Advances In Trauma Care Coincide With Decrease In Gun Deaths

Doctors at the trauma center at Los Angeles County-University of Southern California hospital deal with gunshot victims nearly every day, and their ability to save lives keeps improving.

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We're going to take you now inside one of the busiest hospital trauma centers in the country to hear how care has improved for the victims of gun violence. As the country debates guns and gun control, it's worth noting that advances in trauma care have coincided with decreases in gun deaths and homicides. Researchers are studying what the relationship between those trends may be. But one thing is clear, by changing a few simple-sounding practices, doctors have increased survival rates for trauma, including gunshots, by double digits.

NPR's Kirk Siegler has our story. But first, a warning, this report contains some graphic sound and descriptions.

UNIDENTIFIED MAN #1: Mr. Acres, please return to 7D, Room 134. Mr. Acres, please return to unit 7D, Room 134. Thank you.

KIRK SIEGLER, BYLINE: It's Saturday night at Los Angeles County-USC Medical Center. It's early in Dr. Elizabeth Benjamin's shift. With a large coffee in hand, she makes her rounds in the ICU.

DR. ELIZABTH BENJAMIN: Can you squeeze my hand? Squeeze my hand. Squeeze. Squeeze. Good. Good.

SIEGLER: This woman was shot in the head last night. Dr. Benjamin says she's lucky to be alive. It's an injury that could have been fatal, if not for the quick assessment and treatment of her injuries.

BENJAMIN: The key in a trauma center is you have people that see these injuries every day. So, people are used to the flow of what needs to happen and how quickly it needs to happen.

SIEGLER: Located in East L.A., County-USC is one of the nation's largest and busiest trauma centers. If you want to learn how to treat trauma victims, this is the place to be.

BENJAMIN: And here in sunny California, we happen to get a lot of gunshots and stab wounds. So...

(LAUGHTER)

SIEGLER: Moments later, almost as if on cue, a call comes in, a victim of multiple gunshot wounds is arriving by helicopter.

(SOUNDBITE OF HELICOPTER)

SIEGLER: Up on the seventh floor, a team of paramedics jump out of the chopper and unload a 19-year-old man who's been shot in the leg.

UNIDENTIFIED MAN #2: I've got two gunshot wounds, one to the right - this side here - and the other one is to the right leg.

BENJAMIN: OK.

UNIDENTIFIED MAN #2: He's got motor and neural...

SIEGLER: The victim's pants are torn off. You can see his bloody leg and the two wounds where the bullets hit. He's quickly whisked downstairs to the ER. He's conscious but writhing in pain.

(SOUNDBITE OF MOANING MAN)

BENJAMIN: You can see in there?

UNIDENTIFIED WOMAN #2: No...

UNIDENTIFIED MAN #3: Nope, I can't.

BENJAMIN: All right.

UNIDENTIFIED MAN #3: Let's roll him.

BENJAMIN: Can put this leg down?

UNIDENTIFIED MAN #4: Jaime. Jaime...

SIEGLER: As tonight's trauma team leader, Dr. Benjamin hovers over a group of about a dozen physicians and nurses now working on the victim.

BENJAMIN: OK, we're going to get you some pain medication right now. OK?

SIEGLER: Everything that's happened to this point represents a major advancement in trauma care. Instead of trying to stabilize or even save a victim on site, EMTs just get them to a trauma center as quickly as possible, even if that means passing right by the closest hospital. They call it Scoop and Run.

BENJAMIN: This idea of don't try to save the life in the field, get them to somewhere that has, you know, 50 people waiting and ready as quickly as you can is key.

SIEGLER: This young man's injuries aren't life-threatening. That allows the team to turn its attention to a second call that's just come in, another gunshot victim, ETA by ambulance five minutes. This patient much more serious, a five alarm fire they call it.

UNIDENTIFIED MAN #5: Where are we going?

UNIDENTIFIED MAN #6: Recess 10, second left.

