Tag Archives: blood loss

Q&A: Shot in the Leg

So I read your post on gunshot wounds to the leg and it was very helpful, but what I’m looking for is a little more specific. My character gets shot in the leg, clean, nothing major hit. The wound is bandaged. But immediately after she gets shot, she passes out and isnt aware of anything. Is that believable? If the wound was bandaged right away, would she survive being carried for an hour before even reaching the hospital?

So, what caused her to pass out?

There’s nothing wrong with being able to survive for hours after taking a bullet if it didn’t hit anything vital. Some gunshot wounds can take a long time to kill you. Bandaging it is a good idea, because it will slow the blood loss.

Blood loss can result in losing consciousness. You lose a lot of blood, go into hypovolemic shock, lose consciousness, and bleed to death. If a patient loses consciousness shortly after suffering a gunshot wound, that tells you to look for serious blood loss. You may want to double check and make sure you didn’t miss any internal hemorrhaging.

You know will not cause you to pass out? The pain from getting shot. I feel like I’ve written this recently, but pain does not make you lose consciousness. Pain will keep you awake. While I’m a little less confident of this, I’m pretty sure getting shot will keep you awake. Even if the pain doesn’t, the adrenaline will.

If someone gets shot and passes out, they’re losing blood fast. You lose consciousness when you’re down ~20% of the blood in your body. You die when you lose between 30% and 40%. Napkin math says, if someone gets shot, and it takes 30 minutes for them pass out from blood loss, you’ve got a bit less than 15 to 30 minutes before they’re dead.

So, you have a character who gets shot. Their leg gets bandaged, but they lose consciousness within five minutes of the wound, they’re not going to survive for an hour without medical attention. Even if it takes two hours for them to lose consciousness, taking another hour to get them to a hospital would be an extremely risky decision.

Now, if they’re semi-conscious for most of the ride. Say, the first 50 minutes, and lose consciousness about 10 minutes out, it’s going to be touch and go, they’ve still lost a lot of blood, but that is survivable. If they pass out ten minutes earlier, it’s distinctly possible they’ll be dead on arrival.

If she’s being carried by hand, that carries extra risks because it could aggravate the wound and accelerate blood loss. Especially if they’re carrying her with the gunshot wound at a lower elevation than the heart. The ideal situation would be to lay her out on a vehicle’s bench or a stretcher, with the injured leg elevated above the heart. If you’re bleeding to death, don’t let gravity help finish the job, make your heart work to kill you. It will buy you time.

Also, hand carrying another human being for that long will be exhausting. It’s not impossible, but unless someone’s in excellent physical condition, they might not be able to carry her the distance, and shuffling her between carriers runs the risk of aggravating her wound, making things worse. This is less of an issue if they’ve got her on a stretcher or some other kind of stable platform.

Now, it’s possible she lost consciousness due to some other factor, but I can’t think of any off-hand, that would improve her odds for her survival.

If she lost consciousness shortly after getting shot in the leg, it’s a very bad sign. She’s probably losing blood much faster than anyone realized and would be dead in minutes. My suspicion would be an arterial bleed, which can be managed to a degree by keeping pressure on the artery to reduce blood loss. However, we’re talking about a character having to shove their finger into her wound to stop the bleeding (which requires some fairly specific anatomical knowledge.) Given how fast she lost consciousness, I’m pessimistic about it buying more than a few minutes without serious medical attention.

So, is it believable? No. It’s entirely believable she’d remain conscious, going into shock. It’s entirely believable she’d lose consciousness shortly after the injury, and die a few minutes later. Unfortunately, it’s one or the other.

If she’s bleeding out, her initial symptoms would include a headache, vertigo, nausea, and increased perspiration. These aren’t particularly worrying. She’s loosing blood, but she’ll probably live. However, over time, she’d start manifesting more serious symptoms. These include losing body temperature (and feeling cold), starting to suffer from impaired cognitive function, particularly confusion. Her skin would become cold and clammy, and would get paler as blood pressure dropped. Her pulse would get faster and weaker, also as her pressure dropped. It would become harder for her to remain conscious. Eventually, she would lose consciousness. The faster these symptoms manifest, particularly the more severe ones, the more dire the situation. If she’s going straight to passing out, and help is an hour away, she’s already dead.

I’m sorry, but if she drops after the firefight, you just killed your character.


