A trauma surgeon explains the bloody reality of keeping gunshot victims alive

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The shooting this month at the YouTube headquarters, which left four people injured and one person dead, shook Silicon Valley. But for Dr. Andre Campbell, a trauma surgeon at the Zuckerberg San Francisco General Hospital and the Trauma Center, where three of the victims were kidnapped after the shooting, armed violence is a daily reality.
"Gun violence occurs every day throughout the United States," Campbell told reporters at a press conference held shortly after the shooting. "But I do not see you here, because I would like to make sure that people know that we have a serious problem that we need to address."
Campbell, who has worked at the Zuckerberg General Hospital in San Francisco for more than 20 years and is also a professor of surgery at the University of California, San Francisco, calls gun violence a public health problem. "We have to find a way that the weapons do not cause the damage they cause at the moment," he tells The Verge in an interview. "I'm pretty skilled in dealing with bullet wounds, which is not something you want to become an expert in."

The Verge spoke with Campbell about his work in caring for victims of gun violence, the dangers of uncontrolled bleeding and high-speed bullet injuries.
The following interview has been edited and condensed for clarity and brevity.
He seemed surprised to see so many journalists at the press conference after the shooting on YouTube. What was that for?
The reason why I was surprised is that every day, traumatologists across the country face people who are victims of gunshot wounds. A couple of weeks before, we had a very large shooting in which six people were injured and taken to the hospital. But there was not so much attention in the hospital about what happened.
And when I was walking down the driveway to meet the press with our media partners, it occurred to me that they looked like a lot of cameras and video equipment for this, and I was asking aloud: "Wow. This is a lot of media attention. "But the reality is that this happens all the time, and you do not show up for all that. You showed up for this, which is fine, it was terrible what happened to these poor people who got hurt, but the reality is that you do not show up all the time.
So I wondered aloud, when suddenly people were a little surprised to have an opinion about it. And they did not expect someone to say basically what traumatologists feel all over the country and around the world: that this is a common problem, and it is something that we must have solutions for.
Have you reached the point where you can recognize different weapons because of the wounds you see?
The reality is that if someone is shot by a high-caliber, high-velocity weapon, mass destruction is created. I've seen some of those, but it's hard to really say. The holes are small and come out very large. So those are serious and real injuries that people have, right? But I really can not tell from looking at the wounds unless it's something really big. I can say that most of the people who have injuries are shot with guns, and the guns, cause a good amount of injuries when they shoot you.
How do short weapon injuries differ from high speed weapons?
One of the ways it is described is if a high-speed [bullet] hits your liver, basically it looks like you've dropped a watermelon from the standing position to the ground, and it basically explodes, like it explodes. And that's how your liver looks if it hits you. While if you shoot with a gun in the liver, there is a cone of destruction that is a centimeter around and passes through the liver that way.
What is more difficult to deal with?
When someone has a high-speed weapon, it is much more difficult. But everything depends on where the patient is injured or injured. If they are shot in a vital organ, it only takes one bullet in a bad position for someone to die. So, if you are shot in a main vessel, such as the aorta or vena cava, or the carotid artery, or the femoral artery, you can bleed to death for that.
As a trauma surgeon, what would you like people to know about the kind of destruction bullets can cause to the body?
We all go into trauma surgery because we are trying to save people's lives and take them to their family. And what happens unfortunately when you are shot with a weapon, this can cause irreparable damage. He may have a head injury, he may have a major destruction, he may lose his functions in the arms or legs, depending on whether his spinal cord is injured and the location [the]; Obviously, you can die if you have a massive hemorrhage and you have catastrophic injuries to vital organs. Things can happen that can change a life in a second.
We are pretty good at what we do. But it is better not to receive a shot than to be shot and have us solve you. We are good enough to take care of people when they are injured, but we are not perfect.
Let's say someone comes with a bullet wound, what is the most important thing to do first?
We evaluate your airway, observe your breathing, observe your circulation and observe [at] if you are disabled or not. And then we basically expose them, and we search everywhere to make sure we do not lose any holes anywhere. Then we do an evaluation from head to toe. Look at your head, look at your neck, look at your chest, look at your abdomen, look at your pelvis and legs, and turn them to see if we have examined every area of ​​your body or not.
And then, at that point, then we begin to decide what should be done. Does the patient need to go to the operating room? Are they going to the CT scanner? If the wound is tangential and stable, do they need to go to radiology or should they go to the operating room? So that's what we're doing, since we're trying to figure out what happened to the patient.
Before the patient arrives at the hospital, is there anything that passers-by can do if someone has been shot near them?
There are a number of things that happen when there is a bullet wound in the immediate vicinity. The first thing is that the police must secure the area, number one. Then the paramedics will come. The main thing is that people can not become additional victims after a shooting. You should basically stay out of the way and make sure you are not another victim.
Once things are secure, then there are things you can do [with training from a program called Stop the Bleed]. You can compress with a shirt, preferably a clean one. You can pack the wound if you can, and then apply a well-placed professional tourniquet if you have wounds to the extremities or arms and legs. That is something that a bystander can do to help. But you have to have a little training, you can not do it just because of your love for trying to help humanity. You need training, like anything. You want to do the right thing to try to save people, you do not want to make things worse.
Is there anything else you would want people to know about your work, especially about shooting victims?
I am a trauma surgeon, but I do not work in isolation. We have a very sophisticated trauma system that has developed over the past 30 to 40 years. The system consists of paramedics in the field, consisting of firefighters who help paramedics. It consists of the emergency department, the operating room, the ICU and the rest of the hospital. And then, after we've done everything, patients go to rehabilitation, where they basically learn to do the things that might have been compromised after receiving the shot: they may have to learn to walk, they may have to Learn to get your strength together. There are all kinds of things that happen after injury. There are literally hundreds of people involved in patient care when something like this happens. Now you are talking to me, but I am one of the many people involved in caring for these people after they have been injured.
If you had a message about the number of victims of armed violence, what would you say?
The main thing is that many people are shot, it is a public health problem and this current situation is bad for our patients. That is the message I want to say. Being shot is something terrible. We've become pretty good at fixing people. But we can not save everyone, and that's the hardest part of doing what I do is that sometimes I look at someone and I know I can not save them, and that's really hard.


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