Rickeisha Burgess went to school with many of the young shooting victims she has to tend to as part of her job as an emergency medical technician at King Edward VII Memorial.But the fact she has known them since childhood and still stops to chat with them in the street doesn’t impact how she carries out her duties.“I guess you are desensitised,” she tells The Royal Gazette. “You are used to it. It comes with training. You are trained how to deal with it.”April Smith, clinical manager of the emergency room at KEMH, agrees. “In light of the shootings, we have so many of them, after a while it’s like ‘it’s another shooting’,” she says, shrugging her shoulders to demonstrate how commonplace an occurrence it has become. “The people in the community, [they are] the same way.”Bermuda’s main hospital has had to deal with a significant rise in shootings in the last few years, with 18 fatalities and more than 50 people non-fatally wounded since 2007, compared to a handful of incidents in the previous five years.But ER director Dr Edward Schultz points out firearm victims still make up only a small proportion of the patients treated by his team of 40 nurses, 16 physicians and 26 EMTs.The medics see up to 100 patients a day, which equates to more than 34,000 a year.“From a global perspective, I don’t think this has had a major impact on our operations,” Dr Shultz says, of the increased number of shootings.“We see a hundred people a day and perhaps a shooting once a week or once every two weeks. That’s one out of 700 people we have seen that week.“Every week we see serious back injuries and head injuries and chest and abdomen trauma. Road traffic accidents remain by far the greatest source of traumatic injury.”Still, ER staff have needed extra training to deal with the upsurge in firearm attacks, including from US forensics expert Dr William Smock.The police surgeon from Louisville, Kentucky, was brought in earlier this year to give a series of presentations on treating close and long-range gunshot wounds and not damaging evidence.Procedures for dealing with 911 calls involving gun injuries have also changed in the last two-and-a-half years, since the tit-for-tat gang violence really escalated.Dr Schultz says: “When this started a couple of years ago, we met with the police and fire services and we set up staging areas.“We don’t go into unsafe areas. You may lose staff and you may simply accrue more casualties. It makes no sense to send anyone to an unsafe area.”The ER director says members of the public have criticised EMTs for the time it has taken them to get to a shooting scene. But he explains they are no longer able to go directly there without being cleared by police.Instead, they head to the relevant staging area and wait for the green light to go in.Dr Schultz says shooting victims are typically brought to the hospital in a private vehicle and it’s “relatively rare to get called to the scene of a shooting”. That’s often because those hurt don’t want the involvement of police.Ms Burgess says: “Usually, you get called but it gets cancelled.”It’s now standard practice that once the shooting victim gets to KEMH, the hospital goes on “lockdown”.Dr Schultz says: “The effect of having a hospital on lockdown is reassuring the staff. Bermuda is a small place. We are all related. It’s very common for large numbers of friends and relatives to come to the emergency department.“That can be very disruptive when staff are trying to take care of critically ill patients. We have to have order and we have to have security.“There is always the concern that if somebody wants someone and is intent on causing further harm to that person, that somebody could follow a person. Assailants have followed [to the hospital] but this was before we put the security measures in place.”Dr Shultz says though the shootings “weigh heavily on us”, staff are equipped to deal with them.“I think it does concern all of us very much and we are saddened by the amount of violence that we see in the community. Many of us have seen gun violence in other medical communities where we trained.“I trained in Miami. I know there are people who trained in New York and New Jersey. Gun violence is common in those areas.”Ms Smith says all staff are offered critical incident stress management, known as CISM, but few take advantage of it. ER nurse Ava Clarke says: “It should be mandatory. It’s mandatory with the police.”She says it can be tough to deal with shooting victims, especially if they become abusive, as has happened to her. Relatives and friends can also demand attention when medics need to focus on the patient.Ms Clarke says she has built a real rapport with some firearm victims, only to see them return to the hospital after being shot again. “That’s tough,” she admits.EMT Terrence Tucker says it is not uncommon for medics to know a victim well. “That’s a case where you can’t think about who it is. You have got to do what you have got to do.”Useful website: www.bhb.bm.