\n—If a medical exam is possible, an eight-day course of antibiotic drops (ofloxacine otic) can be offered preventatively to avoid infection of the middle ear and adjacent area (behind the eardrum). In any case, follow-up with Primary Care in 10 to 15 days is ideal for otoscopy and referral to ENT specialist if there is persistent anomaly.
—Occurs frequently in our experience.
\n—Symptoms: pain, ringing in the ears (tinnitus), loss of hearing, vertigo, or dizziness.
\n—Ringing in the ears does not come from the eardrum, but from the inner ear! Hearing loss is the guiding factor for treatment (not tinnitus).
\n—Simple hearing test: rub your thumb against your other fingers next to the person’s ear. Ask them if they can hear, and do the same thing on the other side.
\n—Treatment: If hearing loss persists for 24 hours after the blast, make an appointment with an ENT (ear, nose, and throat) specialist as soon as possible. To avoid or at least limit permanent hearing damage (resulting from the death of cells in the inner ear), a steroid may be indicated: prednisolone in the ear (0.5mg at 1mg/kg/day for 2-3 days) is the most common prescription.
—Occurs rarely in our experience
\n—Symptoms: Difficulty breathing in the days following impact.
\n—Treatment: Emergency. Pulmonary edema requires hospitalization. Air embolisms caused by blast injury to the lungs can cause seizures, strokes, and/or permanent brain damage when air bubbles pass from the lungs to the blood and enter the brain.
—Occurs rarely in our experience.
\n—Symptoms: Abdominal pain, blood in stool (hematochezia) in the days following impact can indicate bowel perforation. Fever and abdominal distention (hard stomach) can indicate peritonitis.
\n—Treatment: Both of these are medical emergencies and require hospitalization!
—Shelter the person from additional noise.
\n—Do not hesitate to contact emergency medical providers if there is any impact on cognitive function or damage to organs.
\n—ENT specialist consultation for blast injuries to ear is suggested within 24 to 48 hours.
\n—Observe people with blast injuries for several days. Symptoms indicating complications may be delayed, such as changes in hearing, breathing, and abdominal functions.
Shrapnel wounds occur frequently in our experience. Shrapnel is often plastic; sometimes it is metal. On impact with pavement, concussion grenades can propel dirt and asphalt alongside shrapnel; this increases the risk of infection. Sometimes entrance wounds are small, even tiny. Sometimes they are large and obvious. Shrapnel injuries are serious even if they don’t look like a big deal. Examination, observation, and follow-up are vital.
\n\nNEVER approach or pick up a canister that is not yet smoking. It may be a concussion grenade with the capacity to blow your hand off. (This has happened both on the ZAD and in the Gilets Jaunes protests).
\n\nExamine and evaluate the breadth and depth of the wound before rushing to bandage it!
\n\nTreatment by area of injury:
\n\nEmergency: potential risk to life. See an experienced medic. Evacuate and evaluate respiratory/neurological/cardiovascular system distress and the extent of bleeding.
\n\nCheck for:
\n\n—Damaged joints.
\n—Nerve damage. Nerve damage requires immediate hospitalization! Check pulse, movement, and sensation above and below the wound; compare the limbs next to each other for reference. Look for paralysis, weakness, or range-of-motion difficulties. Numbness, tingling, or pins and needles indicate nerve injury.
\n—Damaged tendons:
Remove shrapnel based on size. All large pieces must be removed.
\n\n—Occurs infrequently
\n—Treatment: See an experienced medic who can refer patient to a hospital or remove the foreign body and close the skin, employing excellent knowledge of anatomy and controlling the risk of infection with follow-up care and prophylactic antibiotics.
—Occurs frequently.
\n—Treatment: Clean, bandage, and follow up. If there are many obviously shallow pieces of foreign object (like road rash), honey dressing can draw them out without physical removal. Monitor closely for infection.
Localized treatment:
\n\nCleaning and drying:
\n\n—Wash wound with soap and water before you do anything (or with sterile saline solution if soap and water are not available).
\n—Follow with hydrogen peroxide, which has the advantage of foaming and can sometimes draw out little pieces of shrapnel.
\n—If the foreign body is small or difficult to see, use sterile forceps but don’t tear at it or make it worse! It’s not a big deal if it stays in, but it’s usually worth trying to remove it. The body will either reject small pieces naturally, like a splinter, or create a buffer around them. The damage is done when shrapnel enters the body; the additional risk is infection.
Disinfect with antiseptics:
\n\n—Remember: if an antiseptic bottle is open for over a month, dispose of the bottle. Mark the date on the bottle upon opening. Prioritize smaller bottles to avoid expiration.
