Self-inflicted, unintentional GSW

You can imagine the thought process associated with being dispatched to your first gun shot wound. The narrative has been altered to change specificity and situation.

This unit was dispatched to a 32yo male w/ self-inflicted unintentional GSW x1 to the hand. Additional information from caller while en route informed pt conscious and alert. Dispatch notified LEO, en route. Arrived on scene to find two bystanders in an open field. Pt found sitting in passenger seat of van with ~5cm hole in the front windshield. No gun visible. LEO arrived ~2 min after EMS, secured .40cal handgun. Pt states he reached for the handgun on the floorboard of the van and it went off accidentally. Pt had a patent airway, no respiratory distress, and displayed his L hand which had no apparent active bleeding. Rapid trauma exam revealed no life threatening injuries. <5cc blood estimated lost. L hand had ~1cm entrance wound on anterior palmar aspect ~3cm from medial border and ~2cm from wrist. ~1cm exit wound on medial border ~3cm from entrance and ~4cm from wrist. Powder burns noted at entrance wound. Skin warm/dry, pupils sluggish, pulse fast/bounding. Pt refused further physical examination. Wound irrigated with sterile water, bandaged, wrapped with gauze. Pt refused further treatment. Pt refused transport. Pt advised of treatment/transport options and injury severity. Pt signed refusal. LEO witnessed refusal.