Exit Wounds
2:21 pm
Wed January 30, 2013

Medical Improvements Help More People Survive Serious Gunshot Wounds

It seems several times each month, Milwaukee mourns people who have been shot to death.

Last year in the city, gunfire killed 72.

The numbers would be substantially higher, but emergency medical workers have become good at saving lives. In 2012, 500 local people survived gunshot injuries, although some will face life-long challenges.
 

When Milwaukee’s EMTs are summoned to treat a gunshot victim, they follow choreographed steps as soon as they arrive.

“Instantly, if the patient is conscious, we’ll start to interview them, simultaneously disrobe them,” says Fire Department Captain Michael Wright. “There’s a lot of things going on in the individual’s mind that has been wounded, and they may not know how many times they’re wounded. So a question we ask is: ‘how many shots did you hear?’”

Wright says the answer gives EMTs an idea of how many injuries they need to find.

Paramedics place a wrist band on each gunshot victim, designating his or her condition.
Credit Ann-Elise Henzl

The first responders then pull out an array of supplies to manage the wounds and the pain.

“I’ve kind of laid some things out, kind of in the order that we would use them…”

Wright is sitting in the back of an ambulance, at Fire Department headquarters, downtown. He’s spread the supplies out across the stretcher. First on the list: big, sharp scissors to cut through heavy clothing. Also, a gauze dressing, to prevent air from escaping through a chest wound.

“We only want them breathing through their nose and mouth, not out of their chest, so that’s one of the things we put on there,” Wright says.

Wright says Milwaukee extensively trains emergency responders to handle gunshot wounds, because they’re so common. For serious injuries, paramedics use supplies and techniques the military employs.

“We now in all of our paramedic units carry tourniquets and we’ve had to use them several times. And basically, that’s when all other efforts have failed to control the bleeding, and you put it on the extremity above where the injury is, and tighten it down, and that stops the bleeding one way or the other,” Wright says.

Paramedics take the most seriously injured patients to Froedtert Hospital, the region’s only Level 1 trauma center.

“We’re right now in the ambulance bay, where we can hold upwards of 6-8 ambulances at any one time,” says Froedtert & The Medical College of Wisconsin Emergency Medicine Physician, Dr. Stephen Hargarten.

He says patients with the most severe wounds bypass the regular emergency room, and are wheeled to an adjacent space. It’s reserved for trauma victims: people critically injured in accidents and shootings.

“Literally, there is a team waiting for the patient,” Hargarten says. The room has four beds. “So, at the head of the bed is one of our emergency physicians, who is dedicated to make sure the patient is breathing adequately. There are two nurses on either side of the patient, two other doctors on either side of the patient, and there is a doctor at the head of the bed, directing the care,” Hargarten says.

Large clocks hang on each wall, so workers can track a patient’s progress. Machines stand ready, to perform X-rays and CT scans.

Froedtert & The Medical College of Wisconsin Chief of Trauma and Critical Care, Dr. John Weigelt, says the scans help physicians determine the extent of wounds, some of which have become all too common.

“The extremities are classic for gunshot wounds that break bones, injure blood vessels, and cause a fair amount of damage to muscle and what we would call soft tissues. The chest is also a target many times, and so you can have collapsed lungs. And then in the abdomen, anything is fair game,” Weigelt says.

Weigelt says he’s seen cases of one bullet hitting every organ in the abdomen.

Advancements in medical technology have helped surgeons improve their treatment of gunshot wounds. Weigelt says in some cases, new procedures have even eliminated the need for surgery, such when a bullet damages blood vessels.

“The patient doesn’t even have to have an operation. They do have to have what would be equivalent of a coronary catheterization,” Weigelt says.

Weigelt says something else that’s led to improvements in care, is repetition. Froedtert treats an average of 300 gunshot victims per year. Froedtert & The Medical College of Wisconsin Emergency Medicine Physician Stephen Hargarten says successes are a team effort.

“The sooner we get paramedics at the scene, the sooner that they can start those life-saving interventions, the sooner they can get to the right place, the more likely they’re going to have a good outcome. If you arrive with elements of life, chances are you’re going to survive, once you get here. That wasn’t always true,” Hargarten says.

Yet Hargarten says many who survive face daunting challenges.