# Gunshot treatment



## QC (Apr 1, 2009)

Ignore the main story, some interesting observations about gunshot treatment


A trauma doctor who treated one of Sydney's most notorious criminals after he was gunned down in the 1990s at close range says Peter Zervas's bullet-ridden car may have been crucial to his survival on Monday.

Dr John Crozier said he wasn't surprised Zervas survived being shot multiple times, but said the Hells Angel was "lucky" one of the bullets did not sever a major blood vessel, which would have likely resulted in death.

The survival of criminal Edward "Jockey" Smith after he was shot seven times at close range in 1992 - and treated by Dr Cozier - left him "the indelible impression ... that with the right combination of good luck and good treatment a person can survive multiple gunshot wounds", he said.

"A gunshot will kill if it hits a vital structure, for example, the part of the brain [that controls breathing or the heart], or if it hits a major vessel," Dr Crozier, a vascular and trauma surgeon at Liverpool Hospital, said.

He said the hospital treated up to 80 gunshot victims a year and most survived.

"If you arrive with signs of life the probability of survival is quite high."

When police found Zervas, he was leaning against his car. He had been hit at least four times as a gunman pumped 11 or more bullets into his Hyundai, which he had stopped at the security entrance to the underground car park of his mother's Lakemba apartment block.

He was shot in the right shoulder, upper chest, right hip and right foot, but was now in a stable condition at St George Hospital.

"I think the guy's been relatively lucky, but the long and the short of it is: 'Has the patient suffered injury to any major blood vessels?'," Tony Grabs, director of trauma at St Vincent's Hospital, said.

"If someone gets shot and a major blood vessel is not damaged, even if other things are damaged, for example if there are broken bones or bullet holes, usually in most instances it is treatable."

The gunman in the Zervas shooting fired three times through the car's right-hand-side rear window, then fired six through the rear driver's side window, once into the driver's door and one more through the window.

Dr Crozier said the fact shots were fired through the Hyundai's windows or side-panels reduced the risk of a bullet damaging Zervas's major blood vessels, Dr Crozier said.

"The intermediate targets [the car windows and doors] would have dispersed the energy and changed the way the bullet interacts with the body [compared to if it been fired directly at Zervas]," he said.

Likewise, Zervas's clothes could have played a role.

"If a bullet impacts a leather jacket or denim, the hollow can become filled with leather and it doesn't disperse as intended."

Dr Grabs, who has worked for the military, said shootings in the city were also often done by amateurs using lower-grade weapons.

"They fire a round of shots and a number of them don't hit the target, which is completely different to someone with a single bullet wound," he said.

Dr Grabs said he could understand why people were perplexed that Zervas survived, after actress Natasha Richardson died following an accidental fall on a ski slope earlier this month.

"That's the thing with the human body, it depends on exactly the location of injury.

"Natasha Richardson's blood clot started to push on the brain [and she ended up in a] non-recoverable position.

"It does seem incredible that someone would die from a simple fall like that versus someone being shot multiple times."

Dr Grabs also dismissed the idea Zervas survived because of his mental toughness, after a police source remarked: "There's too much of the devil in him to give up."

"You can't turn it on and off ... the truth of it is everyone has that same survival response mechanism," Dr Grabs said.

This included the body shutting down blood supply to non-vital areas, to maintain blood pressure and the supply of blood to the brain to keep the person awake.

Dr Crozier said people's impressions about gunshot wounds were also coloured by unrealistic TV depictions.

"There's a lot of fallacy about what happens when a person is hit by a bullet," he said.

"Often [on TV] people are thrown back to the rear quite a long distance, there are dramatic sprays of blood ... the problem with most of these fictionalised and overdramatised shows is that people watch them and think a single shot will usually kill."

This included the idea people could die from the shock of bullet wounds.

"That's a commonly held fallacy that's out there and depicted in these cowboy westerns, in many low-quality but popular films."

Dr Crozier, who has worked as a trauma surgeon in the UK, Rwanda, Timor, and Banda Aceh, said he had "seen enough over many years in many parts of the world to not be unduly surprised" when people survived gunshot wounds.