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Q&A: Sword Injuries

Would actual sword fights end with a lot of cuts on both combatants or is it more of a “you get tagged first and your out” kind of deal?


This one can really go either way, depending on injuries sustained. So, let’s parse this out a bit, because I might not have been really clear about this in the past.

Shallow nicks won’t do much. You’ll lose blood, but not at an appreciable rate. You’ve almost certainly sustained a few of these in your life. From a writing perspective these are basically cosmetic. From a medical perspective they’re not much more. A sword or knife can absolutely inflict these.

There are rare circumstances where these immediately relevant. Cuts to the forehead can cause blood to get in the victim’s eyes. In combat, this is a debilitating situation. Blood that gets onto the palm can make it more difficult to grasp objects or weapons. (Fresh blood is quite slick. As it dries it will become sticky, so the effect is reversed at that point.)

When you’re talking about lots of cuts, then you’re probably talking about this kind of injury. Individually these aren’t dangerous, but if they start stacking up, blood loss is cumulative, so they can potentially become life threatening, but that’s not a likely outcome for a duel.

Incidentally, if you’re writing a scene where characters are dueling to first blood, then these cuts qualify. In fact, that’s what the duelists will aim for. It’s the easiest kind of injury to sustain, and if the participants don’t want to kill one another, this is the safest route to victory.

When I’ve been talking about injuries that create a decisive advantage, I’m talking about deeper cuts; ones that open up veins or debilitate limbs. Injuries where bloodloss will lead to impairment and death.

In a duel, these will kill you. When I say things like, “with first blood, the clock is ticking, and your character will die if they don’t find a way to turn the fight around,” I’m talking about these deeper injuries. A person can survive a few shallow cuts without much ill effect, and in most cases can survive quite a few without aid. Deep cuts are immediately dangerous.

Here’s the problem with this: I’m talking about these like they’re two separate kinds of wounds; they’re really not. They’re both cuts. If we’re being technical, the deeper variety are “lacerations.” But, that makes it sound like there’s a clean delineation between these injuries which simply doesn’t exist.

So, I’m going to step back and put this in abstract terms, as they apply to characters for a moment.

Characters can suffer “cosmetic injuries.” These will result in bleeding. As I mentioned earlier, blood After the fight is over, they’ll hurt. Unless your character is getting covered in these things, they’ll never kill them. These can be sustained anywhere, but when you’re talking about strikes to the forearm (except along the inner arm) or to the face, bone will usually stop the strike before it gets to deep.

Characters can suffer “wounds.” These will result in a lot of bleeding, way too much bleeding. These, “start the clock.” Without medical attention, even just self inflicted first aid, these will kill your character. Usually these are sustained to limbs or the torso. Places where you can get fairly deep without striking bone.

In the real world, blood loss will impair the fighter, slowing them down, confusing them, making combat more difficult. This means their defense (if they have one) will suffer, and it will be far easier for their opponent to get through it with a kill strike. A blade through the throat or chest, for instance. This isn’t always true in fiction, but it’s a function of how the human body works that’s worth remembering.

If you’re asking, “is it plausible for a character to win a swordfight with lots of tiny cuts?” Yes. If you’re asking, “is it plausible for a character die in a swordfight with one or two deep, lethal wounds, and to be otherwise untouched?” Again, yes. It really depends on the circumstances of the fight.

I hope that clears things up some, and am genuinely sorry if I’ve confused any of you by glazing over this. That one’s my mistake.


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Q&A: Shock

In film often when characters get stabbed/assaulted they can often continue to fight or don’t pass out immediately. How does adrenaline or shock factor into the physical reaction, especially when the character isn’t a cop or military and isn’t accustomed to being in these violent situations. How long would they be able to function before they crash? Is it possible to run away or even fight?

Taking these questions in reverse order: Yeah, kinda, sometimes, and it varies wildly, based on the injuries sustained. Also, it’s not the adrenaline crash that kills you.

Adrenaline rushes mean that you’re often unaware of injuries sustained in the moment. I’ve never been fully certain if adrenaline actually dulls the pain response, or if it simply causes your brain to ignore it. Either way, while you’re under an adrenaline rush you can suffer injuries and be unaware of them. It’s why you’ll sometimes see characters (and, for that matter, real people, with prior experience) checking themselves for injuries after combat (or any other traumatic event). It is entirely possible to be wounded and have no idea it’s happened until you’re trying to figure out where all that blood is coming from.

