A fighting chance to survive a gunshot

THE MAN lies motionless on the ground, a leg bleeding heavily from a gunshot wound. A roiling circle of bystanders shouts and flails around him. Someone wails, "That's my brother! Save him!"

An onlooker takes control of the chaos, barking orders to stand back, while another tightens a tourniquet around the victim's leg. Then everyone clears a path so police can scoop the man into a squad car and race to the hospital.

The scene I just described was a pretend one, thank God. It was staged last week at North Philly's Ladder 12 firehouse on West Cambria Street as part of an extraordinary new program from Temple University Hospital called "Fighting Chance." It's taught in the community by staffers from Temple's trauma and emergency departments, who are training neighbors in simple, proven ways to save gunshot victims' lives in the critical minutes before first responders arrive.

It's based on methods used in war zones. And if Philly - with 1,238 shootings in 2015 - isn't a war zone, someone please tell me what a war zone looks like.

In truth, bystanders themselves can be first responders, because they're usually first on the scene. Whether they know what to do for a victim of a penetrating injury from a bullet (or a knife) can make the difference in whether that person lives or dies.

Depending on the injury, a victim can bleed to death in less than five minutes. So, one less minute of bleeding at the scene is one more minute a hospital trauma team can use to save the victim's life, says Tim Bryan. He's the Temple ER doc who cocreated "Fighing Chance," adapted from techniques he learned as a Special Ops combat medic during eight years of active duty.

When I ask Bryan how often a gunshot victim arrives at Temple a minute too late to be saved, he answers bluntly, "All the time - every few days."

"It's so frustrating," says ER nurse Amanda McMacken, one of a dozen-plus nurses who have happily given up their nights and weekends to help develop and teach "Fighting Chance."

For two hours, program participants learn how to control bleeding, position a victim to aid breathing, and lift and carry him to safety while keeping themselves out of harm's way. Then they take part in an intense role-playing session to test their new skills, creating a scene that mirrors the bedlam of a shooting's immediate aftermath.

Many of the two dozen participants at the Ladder 12 training didn't have to try hard to playact their fright and confusion. They just summoned their own memories of traumatic events.

"If only someone had known what to do," sighed Alice Kelliam, 63, of Germantown, thinking of her husband, who was shot and killed 10 years ago in a robbery, and of her nephew, slain by a drive-by bullet six years later. "They died before help came."

Rosetta Crawford, 58, has seen the aftermath of four shootings. Her neighbor Lucie Curry, 55, has seen three. The longtime North Philly residents recalled the time a shooting victim collapsed on their North Rush Street block from multiple gunshot wounds.

"You freeze," said Crawford, a block captain. "You're in a panic. You hear shots, but they echo. You don't know where they're coming from. You don't know when they're going to start shooting again. You stay in the house until the shots stop before looking to see what happened."

The teen on their pavement was bleeding from multiple wounds. A young girl, his sister, wailed next to him.

"We called 911; that's all we could do," said Curry, an assistant block captain.

They don't know if the victim made it. But if they'd known what to do while waiting for cops to arrive that day, said Crawford, "we'd have helped him. Of course we would."

"Fighting Chance" began with a phone call.

Wayne Jacobs, a respected community activist who helps ex-offenders find employment, knew of the Temple hospital's "Cradle to Grave" program, which aims to keep at-risk kids from becoming perpetrators or victims of violence. So he called Scott Charles, Temple's trauma outreach coordinator and the program's cofounder, with a proposal:

If Temple would create a first-aid program to treat gunshot injuries, Jacobs would recruit neighborhood residents to take the class.

"It's not just drug dealers and criminals getting shot; it's also innocent bystanders," says Jacobs. "We need people on every block who know what to do."

Charles ran Jacobs' request past Bryan, the former combat medic, who is also assistant director of Temple emergency medical services.

"I thought he'd say, 'It's too complicated,' " says Charles. "But he said, 'We can do that.' "

Bryan knew a startling statistic: About 80 percent of Philadelphia gunshot victims survive their wounds. That sounds like an impressive number. But it pales alongside the 90-plus-percent survival rate of U.S. troops who suffer penetrating trauma injuries in war zones.