But there was one victim - "Jockey" Smith - whose survival stuck in his memory.

"Jockey Smith was a day out of Long Bay and was shot about five metres away about six or seven times as he was running up stairs in Bondi.

"I was involved with his care that day.

"When he arrived he had multiple gunshot wounds to the chest and abdomen; he was barely alive.

"We split him from the chest to just above the penis, a big mid-line incision.

"He'd been shot through the liver, bowel, but it hadn't hit the heart or aorta, so he survived for several months ... before he was killed by a policeman in Victoria.

"The reality was he survived after being struck that many times, as close as he was, by someone very committed to killing him.

"He left the indelible impression in me that with the right combination of good luck and good treatment a person can survive multiple gunshot wounds."

http://www.smh.com.au/national/how-...ed-hail-of-bullets-20090401-9ik4.html?page=-1


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## amlove21 (Apr 2, 2009)

you know, here is the thing about gunshot wounds, stab wounds, general trauma- any of this stuff, i would prefer my patient to be lucky, and not good. I think this article speaks volumes to a couple of different points, and some of the other medic types can speak volumes on this- I have seen people who have NO REASONABLE BUSINESS pulling through an injury making it happen. All you need is a little luck in a heart attack, shooting, stabbing, car accident, whatever- and your human self will make it. You would be surprised by who makes it and who doesnt, and often there isnt any rhyme or reason. 

I think they are WAY, WAY off when it comes to the mental toughness aspect of it, however. In "On Combat", by Lt Col Dave Grossman, Dr Grossman describes a policewoman who was followed home by gang members and viciously attacked. She took a .357 slug, within ten meters, to center mass as she exited her car to enter her house. She took a direct hit to her inferior vena cava and most of her right ventricle- and returned fire. It blew a tennis ball sized hole in her right shoulder blade. Even as she was fading, she continued to fire, till she was empty, and called help for herself. She even scored no less than 4 hits on the three attackers. The most amazing part? She was back on the job less than 9 months later. 

Ladies and gents- I am, and have been for a while now, of the belief that strong, trained warriors are harder to kill than average humans (no offense to normal humans :)). While a little luck goes a long way, it can be the other way too. A weak mind can a strong body deceive. 

Which brings me to my point for medics, or if you are the first responder to an accident, whatever- work every case as if it were your brother/sister/mother/father/best friend- cause you never know who might be too damn stupid to die. 

Just my two cents, but awesome article.


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## 8'Duece (Apr 2, 2009)

So there's so many variables that are not discussed here. 

It seems vague on some level, but spot on to others.  For instance, if most thugs are using ball ammo in shootings it may make a large difference in the outcome of the intended victim vs using a high end jacketed hollow point or frangible round, especially if the victim is hit multiple times not just once. But, I'm no expert on the matter and I wouldn't want to be shot by any caliber bullet. :eek:

I'm sure there are plenty of statistics out there with more attention to detail on the matter of type of ammo, number of hits, time to treatment, type of treatment, availability of first responders and location of hospitals and trauma care units etc. 

Neat article though.


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## Muppet (Apr 3, 2009)

I agree with you A.M. I have had more that a few G.S.W.'s in the past, most to the head that refused to die and stayed alive in S.I.C.U. for days before dying of M.O.S.F. or brain death. 1 in particular had brain matter, decorticate posturing and was normotensive with an hospital stay of 4 days before dying. The body is an amazing thing.
I do also believe that the training that out "warriors" recieve including the ones on this board assist them in staying alive, perhaps from the mind/body thing and of course the sympathetic response to shock. Just my :2c:

F.M.


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## 7point62 (Apr 16, 2009)

amlove21 said:


> Which brings me to my point for medics, or if you are the first responder to an accident, whatever- work every case as if it were your brother/sister/mother/father/best friend- cause you never know who might be too damn stupid to die.




bump


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## HOLLiS (Apr 16, 2009)

One of the great wonders of life, we don't know till we know.


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## Ranger Psych (Apr 16, 2009)

the hard will hold on for a long time but the bad thing is, when the grip slips it's going to be from a long ways up that rope because they fought for every inch of it.


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