Depending on what you’ve just been through, coming down off an adrenaline rush can be deeply unpleasant. Your brain is sure something’s fucked up, but it can’t pin down exactly what or where, so it’s going to take that out on you, and everything aches. Adrenaline crashes won’t kill you. (There may be some weird outliers here for people with heart conditions, but, in general.) A crash may make you wish you were dead, or make you want to throw up on people, but it’s not lethal.

In the moment an adrenaline means that you can suffer (fairly severe) injuries and keep on fighting. If the injury doesn’t outright disable a limb, you can keep using it, even if that’s a very bad idea. Getting stabbed or shot is no guarantee that someone will sit down and peacefully bleed to death. Actually, shooting someone is a pretty good way to ensure they won’t sit down and bleed to death without protest.

When you’re trying to figure out how long it will take someone to die, you’re actually asking about how fast someone bleeds out. This relates directly to the injuries sustained. Someone who’s had a knife driven into their neck isn’t going to keep fighting. Someone who had it run through their bicep or buried in their shoulder blade, probably can.

We’ve covered blood loss before (and I strongly recommend you take a look at that tag, if you haven’t), but that’s the real factor here that controls if someone can fight. If they still have enough blood in their body to function. Lose too much, your ability to fight is impaired, and you’ll eventually fall unconscious and die.

Blood loss is why concepts like, “first blood,” are important in duels. Once that happens, the clock is ticking for that character; the longer the fight goes, the more their ability will decay, and unless they find a way to turn it around, they will die. (Even if they manage to prevail, they may still die without medical attention.)

Fighting through a stab wound is a fantastically bad idea. Engaging in any physically strenuous activity that raises your heart rate, (for example: fighting someone, or running away), will speed up blood loss, meaning impairment kicks in sooner. Still, the point of adrenaline is to keep you functional after sustaining an injury, so that you can survive.

If someone suffers an injury which disables them in some way, such as breaking an arm, there’s no powering through that. Adrenaline won’t let you override shattered bones. The biomechanical pulley system of muscles and tendons simply doesn’t work with broken bones.

So, the short answer is, “yeah, kinda.” You can keep fighting after being attacked. So far as it goes, there’s plenty of cases where someone took a stray bullet and kept on fighting, only to bleed to death later.


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do you have any comparisons on how big a knife has to be to do x amount of damage and the type of the blade? (I don’t really know if that made much sense)

It doesn’t really work like that.

Damage as a value is something you see in games because it’s an easy to
articulate abstraction. “You have a knife it does five points of damage. You
have a character, they have fifteen hit points.” That’s very easy to calculate,
and you’re looking at 3 attacks before the character expires.

What knives, and most weapons, actually do is tear apart tissue. It’s not
that your liver takes X amount of damage, it’s “did the knife pierce it? Is it
now bleeding?”

For games, that’s a bit daunting. It’s a lot easier to say a character can
take a fixed amount of damage before they expire, then tell the players to work
within that limit. At that point, it’s a natural fit to say that weapons have
fixed damage values. You can then modify these two elements to create a sense
of verisimilitude. It’s not how the world actually
works, but it feels good and creates a legitimate tensions for the

The closest you get to a hit point style calculation in the real world is, “how
fast are you loosing blood?” Usually, that’s what will kill you. At that point,
the only real distinguishing element is how big a hole did your weapon make. It
doesn’t have to be very big to get the job done. Bigger holes, or more holes
will get the job done faster.

The size and shape of a knife isn’t about how much damage it does, but how
you can use it. Anything over three inches is long enough to kill you. Larger
knives allow for different strike patterns. At a slightly abstract level, with
larger knives you’re trading speed and agility for mass. So, you use them in
different ways, prioritize different targets, and fight at different ranges.
Small knives are usable at zero range, while large knives (like machetes or bayonets)
actually have a minimum effective range, like swords and other “full sized”
melee weapons.

There is a purpose to the hitpoint abstraction, even in your writing, so
long as you keep in mind that it’s an artificial system. As we’ve said, many
times before, combat takes a toll on its participants. HP can be a legitimate
way of pacing your fight scenes, so long as it’s not information you’re putting
directly in front of your audience.

You never want to say, my character took X damage from that attack, but if
you’re actually writing about how your character narrowly avoided a blow that
caught and tore their jacket, or how they skinned a knuckle.