That's right. You're more likely to survive a gunshot wound in a hot, filthy desert, hours from a hospital, than you are if you're shot within blocks of one of Philly's trauma centers. That's because every soldier who enters a war zone is trained to stop bleeding until the wounded can be transported to a medical center.

Says Bryan, "With penetrating trauma, the simple fact is that some people are going to live and some are going to die no matter what you do. But then there are the people in the middle, who can go either way. Every study shows that their chances of surviving go way up if the person standing next to them knows what to do."

So Bryan and staffers from Temple's emergency and trauma departments spent 2015 creating "Fighting Chance," based on tenets of the U.S. military's Tactical Combat Casualty Care course.

By coincidence, the course was coming together just as the White House launched a program called "Stop the Bleed," which is pushing the same notion of training bystanders to "be the help until help arrives" in bleeding injuries. Its organizers foresee the day that the public - already acquainted with CPR and defibrillator use to treat heart attacks, and the Heimlich maneuver to save choking victims - has access to similar tools and knowledge to stanch bleeding.

Charles, who has deep community ties, sought input from the 25th Police District's commander, Capt. Michael Cram, for input. Would "Fighting Chance" fly with his officers? And where should Temple pilot the training?

Cram's answers: Yes, and the perfect site was the 12th and Cambria Rec Center. The place is home base to the 12th and Cambria Advisory Board, a dynamic group of activists who, in a few short years, have chased away the worst of neighborhood crime. They'd started Town Watch and Safe Corridors programs, strengthened relationships with police, installed cameras and lighting around the rec center, reestablished block captains, and designated 80 neighbors as 311 liaisons to report quality-of-life problems to the city.

"There is nothing we won't do for the neighborhood," says board member Mike Abdullah Beatty. "People know each other now like they did in the old days."

Adds fellow board member Ricardo Rose, "We were excited about 'Fighting Chance.' We knew it was another way to bring people together."

And, wow, were the enthusiastic attendees quick learners.

A few days after the first training session, an elderly man collapsed on the sidewalk in front of the rec center. A teen named Mike Foster who'd attended the program quickly turned the man on his side - as he had been taught in the training - to keep his airway clear. He and others then got the man into a car, using more proper techniques, and got him to the hospital. The man recovered, to the joy of his grateful family.

"We were so proud of Mike," says Beatty. "This stuff works."

"Hey, everyone, line up. We're doing this for real now," bellows Bryan at Ladder 12 last week, after the night's excited participants - including about a dozen teens from the Fire Department's Explorers programs - have learned the techniques of "Fighting Chance."

Bryan designates one participant to be the victim, others to be active responders, and the rest to be the shouting, confused bystanders who needed to be controlled so police could make their way to the injured. Temple's dynamo nurse trainers interspersed themselves in the crowd to support or correct the action.

"Ready?" yells Bryan. "OK - BOOM! The shot's fired, the guy's on the ground!"

The group leaps into action. One of them takes charge of the scene, pushing bystanders away from the victim, instructing another to call 911. Another kneels next to the "bleeding" victim, ties a tourniquet around his leg, and then, with another helper, turns the man on his side so that he doesn't choke on his own blood.

"He can't breathe!" shouts Bryan, and they use another technique to sit him up safely.

"The cops are here! Move him!" says Bryan, and they carry him to a "squad car"- two chairs, side by side - where they make the motions of securing his seat belt, lest the man, now "unconscious," slide off the seat onto the floor, where it will take ER staff precious minutes to free him.

"You did it!" shouts Bryan. "You just saved his life!"

Those in the crowd cheer, exhilarated by what they've learned, hopeful they never have to use it.

The plan, say Charles and Bryan, is to expand training beyond the 25th District. They're looking for funds to produce a training video, which would bring the techniques of "Fighting Chance" to more people more quickly.

But for now, they're pleased that one man's good idea has made it to fruition. And that bystanders, instead of standing by, are learning to be the help, until help arrives.

For more information about "Fighting Chance," call 215-707-8398 or email scott.charles@tuhs.temple.edu

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