The Trauma of Treating Gunshot Victims as a Paramedic

This post originally appeared on the Trace.

Justin Duckett works on the front lines of Memphis's gun violence epidemic. He is a firefighter and a paramedic in Orange Mound, one of the most violent neighborhoods in the city.

Increasingly, when he responds to a medical call, it is to treat a gunshot wound victim. There have been 189 homicides in Memphis so far this year, an uptick of 17 percent over the same period last year. The Memphis Fire Department has responded to more than 480 gunshot calls.

In his nine years on the job, the 31-year-old Memphis native estimates he's attended to hundreds of shooting victims.

Duckett practices a kind of battlefield medicine: After racing to the scene, either in a fire truck or ambulance, his priority is to keep gunshot patients from bleeding to death until he can get them to a hospital. The work is high-stress, fast-paced, and disturbing. He sees things that he can't forget. Some days, he gets home and finds specks of blood from victims still on his wristwatch, or on a pen he'd been writing with earlier.

Duckett spoke with the Trace about trying to save people struck by gunfire, and how he copes with the emotional strain of his job.

Describe what happens when you get a call for a shooting.
Justin Duckett: The first thing we think about with any call is our own safety. We ask dispatch, "Hey, are police there?" If we pull up and one of us gets shot, now you have two patients and still nobody to help. We use judgment, though. If a six-year-old kid just got shot, and I feel like I can get that kid outta there, I'm going to.

Once I get to the patient, my first question is always, "What happened?" Just from the first few words I can get a good idea of their breathing and mental state. While I'm getting their story, I'm getting their clothes off, I'm looking to see where the holes are. I'm also looking for bleeding. If the patient is losing blood at a high rate, I need to jump straight to controlling this blood loss. As a paramedic, I can always intubate you and breathe for you. But I can't give you blood.

If the bullet hit an extremity, we'll apply pressure. We might have to apply a tourniquet, or an iTClamp, which looks like something out of a horror movie. It's like a hair clip with the teeth, except it's all needles. If a gunshot has blown open a hole in your leg, now you are missing tissue, and it's hard to pinpoint exactly what's bleeding. The iTClamp will pull all that tissue together. At that point, we're down to a last-ditch effort.

Trauma calls, or gunshot calls, are the quickest kinds of medical calls. Gunshots are really just the most barbaric form of pre-hospital medicine that we do.

Where is the deadliest place on the body to be shot?
With gunshots, a little bitty hole the size of a dime can create the damage the size of a cantaloupe on the inside. You can't even begin to understand what's bleeding—or what's seconds away from bleeding. A person may have been lying there long enough that they obstructed something that was bleeding, and as soon as you start moving them around, boom, that little nicked artery opens up.

The number one thing there's no coming back from is getting shot in the center of the chest, especially in the heart. And if you're hit in the lungs and they can't hold air, you suffocate to death. Or if they fill up with blood, you drown to death. The head's tricky because the body is so resilient, it'll still try to force you to breathe and try to keep the heart pumping.

Is there a kind of shooting you dread responding to?
A child. Before we even get out of that station, you can tell everybody's thinking, I hope when we pull up, it's not what they said it is.

Most of our training is based off an adult. With a child, everything you do is magnified. A child only has so much blood circulating compared to a full-size adult. The difference between that child bleeding to death and possibly having a chance to live is seconds.

Whereas a doctor can say, "This person weighs 55 kilos, we estimate he's lost this much blood," we're on the street. I don't get the luxury of knowing exactly how much a person weighs or how much fluid they need to replace the volume of blood loss, because the heart needs something to pump. I get one quick guesstimation.

Is there a particular call that sticks with you?
Every fireman has a couple they never forget. One of mine came four or five years ago, on my first day at Station 16. There were three children, and the oldest called their grandmother and told her, "My parents are lying here in the living room, and they're not talking. They won't wake up." Then grandma called 911.

When we walked in, the back door was kicked in. There were bullet holes everywhere. Blood everywhere. The shooting happened at some point during the night, and nothing more could be done for the parents. But you got three little ones that don't understand what's going on—a seven-year-old and a four-year-old and a two-year-old asking when their mommy's going to wake up.

The Trace has reported on how mistrust between law enforcement and residents can perpetuate the cycle of violence. Do you notice this dynamic in your work, and does it ever affect your ability to reach gunshot victims in time to save them?
As a fireman or paramedic, you're generally accepted better than police. When somebody sees the big fire truck, or the ambulance with all the lights, they automatically associate it with help.

But if the ambulance comes, the police are going to come as well. And so people will avoid calling if they can. They don't want to tell you who did this to them, because they're scared that they might do it to them again or might do it to their family.

The one that completely messes your night up is when you've been running all night on the unit, you finally get back to the station, and you think, Whew, I'm going to sit down for a second. Then you hear boom, boom, boom on the door. You look outside, you see a car pulling off, and a body lying right there in front of your station.

As a paramedic, you see a lot of horrific things on a regular basis. How do you cope with the stress and sadness of the work?
After any bad call we go through a mandatory debriefing, where we talk about what happened and get it off our chests. But very rarely will a fireman just come to you and say, "Hey man, that last call really bothered me." It ain't gonna happen. You're better off looking for the tooth fairy. It's that alpha-male, we're the strongest, best, baddest-in-the-land mentality.

Paramedics are said to have higher rates of divorce, suicide, and alcohol abuse. Is it the stuff that we see? Or is it because we all share the same personality, we all share the same faults?

Honestly, though, the thing that truly makes you move on, is the other guys. We wake up together, eat together, go to calls together. We're around each other so much that we can tell, "Hey man, something's not right." Like, I love sweet tea. If we come off a jacked-up call, my lieutenant might go in and put on a pot of tea. That's what I feel helps better than any formal program.

What's the one thing from your years as a paramedic you wish you could forget?
I wish I could erase the smell of iron. That weird metallic-y smell. You can almost taste it.

Sometimes I'll be working on my bikes, or bite down on one of those old forks, and it automatically triggers: bad. It's the smell you get when you walk into a room covered in blood.

A version of this article was originally published by the Trace, a nonprofit news organization covering guns in America. Sign up for the newsletter, or follow the Trace on Facebook or Twitter.

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