\n—Yellow Betadine, povidone iodine. (Use red Betadine first if washing with soap and water is impossible.) It exists in individual doses too. Iodine allergies don’t apply to Betadine.
\n—Chlorhexidine is good, such as one-time-use Dosiseptine, but not Biseptine (alcohol-based) because it stings.
\n—Diluted sodium hypochlorite (Dakin’s solution) works well but has to be diluted at 50% in sterile water, so it is impractical. Alcohol is efficient but burns a lot.
\n—For puncture wounds: Disinfect surface and interior. Use an antiseptic syringe without a needle. Put the end of the syringe inside the wound before injecting. Don’t use hydrogen peroxide for this.
Bandaging:
\n\n—Approximated wound with controlled bleeding: dry bandage, gauze compress, elastic bandage.
\n—Wounds oozing blood or pus: Consider an absorptive cushion like hemostatic packing, followed by a compress and bandage on top.
\n—If moderate bleeding or unapproximated wound: use clean raw honey (not the corn syrup kind), Neosporin, or tulle gras, then compress and bandage.
Dressing changes:
\n\n—Every 24 hours at the beginning (depending on severity), then every 48 hours.
\n—Rinse with saline solution. Don’t reapply antiseptics, as this can delay healing.
\n—Prevent secondary infections. These occur frequently with shrapnel wounds! Signs of infection include redness, inflammation, pus and weeping, or fever. Get an experienced medic’s advice and local or oral antibiotics for 48 hours after injury.
\n—Abscesses may necessitate x-ray, ultrasound, or surgical consultation depending on the wound.
To pass on to injured people: If you experience fever, chills, stiffness, redness, wetness around the wound, red plaques or streaks on the skin, or a neurological or motor deficiency, consult a doctor, medic, or go to an emergency department immediately.
\n\nTakeaways for shrapnel wounds:
\nDon’t dig too hard to get out small pieces.
\nAssess immediately for nerve or tendon injury.
\nMonitor for signs of secondary infection for several days.
Rubber bullet injuries often leave a big bruise. Check for other lesions! If you suspect trauma that will necessitate surgery, do not give them anything by mouth. No drinking, no eating, no smoking.
\n\n![](\"https://cdn.crimethinc.com/assets/articles/2020/06/08/11.jpg\")
Rubber bullet.
\n—Assess neurovascular status: Pulse, movement, sensation, and color. If there’s an anomaly, hospitalization is urgent.
\n—Palpate the bones for pinpoint pain and crepitus. Test each joint for range of motion. If you can’t rule out a fracture, get an x-ray within 24 hours. Suspected displaced fracture (shortening, etc.) requires an x-ray immediately.
\n—Rubber bullet impacts on muscles and tendons are not an emergency.
\n—Treat all bruises or hematomas with Arnica (Arnica montana) tincture or gel or Ground Daisy (Bellis perennis) tincture. Apply topically as soon as possible (actual tincture, not homeopathic).
\n—If plan is to hospitalize, wait before applying topical treatment: it may mask the seriousness of the condition.
\n—The most important thing is to immobilize the injury.
—See an experienced medic.
\n—Palpate facial bones looking for pinpoint pain and crepitus indicating a fracture: orbitals, nose, zygomatic processes, mandible, chin, dental articulation (closure and alignment). Examine each tooth.
\n—For teeth that are broken, moving, unseated, or painful—see a dentist immediately. Conserve the tooth in milk, saline solution, or saliva. Ideally, the injured person would carry it in their mouth, taking care not to swallow.
Simple Neurological Face Assessment:
\n\n—Immediate hospitalization.
\n—Nothing by mouth: no food, no drink, no smoking.
\n—Rinse area with sterile saline solution.
\n—Have the person lie down and cover both eyes with sterile compresses.
—Probable fracture.
\n—Get an x-ray.
\n—Epistaxis is bleeding from the nose; it can become a large hemorrhage.
—Pain may indicate a broken rib or lung damage. See an experienced medic.
\n—Rib fracture: pinpoint pain when palpated along the sternal line.
—Pneumothorax: pain and cough, sometimes spitting blood.
\n\n—See an experienced medic.
\n—Check for:
—Check for signs of internal hemorrhage (shock) such as pallor, weakness, diaphoresis (sweating), tachycardia with normal blood pressure. \n—Late signs include low blood pressure, altered mental status, loss of consciousness. \n—Watch them for several hours!
\n\n—Look for blood in the urine. Ideally get a urinalysis done to check for kidney damage.
\n\n—If bruising or excessive pain, get an emergency ultrasound.
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