UNIDENTIFIED MAN #5: Second left. Second left.

BENJAMIN: Five minutes.

SIEGLER: Paramedics rush the victim to the E.R. and the tension is now way up.

UNIDENTIFIED WOMAN #3: One, two...

UNIDENTIFIED MAN #6: You got the sheet? Got the sheet?

UNIDENTIFIED WOMAN #3: One, two, three, one two three...

UNIDENTIFIED MAN #7: Thank you.

UNIDENTIFIED WOMAN #3: It's all right. Carol...

SIEGLER: It takes six people to hoist the patient from the stretcher to the table. Dr. Benjamin is no longer hovering. She's right in the middle of things. This man's wounds are so severe they'll need to open his chest right here in the E.R.

(SOUNDBITE OF EMERGENCY ROOM)

SIEGLER: It's gory. Blood is everywhere. And every one has a job. One person holds down the victim's legs. Another grips huge clamps to pry his chest open so a doctor can reach in and grab hold of his heart.

BENJAMIN: Evacuate your cloth, bring your lung down, Go. Go. Go.

SIEGLER: They do a few brief repairs, which work, buying them enough time to x-ray his chest and pelvis, before they wheel him up to the operating room.

(SOUNDBITE OF ALARMS)

UNIDENTIFIED MAN #8: Ready, x-Ray.

BENJAMIN: (Unintelligible) for X-Ray.

SIEGLER: Before hurrying into the O.R., Dr Benjamin stops to scrub her arms and hands.

BENJAMIN: His heart stopped multiple times during that. We were doing intra-cardiac - we're doing cardiac massage. So that means basically somebody has their hands in his heart, inside the chest, in the emergency room, helping it pump as his heart is not pumping on its own, so it needs somebody to pump it for him.

SIEGLER: What the doctor is describing could never have been done by an EMT in the field, and it wouldn't have happened anywhere 20 years ago. It's a vivid example of just how aggressive trauma treatment has become at hospitals like County-USC.

DR. DEMETRIOS DEMETRIADES: And because it's a trauma team activation, it takes full priority; priority over all other patients. Even if the hospital is very busy, you drop everything, you go for this patient.

SIEGLER: Dr. Demetrios Demetriades has driven a lot of these changes since taking over County-USC's trauma unit in 1992. Improved CT scans have helped doctors quickly pin point the extent of injuries. Blood and plasma are used liberally to try and stabilize the patient, a lesson learned from the military. But Demetriades says the biggest improvement is that there are simply more trauma centers like this available to more people.

DEMETRIADES: If you have severe trauma and you are admitted to a trauma center, your chances of survival are about 25 percent higher. This is a major progress. It makes a big difference in a big scale.

SIEGLER: Dr. Demetriades is currently studying what role the recent advancements in trauma care are playing in the declining U.S. homicide rate.

BENJAMIN: OK. Can I get a valve core retractor please? And we need some wraps - a ton of wraps, just keep them coming.

SIEGLER: Still, even the most experienced and aggressive trauma centers like County-USC can't save everyone. The man with multiple gunshot wounds to his chest has been in the O.R. for more than an hour. Dr. Elizabeth Benjamin is still in her scrubs when she walks out to deliver the bad news to two cops, who have been waiting outside.

BENJAMIN: We're done.

UNIDENTIFIED MAN #9: Did he make it?

BENJAMIN: No.

SIEGLER: The man had no pulse when he arrived at the hospital. And his chances of survival were slim.

BENJAMIN: But they're not zero. So that's why we do it for those few people that we can save with that. Unfortunately, for him, his injuries were just so broad over too many different organ systems that that was not possible.

SIEGLER: Benjamin then gets ready for the other most difficult part of her job. She has to deliver the news to the victim's wife. It's 1:00 A.M., six more hours to go on her shift.

Kirk Siegler, NPR News.

(SOUNDBITE OF MUSIC)

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