If the patient’s overall status permits, certain historical information may help the clinician in management. If the patient is unable to provide any historical information, EMS personnel or friends/family present may be able to assist with providing information. Per ATLS® protocol, an “AMPLE” history should be taken at a minimum (see Table 4) along with the following questions.28
Curiosity will often lead the emergency clinician to ask about the circumstances of the ballistic injury, but these details are rarely helpful except to determine whether the wound was self-inflicted, which will require later psychiatric evaluation after the traumatic injuries are addressed and the patient is stabilized. For more information on assessing depressed and suicidal patients in the ED, see the September 2011 issue of Emergency Medicine Practice, “The Depressed Patient And Suicidal Patient In The Emergency Department: Evidence-Based Management And Treatment Strategies.” Tetanus status should be obtained, and prophylaxis is indicated for most gunshot wounds.