Absolutely. If your fight or flight hasn't kicked in before the gun shots it WILL kick in once the shots start and you know they are shooting at you. Like I said there was that kid who was shot in the forearm, he didn't fight but managed to zig zag around cars to avoid other shots. I arrived on scene maybe 90 seconds after the call went out and found him walking normally to the point only the blood on his arm was an indication of a gun shot wound and the inside of his arm must have been interesting. He was released from the Trauma Center 2 hours later. "Why" some may ask (but not you, if I recall right you work in an ER?)? The X-Ray revealed the bullet (small caliber .32 or smaller) had hit one of the bones in the forearm and fragmented. They would have done more damage going in and removing the fragments so they said "here are your follow up instructions, good luck they are a souvenir."
Bullets to extremities will do one of four things:
1 - In and out without hitting anything major ([Monty Python]It's only a flesh wound![/Monty Python]) - clean it up and send them out.
2 - In, damage nothing major, and stop - clean it up and send them out. The puncture wound from the bullet track is less traumatic to the body, generally speaking, then digging it out.
3 - In, break the bone or damage vascular structures - repair the damage. This will generally mean a trip to the OR.
4 - In and out (with or without hitting anything major in the limb) and then into the another body part (usually the torso). Probably a trip to the OR.
The first two are the most common. Bullets are considered sterile by many, so most aren't even started on antibiotics. The wounds are most often not even closed, because closing the end(s) of a puncture wound provides a perfect environment for an anaerobic infection.
Although I did see one interesting case that started with an extremity injury...
Three men, hunting deer. 30-06 loaded on the dash. Stopped dinner. Slammed the door, knocked the gun off, and it fired.
The bullet hit the first guy, went through his upper arm, then in the ribs at an angle, bounced off the
inside of his sternum, and exited on the other side. He got chest tubes in both sides, and did fine.
Hits the second guy below the ribs, exits on the other side, rupturing his aorta and pulling a big loop of bowel out through the exit wound. Died very quickly.
Hits the third guy at the lower ribs, penetrates a couple inches and stops in the lung. Removed it, put in a chest tube, he also ultimately did fine.
As to the original subject...
I think one thing that needs to be stressed in these short courses is that the goal is
not to beat the other person. It's to create an opportunity to escape.