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The clock starts ticking when the bullet hits the flesh and the blood begins to flow.
How long before the bleeding can be stopped and the lost blood replaced is the difference between life and death, if doctors can repair the damage.
“Time is tissue,” says paramedic Jeremy Hill of the Columbus Department of Fire and Emergency Medical Services. “If blood’s not circulating to a part of the body, then that part of the body starts to die.”
And that part of the body could be a vital, internal organ.
Hill and colleague Skyler Baldwin say they may impede bleeding from arms and legs, when treating a gunshot victim, but if it’s internal, the best they can do is start an IV, assess the damage, and get to the emergency room.
That means the trauma center at Piedmont Columbus Regional, where trauma program manager Mary Bizilia’s staff goes to work, acting on the information the medics call in.
“They would give us as many details that are pertinent and possible that they have,” she said, so the emergency room crew can ready an operating room for surgery.
With gun violence increasing in Columbus and across the country, the Ledger-Enquirer spoke with frontline workers in emergency medical care to better understand the challenges they face here.
Those who regularly deal with gunshot wounds can tell the pace has picked up. “It’s a lot more frequent now,” said Baldwin.
Said Bizilia: “It is unusual compared to the past. I think in the past year we’ve seen this particular mechanism of injury, gunshot wounds, double, at least double.”
The average is 30-40 every month, about one a day, she said.
Fire Marshal John Shull, also a paramedic who serves as the department’s public information officer, had figures showing that from Aug. 6, 2020, to Aug. 23, 2021, medics were called to 213 shooting incidents.
“If my calculations are correct, that is a shooting every 31 hours,” he said.
Columbus’ climbing death toll has been clear from annual tally of homicides, most of which involve guns: 83% of the 234 homicides between 2016 and 2020. Last year Columbus had 46 homicides, more than the 41 in 2019, 34 in 2018, 44 in 2017 and 28 in 2016.
The nonprofit Gun Violence Archive says increasing gun deaths are a national trend: About 44,000 people died from gunfire in 2020, around 24,000 by suicide.
Excluding suicides, homicides and accidental shootings annually claimed an average of 15,284 Americans from 2016 through 2019, according to the archive. In 2020, those deaths totaled 19,411, topping every tally of the past 20 years.
Of Columbus’ 52 homicide victims in 2021, as of Sept. 20, all but five were shot.
Taking the call
If you encounter someone who’s been shot, get to safety yourself before calling 911, the workers said.
“Give us as much information as possible,” said Shull. Dispatchers will want to know how many are wounded, how many shots were heard, and whether a shooter still is present. The medics prepare based on the details they get.
But when they get there, they may not immediately rush in to treat the injured.
That’s because they’re required first to make sure police officers secure the scene, before they go in, a protocol that can be frustrating both for the medics and the witnesses who called them, said Baldwin and Hill.
Hill said he has faced that rancor, while waiting for police:
“You have to say, ‘There’s nothing I can do right now, because I don’t know what’s in there. So if I go in there, and something happens to me, now somebody’s got to come for me.’ I just escalated the whole situation by not following protocol and doing what I was supposed to do.”
Once the scene is safe, the treatment begins: Medics must assess the patient’s condition, and determine where the wounds are.
“It could be something as minor as someone was grazed in their arm, or it could be they were shot seven times,” said Baldwin. “We just have to go from there. Each one is completely different.”
Typically they start an IV, to get fluids into the blood stream. They don’t administer blood, but the fluids keep the circulation system going, they said.
The IV also opens a portal for giving medication, and for the hospital to replace the lost blood, when the patient arrives.
“As a patient becomes hypovolemic, meaning that they’re losing their blood volume, it gets harder and harder to get an IV on that person, because their veins are kind of flattening out,” Shull said. “And sometimes we have to get them in the neck, at that point, if we can.”
If the patient has been shot in the torso, the medics can’t tell how much damage was done.
“The internal injuries that somebody receives, you don’t know what happened in there,” said Hill. “When a bullet enters, it’s going to cause a pathway through there that just wreaks havoc on the inside of a body.”
The best he can do is assess where the wounds are, and which are entrance wounds and which are exit wounds, to estimate the bullets’ paths, Hill said. “So now when I get to the hospital, I say, ‘Hey Doc, this is the wound track. This is the entrance, this is the exit.’”
To the hospital
The emergency room readies for the patient based on what the medics report.
“Really any traumatic injury is all the same.,” said Bizilia. “The only thing that kind of separates a gunshot wound from, let’s just say a motor vehicle collision, would be that our security measures would be amped up, a lot.”
Officers working security guard the emergency room and other hospital entrances, on alert for anyone who might cause further trouble.
