Ep. 32 | Scene to Subpoena: Documenting Gunshot Wounds When It Matters Most
In EMS, we train for GSWs like they’re rare. But if you work in our system, you know better.
Gunshot wounds are not once-a-career events—they’re weekend-normal. And the way we document them doesn’t just impact the trauma team. It can affect a criminal investigation, a patient’s legal outcome, and your own credibility on the stand.
This blog is your deep dive into the clinical reality, legal implications, and documentation standards for gunshot wounds in the prehospital setting, based on our latest Life and Sirens podcast episode: Scene to Subpoena.
Why GSW Documentation Matters in Our System
In the communities many of us serve, GSWs aren’t theoretical. We run them regularly—sometimes multiple times in a shift. They come with:
Underserved populations
High-crime neighborhoods
Frequent law enforcement overlap
Increased courtroom relevance
We’re often first on scene—before crime scene tape, detectives, or forensics. That means our chart may be the first legal document tied to that case.
The Clinical Side: PHTLS Doesn’t Skip Documentation
According to PHTLS 10th Edition, your focus should be on:
Airway and hemorrhage control first
Platinum 10: <10 minutes on scene for critical patients
Life threats via MARCH or XABCDE
But clinical care is documentation. We’re not just treating the wound—we’re also translating that care into words someone else can understand.
PHTLS Clinical Pearls
Document “penetrating injuries” with anatomical landmarks.
Differentiate junctional vs. extremity bleeding—and what was done.
Trend vitals. Track changes in GCS and perfusion.
DCHART: Your Legal Lifeline
Let’s stop writing “GSW to leg” and calling it a day.
Your DCHART is the legal map of what happened. It should include:
Dispatch: Was it an “unknown problem” or “gunshots heard”?
Chief Complaint: Use exact quotes: “I got shot in the alley.”
History: Who was there? What did the patient say? What didn’t they say?
Assessment: single penetrating injury, 2 cm, 3 inches above R knee. No soot. Tender, pulsatile bleeding.
Rx: Hemostatic gauze applied. 18g IV. TXA if indicated.
Transport: Emergent? Stable? Reassessed?
Common Mistakes to Avoid:
Writing “appeared intoxicated” instead of “slurred speech, alcohol odor”
Leaving out tourniquet times
No wound locations, no descriptions, no mechanism
Two Narratives. Two Outcomes.
Bad Call (Summary):
“GSW to leg. Bleeding controlled. Transported to hospital.”
No wound location. No intervention timeline. No secondary survey details.
In court? Practically useless.
Good Call (Summary):
Penetrating injuries described with location, size, bleeding status.
GCS trended. Hemorrhage controlled with hemostatic gauze.
O2 admin, vitals, IV, trauma bay pre-alerted.
Patient statements quoted directly.
Scene described. Timeline clear. Report detailed.
The Legal Reality
At what point does your chart become evidence?
Immediately. From the second you touch a patient in a potential crime scene, everything you do (or don’t document) matters.
Legal Tips:
Avoid editorializing. Stick to what you saw, heard, and did.
Maintain chain of custody when cutting clothes, moving items, or transferring personal effects.
Don’t let PD dictate your chart. You’re not there to build a case—you’re there to record facts.
This Is Why We’re Qualified to Talk About It
At Life and Sirens, we serve areas where GSWs are frequent, fast, and high-risk. We’ve seen firsthand how poor documentation delays justice—or costs it. We’ve also seen how one solid narrative can clear up a cloudy timeline or protect a provider from legal fallout.
We’ve run the calls. We’ve watched the courtroom fallout. We’ve lived it.
Final Takeaways
GSW documentation is both clinical and legal.
Use DCHART like your job depends on it—because it might.
Stay neutral, be accurate, and document everything.
Resources:
NAEMSP documentation guidelines
PHTLS 10th Edition updates
