EMTs and Paramedics: How does one treat a gunshot wound?

ABCs. Always. As a medic I have no idea what the extent of the damage is. The wound track of a bullet needs to be determined by the ER and surgical staff. Bullets do all sorts of funky things and a through and through does not mean the round didn't bounce off of a bone and hit something on its way out. The foundation of advanced life support is good basic life support. Secure the airway and make sure the victim is breathing. Put them on high flow oxygen. Control bleeding. Pressure bandages and direct pressure to the entry and exit wound. ABCs are done so now I move on to assessing which can be done very quickly. Expose the victim and look for more wounds. Only one? Great. Get them on a backboard, put a cervical collar on, load them and go. Get two large bore IVs in place, one in each antecubital and run fluids. Put them on the monitor and keep an eye out for arrhythmia. During transport constantly reassess the ABCs. Are they breathing? Is the airway secure? Is the bleeding under control? Pain? No one ever died from pain. Are they awake? They might be. They might not be. As long as my ABCs are being dealt with it doesn't matter to me. Call in a report to the receiving trauma facility, continue to monitor the ABCs and get them there safely and quickly. Turn them over, give report, assist ED staff if you can, write up the paperwork, clean the unit, and get ready for the next call. There's always a next call.

An EMT/Paramedic can't definitively treat gunshot wounds. What we can do is keep the patient alive long enough to get the treatment they need. This starts with controlling the bleeding using direct pressure, wound packing with hemostatic gauze, and sometimes using a tourniquet. It also includes managing shock from blood loss, helping the patient's breathing by using chest seals, needle decompression for collapsed lungs, and airway management like placing breathing tubes and providing oxygen. The majority of our job, though, is to rapidly extricate the patient to a trauma center where a surgeon can evaluate and treat the wound. This evaluation will usually include x-ray, sometimes CT scans, and sometimes ultrasound, to determine if anything vital was injured. If the wound doesn't require surgery, then an ED physician will give antibiotics and clean/dress the wound appropriately.

Tough question... there are so many variables but primarily realize that controlling any life-threatening bleeding and maintaining the life-sustaining functions of airway/breathing/circulation will be paramount second to getting the patient to the OR.  We can only do so much on a scene and the survivability oftentimes relies on our ability to get the patient to the hospital.