PHILADELPHIA – Thunder, followed by torrents of rain, punctuated the sultry night. An Imam with a multi-colored skullcap comforted a woman wearing a black burqua in the crowded waiting room of the emergency department. Her body was contorted in pain as she lurched forward, then fell backwards. Patients' children played in front of the soda machine.
An announcement in the nearby surgical trauma department alerted the staff that an ambulance was bringing in a stabbing victim and was five minutes away. Eight members of the trauma team put on lead-lined smocks to protect themselves against any x-rays, purple latex gloves and a transparent plastic guard to keep blood from spraying into their eyes.
Minutes later, a 24-year-old woman was brought in. Her blood-soaked sheet was tossed on the floor. She squirmed in pain from stab wounds to the face and back and fitfully tried to remove the oxygen mask. She babbled incoherently as the head trauma surgeon examined her body carefully with a pocket flashlight to find all the punctures. This bloody tableau provides a glimpse into a city torn by escalating violence.
This is not Baghdad. This is the emergency department at the Hospital of the University of Pennsylvania in Philadelphia. The City of Brotherly Love's per capita murder rate last year was the highest of the nation's 10 largest cities, and the rate this year is running ahead of last year.
The chief of trauma, Dr. C. William Schwab, and his surgical team have saved the lives of many victims of violence in the city. But, thousands of miles away, his techniques have also saved the lives of many American soldiers in Iraq and Afghanistan, because Schwab was instrumental in their surgeons' training.
To stabilize victims of gun violence in Philadelphia, Schwab pioneered shorter surgeries called "damage control," which sharply reduce blood loss and the risk of further trauma. Marathon operations that were once common often led to complications and death.
Dr. John Pryor, who is a major in the Army reserves and is a partner of Schwab, was trained by Schwab and served in Iraq for four months this year.
"The techniques that Dr. Schwab developed — namely damage control — have probably done more to save lives with critically ill patients than any other technique," Pryor said in a phone interview. "I applied those techniques to our soldiers in Iraq."
Soldiers are often treated at forward field hospitals as quickly as 20 minutes after they are wounded.
"Surgeons clamp the blood vessels and pack the wounds to stop the bleeding and then send the wounded by helicopter to a hospital in Baghdad, where a second operation will take place once the patient is sufficiently stabilized," said Pryor. "Staging a series of shorter operations enables the patient to recover between operations, and that's why more soldiers have survived this war than previous ones."
The U.S. military assigns Army surgeons to train with Schwab and his team before they go to Iraq and Afghanistan.
"The military sends its surgeons to inner cities to learn about trauma surgery because we have so much experience dealing with multiple gunshot wounds every day," Schwab said sadly. "We can prepare Army surgeons for what they will face on the battlefield.
"The only reason I don't get depressed seeing all these gunshot wounds daily is because we learn so much from this carnage that we can use it to teach American military surgeons bound for Iraq."
Intervention From the 'Deadly Path'
Schwab's achievements have received international recognition. Doctors from around the world come to Philadelphia to observe his treatment of gunshot wounds.
"We send our doctors to study with Dr. Schwab and his team because it's the best place in the United States to learn trauma surgery and save lives," declared Dr. Sten Lennquist, a Swedish surgeon and editor of International Disaster Medicine Journal. He selected the hospital in Philadelphia to train Swedish trauma surgeons.
A group of Swedish surgeons visited Schwab's trauma center in March to learn how to better treat gunshot injuries they rarely see. One of the Swedes said he saw just one shooting injury in his 15-year career. In contrast, 317 people were shot in Philadelphia during the first two-and-a-half months of this year, at about the time the Swedish doctors arrived.
Schwab is a slightly built man with an eager smile and boundless optimism, despite seeing so many shattered young bodies in the trauma bay. He and Dr. Therese Richmond, an associate professor of nursing, created the Firearm and Injury Prevention Center at Penn (FICAP) to develop strategies to combat homicide and suicide.
Leading a team of more than a dozen researchers, Schwab and Richmond are examining the connections between the lives people lead, where they live and the bullets that will maim or kill them. The team is charting the journey people go through from being safe to being shot.
"We're trying to find intervention points where we can get people off that deadly path," Richmond said.
FICAP opposes gun violence, not guns; the group's studies show that young people who are exposed to violence are twice as likely to be violent as those who did not have similar experiences. FICAP has helped to develop the National Violent Death Reporting System that is now funded in 17 states to study patterns and risk factors. Researchers have identified the need to better address firearm suicide in more rural areas and better identify those most vulnerable. They are also assiduously studying the role of alcohol in firearm injury.
Schwab is guided by his belief that everyone has an obligation to make the world a better place.
"Our job in this world is to make it better for our fellow man and the next generation," he said. "I was raised to believe that if you were given gifts, like a good family and a good education, you have to give back to the society more than you took."