“If it was an act of violence, we want to make sure that nobody’s following the patient,” said Bizilia. Sometimes the shooting was related to a family dispute, and angry relatives arrive, she said.
“If there is any type of drama going on, they might just decide to settle it here in our hospital,” she said.
The staff “swarms” the patient upon arrival, she said. The crew includes trauma nurses, surgeons, X-ray technicians and a pharmacist. For internal bleeding, an operating room is prepared for surgery.
“The only way to save them is to stop the bleeding and replace the blood,” Bizilia said, so any damage must be patched.
“You can’t fill a bathtub up if the drain’s open,” she added. “Sometimes the bleeding is inside their organs, and the only thing we can do then is to take them to the operating room so the surgeon can stop that bleeding.”
She said police usually arrive to question the patient, if possible, but the ER staff leaves that to the authorities.
“We focus on the care of the patient. We let law enforcement get all the details,” she said. “In my medical mind, it’s almost like, I don’t care who did it. We’ve got to fix this problem.”
In the midst of a crisis, emergency medical workers don’t have time to think about the stress, they said. They rely on their training.
Both Bizilia and Hill called it “muscle memory,” performing a procedure so regularly it feels automatic.
“All the instructors I had, they drilled it so hard: the systematic movement,” said Hill. “It’s muscle memory: Do it over and over and over and over.... You don’t even have to think about what you’re doing. It’s just you see it, you do it.”
The time to reflect is when the emergency has passed, the workers said.
“Sometimes we’ll go through these situations, and then it dissipates, and you’re like, ‘Wait, what just happened?’” Bizilia said. “You’ve got muscle memory, and it’s like a light switch turns on and you go.”
What they witness can weigh on them, but having colleagues to talk to helps, and both the city and the hospital offer counseling services through the Pastoral Institute, they said.
A child’s death can be the hardest to accept, Hill said: “The kid calls are difficult.... When it’s a child, they haven’t experienced life yet, and a lot of times, they’re confused about what’s happening.”
Bizilia once worked as a helicopter life-flight nurse. She still remembers a teenager who died after a skateboarding mishap, one of two or three cases she can’t forget, she said: “They’re the ones that never leave you.”
She said she wishes she could talk to some of the teens involved in gun violence today.
“I just want to beg and plead with them: Please stop. You are so young, and there’s so much more to do.”
Hope and camaraderie
Bizilia is 35, from Opelika, Alabama, where she decided to become a nurse so early that she can’t remember making the decision.
“I was just always going to be a nurse,” she said.
A devout Christian who’s been on overseas missions to Kenya and Honduras, she found emergency care a good fit for that.
It’s worth the sleepless nights, she added: “I don’t sleep well.... I will admit I get burnout sometimes, but I know I’m exactly where I’m supposed to be right now for a purpose, and I love my job, and I love the people I work with.”
The paramedics echoed that.
Hill, 38, is from LaGrange, Georgia, and now lives in Harris County. He set out to join the military, but was medically disqualified. He joined a volunteer fire department before becoming a paramedic.
“Until you experience it, you have no idea how it’s going to affect you,” he said, recalling an instructor who told him that if you do the best you can on each call, you have nothing to regret afterward.
“When you leave that call, you need to leave all that emotion and stress with it, because you did everything you could,” the instructor said.
Baldwin, 27, a Columbus native, was inspired to become a paramedic by his father, a combat medic deployed four times, serving in Iraq and Afghanistan, he said.
“I just think we have one of the best jobs in the world, with the people we get to hang out with, honestly,” he said. “We’ve all been working together for years.”
Said Hill: “I’d say it’s a calling. You want to do it or you don’t.”
BEHIND OUR REPORTING
How we did this story
With the continued rise in homicides and gun violence across Columbus, Ledger-Enquirer reporter Tim Chitwood wanted to know how this impacted people on the other side of an incident -- the emergency service workers who have to respond these shootings and provide care.
This story is part of our ongoing, in-depth coverage of homicides in Columbus. While we recognize our role in providing daily news on shootings, arrests and homicides, it’s also important to take a step back and look at the news cycle from a broader view.
If you would like to share your experience or ideas, please email Tim Chitwood at [email protected]
Tim Chitwood is from Seale, Ala., and started as a police beat reporter with the Ledger-Enquirer in 1982. He since has covered Columbus’ serial killings and other homicides, following some from the scene of the crime to trial verdicts and ensuing appeals. He also has been a Ledger-Enquirer humor columnist since 1987. He’s a graduate of Auburn University, and started out working for the weekly Phenix Citizen in Phenix City, Ala.
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