This fast-paced lecture by JEMS Medical Editor, Ed Dickinson will review the fundamentals of ballistic injuries and the science and operationalization of the interventions listed above. This is an important presentation because the world is an increasingly dangerous place, with rising tolls of gun shot wounds in urban trauma and active shooter events across the country that know no geographic boundaries. The definitive care of gun shot wounds still rests in the hands of skilled physicians and surgeons within the walls of the hospital. Our mission as emergency care providers is to deliver patients to those skilled colleagues alive. The prehospital management of penetrating trauma has changed significantly. Lessons learned in combat are now well disseminated into the field. Our experiences with hemostatic agents, tourniquets ,non-EMS transports, permissive hypotension, junctional bleeding control devices, TXA and prehospital transfusions, have shaped our revised approach to the management of penetrating trauma and allowed us to deliver more penetrating patients alive to definitive care. This lecture will help you save patients in need of rapid, definitive care.