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Last Updated: Wednesday, 14 November 2007, 12:45 GMT
'Each one is a tragic waste of life'
By Chris Summers
BBC News

Mike Walsh is a consultant who heads up one of the country's top trauma teams, based at the Royal London Hospital in Whitechapel. He has dealt with dozens of gun crime injuries.

"It is not for me to judge if they are a 'goodie' or a 'baddie'," he said.

THE SURGEON
Mike Walsh
Name: Mike Walsh
Job: Head of trauma team
Workplace: Royal London Hospital

He is the consummate professional who avoids making judgements when a patient comes in, and gets on with the job of trying to save a life.

Because it is the home of London's Air Ambulance Service, the Royal London Hospital in the heart of the East End receives a large proportion of the capital's gun crime victims.

The air ambulance will land at the hospital in Whitechapel and the victim will be taken to the resuscitation unit, where a team will try to stabilise him - it usually is a "him": 99% of victims are male.

Highly skilled team

It is then that Mr Walsh and his team go into action.

It's a myth that you have to retrieve the bullet
Mike Walsh

The team consists of a trauma surgeon, an anaesthetist, a neurosurgical expert, an accident and emergency doctor, and several highly trained nurses.

Mr Walsh is just one of three consultants who work on a shift system which means that one of them is on call 24/7.

"The immediate priorities will be A, B, C - airways, breathing and circulation," he said.

Many gun crime victims die en route to hospital or shortly after their arrival.

But if the team can stabilise their vital life signs and stop the bleeding, there is a chance they will survive.

A gunshot wound X-ray showing shotgun pellets (Scott Camazine - Science Photo Library)
Shotgun pellets can sometimes remain in the body for years
Mr Walsh said: "Sometimes we carry out what we call damage-control surgery, when you do what you can to keep the patient alive, and then send them up to intensive care before completing the surgery 48 hours later when their bodies are physiologically in better shape.

"It's a myth that you have to retrieve the bullet. The police might want the bullet for forensic reasons but we won't remove it unless it is easily accessible or medically it needs to be removed."

Mr Walsh and his team are clearly among the best in Britain, but he believes there is a need for more training.

"When it comes to gunshot injuries, I think we are behind in the UK. Partly it's because of a lack of experience in dealing with these injuries," he said.

Mr Walsh said it would be useful to see some of the work done in hospitals in South Africa or the United States, where they deal with a far higher rate of casualties.

"We have a military surgeon on our books. Last year he was in Afghanistan and this year he is going to Baghdad, and he will bring back new ideas," he said.

Increase in gun injuries

So are the newspaper headlines right? Are things getting worse?

Mr Walsh is in no doubt: "If you take penetrating injuries - that is stabbings and shootings - they have increased by 15% to 25% in the last five years."

Hassan Jabir recovers after receiving a gunshot wound in Baghdad
In Iraq, surgeons are building up experience in treating gun injuries
"To me it's a job you have to do and I just get on with it, but the bigger picture is what bothers me. I have teenage boys and there is the increasing risk of them getting stabbed or shot. What is it about society which is allowing it to happen?"

Mr Walsh often has the unenviable task of breaking the news to relatives when a gun crime victim dies.

"It's just such a waste of life. They are usually young, fit men and it's just a tragic waste of life."

Some of his patients are clearly no angels. Sometimes they have been shot in revenge for a previous violent incident, or they may be attacked as part of a dispute over drugs.

But Mr Walsh is not interested in what his patients have done before they arrive at the Royal London.

"Often we get patients who need to be put under armed guard, but we try not to let it get in the way. We don't want them to be so intrusive as to affect patient care," he said.

When I asked Mr Walsh what he wanted his over-riding message to be, he replied simply: "Stay away from guns.

"People should grow up and stay away from the sort of situation which leads to guns, because if you carry a gun you are either going to shoot someone or get shot."



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