Medical Examiner

Basic CPR Doesn’t Help Gunshot Wounds

Rick Santorum’s suggestion is medically ridiculous, and it betrays a worrisome misunderstanding of gun violence.

Photo illustration: Rick Santorum.
Photo illustration by Slate. Photos by Scott Olson/Getty Images and Thinkstock.

Over the weekend, former senator and current nuisance Rick Santorum went on CNN and made an interesting suggestion about what kids ought to be doing instead of protesting gun violence.

“How about kids, instead of looking to someone else to solve their problem, do something about maybe taking CPR classes or trying to deal with situations where there is a violent shooter and you can actually respond to that?” he said.

Well, how about it? Would CPR classes help in this situation? What could kids do to “try to deal with situations where there is a violent shooter”?

Many medical professionals immediately tweeted the answer to these questions (they are “no” and “nothing”), but I think it’s worth explaining why this wouldn’t help in further detail. The main misconception stems from how we picture—or how we fail to picture—what results from shooting a gun at a human being. The media shows crying survivors and single-file lines of children being evacuated from active shooter scenes, but since the Vietnam War, unfiltered images of mass carnage have been out of style. This seems civilized but actually dissociates us from the reality of these nightmares, to ignore how completely military-style weapons maim the human body. Recently, the idea that this kind of censorship is ultimately harmful has gained credence, as my colleague Jamelle Bouie wrote after Parkland.

Unlike normal injuries, gunshot wounds—particularly those from assault weapons—unleash exceptionally brutal havoc, making battered organs like the liver look like an “overripe melon smashed by a sledgehammer,” as radiologist Heather Sher wrote for the Atlantic. The damage is so extensive that most of the kids in Sandy Hook, for example, didn’t even make it to the hospital. But because we don’t confront this reality, many people continue to harbor false notions about the chances of surviving a gunshot and what trauma physicians can do to save victim.

But when a body is riddled with bullets, organs are obliterated. Lungs collapse. And when someone approaches death from a gunshot wound, it is usually because a bullet has pulverized a wall of the heart or ripped a major blood vessel apart, leading to massive internal or external bleeding.

CPR, when it works at all, does so by artificially squeezing the heart. Chest compressions force blood to circulate when the heart has stopped beating. But when little or no blood remains in the circulatory system, as in massive hemorrhage caused by penetrating trauma, CPR (in the absence of rapid blood transfusion) just makes the situation worse. The more the heart is compressed, the more any remaining blood spills out from the vessels into spaces where it can’t be used. Perhaps Santorum did not realize that when he suggested that kids start performing chest compressions on their dying classmates, but he was essentially advocating that they help finish the job. Every trauma expert I have ever worked with has always said the same thing: There is no role for external chest compressions in cardiac arrest caused by hemorrhagic shock. CPR often worsens things.

How do first responders and physicians save lives from traumatic hemorrhage? The answer is we attempt to find and then control the bleeding. Tourniquets are back in fashion for extremity wounds in the field. But mainly, our trauma guidelines focus on the chest and abdomen. As experts emphasize, the only relevant questions are “where is the bleeding?” and “which cavity to expose first.” So the only way that these kids could help prolong the lives of their shot classmates would be to start advanced trauma life support, like open-heart surgery and the placement of chest tubes.

Even considering how difficult passing sensible gun legislation has proven to be in the present political climate, I’d still prefer another attempt at that over trying to train high schoolers to perform as trauma surgeons during a crisis. Long odds are better than impossible ones.

Disclaimer: The opinions expressed in this article are solely those of the author and do not reflect the views and opinions of Brigham and Women’s Hospital.