From his experience with hundreds of gunshot victims, Wintemute knows only too well that their wounds are among the hardest for doctors to deal with. The gaping holes torn into the flesh by bullets of any kind can easily destroy major organs, unleash torrents of blood, produce severe infection and in general cause widespread bodily mayhem. Gunshot wounds also account for a major part of the rise in spinal injuries in the U.S.; even the grazing passage of a bullet along the spinal cord can be enough to cause paralysis. Two-thirds of gunshot victims do not live long enough to receive medical attention.

On the other hand, gunshot victims who live to tell about it often owe their survival to the vast improvements in emergency trauma care since the 1960s. Not only are response times faster, but treatment often begins right at the scene as highly trained paramedics work under the direct radio supervision of physicians back at the hospital. In the most serious cases, paramedics may have already started intravenous fluids, inserted breathing tubes and alerted doctors about what to expect even before the victim arrives.

When the patient is wheeled into the "resus" (resuscitation) room, a fully mobilized team is usually ready and waiting. At a large urban medical center such as U.C. Davis, this may include a physician specializing in emergency medicine, five residents (including an anesthesiologist), three nurses, a respiratory therapist, X-ray and trauma technicians and several aides. While one doctor tries talking to the patient and checks for major injury, another starts drawing blood for tests. Other team members may be inserting catheters, stanching bleeding, administering blood or other fluids. Within five to 15 minutes, the patient may be on the way to the operating room. Says Wintemute: "We've come to recognize that there is this 'golden hour'--the first hour after trauma--when we have the best chance of saving the patient."