If you honestly have a hard time pacing fight scenes, giving your characters
a fixed value representing their health, stamina, and general good luck keeping
them out of harm, and then chipping away at it isn’t the worst possible exercise.
So long as you don’t turn around and then simply relate a turn by turn
breakdown of who slapped whom around, you may find it helpful in gauging how
fast your fight scenes should play out.

But if you’re close enough to use them, knives will absolutely ruin somebody’s


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Hey there. Went through some of your old asks to see if you’d talked about this before, but couldn’t find anything. My question is this: I’ve got a character who’s arm has been cut clean off at the shoulder (through some kind of magical, incredibly sharp sword). He’s got access to essentially modern-day medicine. How long will it take for him to bleed out/reach the point where doctors can’t save him?

At a wild guess, I’d think somewhere south of five minutes. The way you would calculate a concrete number is to divide ~2.25 liters by the volume of blood lost per second. That should give you the answer of roughly how many seconds your character can survive. Again, if it’s over 300, I’d be surprised.

There’s a minor issue in that calculation; the blood loss wouldn’t be completely
linear, and if you really wanted to do the math and get it just right,
you could use their blood pressure, and use that to get the volume of
the first couple spurts. Remembering that blood pressure drops as you spray blood all over the place like a broken lawn sprinkler; but even at low pressure, a wound like that is going to loose blood fast.

This is also why I can’t tell you exactly how fast your character will be losing blood. The answer there is “very,” but that doesn’t really help for a calculator.

That 2.25l value is actually an average. The real target is the victim losing ~40% of their total blood. For an average adult male, that’s going to be 2.24l. But, because all of these values are relative to the size of the victim, the time to bleed out shouldn’t be affected by this. There are a lot of medical conditions that can affect bleed times, and recovery. But, I’m willing to go out on a limb and say, at these volumes, none of them will really matter much.

The Wikipedia article on Bleeding should cover you for identifying the symptoms. It has (at the time of writing this), a copy of the four hemorrhage stages. The very short version is that the victim will become cold and clammy, disoriented and confused, unconscious, and dead, in roughly that order.


Does a person die immediately when they’re shot once, or do they have to be shot multiple times? Because I’ve seen in movies and books that a character is shot once in a not-that-important place, and they immediately collapse. Yet I’ve seen news articles that describe a person getting shot multiple times yet they still manage to get away.

Keeping in mind, the usual disclaimer about not being a doctor; my medical knowledge being limited, and I’m going to be simplifying some of this a lot?

In general? No. Gunshot victims usually die from blood loss. This can happen pretty quickly, or it can take awhile, it all depends on what the bullet damages. But, it’s not usually an instantaneous process.

I could swear we reblogged an infographic on blood loss symptoms by volume, but all I can find right now is this.

If a bullet nicks or severs an artery, this will result in rapid blood loss and death. We’re still talking about at least a couple minutes before death. With non-vital areas, where there’s only soft tissue damage, you could be talking about bleeding out for hours.

If the bullet damages internal organs, then things get a little messier. If the bullet manages to destroy something you actually need, like the brain or heart, then you’re going to die.

That’s the simple part… here’s the part that’s slightly outside my expertise. Hydrostatic shock is where a gunshot strikes someone, and kinetic force from the gunshot is transmitted through the fluid in their body to injure other organs. I’ve seen the discussion go back and forth over the years, some people insist that hydrostatic shock can rupture internal organs and cause people to suffer lethal injuries from relatively minor wounds, and there is some support to the idea that hydrostatic shock result in minor hemorrhaging. The other side of the argument is that, while the shock wave does occur, it isn’t actually life threatening. (There’s also a contingent who’ve been waging an edit war on the wiki page claiming that hydrostatic shock doesn’t exist at all.)

The actual hydrostatic shock wave increases the more a bullet disrupts the tissue. So .45 hollow points will produce more shock than a jacketed 9mm. These can result in minor brain hemorrhaging, but this usually comes up in autopsies, meaning they probably died from getting shot, and it turns out there was additional trauma that went undiagnosed.

If I’m sounding like I don’t know if this is relevant or not, it’s because I don’t. Ignoring specialized hydrostatic shock rounds (again, like hollow points, high explosive rounds, or anti-materiel rifles), I’m not sure if hydrostatic shock actually kills people, or just slaps an extra layer of damage on an already life threatening injury.