10 Alumni Journal - SUNY Upstate Medical University

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Bill Schwab’s work as a trauma surgeon and advocate for gun safety have earned him international recognition. He had to do it too many times—tell a mother her teenage son was dead from gunshot wounds, after another senseless shooting. Despite the best surgical skills and medical technology, nothing could save her son. Everything was done but all was lost. That experience, night after night, week after week, was so emotional for trauma surgeon C. William Schwab, MD ’72, that he decided to turn to others for help. In 1997, Dr. Schwab, chief of the Division of Traumatology and Surgical Critical Care and Professor of Surgery at the University of Pennsylvania School of Medicine, resolved to fight back at what he calls “a preventable epidemic,” by founding the Firearm and Injury Center at Penn (FICAP). “We wanted to do more than the surgery,” says Schwab. “We wanted to understand the root causes of gun death and look for interventions that might save these kids.” The intent was to stimulate a movement among health professionals to see handgun injury as a public health issue rather than a political issue, and lend their expertise to evidence-based prevention. To that aim, FICAP has created a community of scholars that collect and analyze data on all types of firearm violence, as well as associated risk factors and repercussions. These efforts are developed to help create safer communities with fewer gun injuries and deaths. “Only through legitimate research will we be able to identify the causes of violence,” says Schwab. “At the same time, we need short-term solutions to lower the death toll and live more safely.” Schwab emphasizes that FICAP’s focus is on injury prevention, not gun control, a clarification that focuses on strengthening the body of effective evidence rather than ideology. “We’re not an advocacy group. We’re a group that uses interdisciplinary scholars to examine data and attempts to inform policy,” he says. “FICAP opposes gun violence, not guns.” on the front lines Despite his public policy work, Schwab is first and foremost a surgeon, one who is known far and wide for developing and refining techniques to improve survival in multiple gunshot wounds. In a paradigm shift in trauma surgery,“damage control” as he calls it, is now being used to save the lives of soldiers injured in Iraq and Afghanistan. Through both research and surgical skill, Schwab and his team have saved many victims of violence in Philadelphia. But, thousands of miles away, in countries as disparate as Iraq and Sweden, Schwab is also saving countless lives because of his unique role in their surgeons’ training. Surgeons from Sweden and other countries who rarely see gun wounds in their home communities visit Penn to observe and learn from Schwab. “In two weeks here, they’ll have more experience than they would in a lifetime at home,” says the surgeon. “Throughout history, war has been the greatest stimulus for the advancement of medicine and surgery,” says Schwab, who in 2006, became the first senior visiting-surgeon at the U.S. Army’s Regional Medical Center in Landstuhl, Germany, operating on wounded American and Canadian soldiers through a volunteer program developed by the American Association for the Surgery of Trauma and the American College of Surgeons’ Committee on Trauma. “Whether an injury is from an IED in Iraq or a shooting on the streets of Philadelphia, the consequences are the same,” says Schwab. “Surgical techniques such as damage control, originated in major trauma centers in the United States during the last 15 years” in direct response to urban gunshot injury. 8 A l U M n i J o U r n A l / s P r i n g 2 0 1 0
Dr. Schwab with the Penn STAR Flight team, a program he established in 1987. According to Schwab, “damage control” is unconventional surgery used when someone is dying from wounds. Minimal surgery is done to stop bleeding, limit contamination and save life. Definitive repair is delayed for several days until organ perfusion and function is reestablished. Taking the time to perform definitive surgery immediately often resulted in “a fully repaired but dead patient,” says Schwab, co-editor of The Trauma Manual and the recently published text on the subject Damage Control Management of the Poly Trauma Patient. He and his colleagues instead began to use this abbreviated resuscitative surgery to halt the downward death spiral associated with these injuries. To control bleeding from damaged vessels or restore flow where needed, they inserted plastic tubes or vascular shunts, “like a quick fix in a broken plumbing system,” explains Schwab. They clamped, stapled or sutured bowel ends to control intestinal spillage and contamination. After packing all raw or dissected surfaces, they then temporarily closed the abdominal or chest A l U M n i J o U r n A l / s P r i n g 2 0 1 0 9 wall. Patients were then moved to intensive care. After restoration of normal physiology and re-examination of all injuries, the surgeons then did definitive repair surgery a day or so later. The improvement in survival for gunshot victims was so profound using these techniques that the U.S. Armed Forces Medical Corps, which directs care on the battlefield, added damage control as a principle technique. This abbreviated far forward surgery is felt by many surgeons to provide a significant improvement in survival. “It’s a way to take what is a terrible liability in the United States (urban gunshot injury) and translate it into a survival advantage,” says Schwab. “It is the fulfillment of the teaching mission of academic medicine—saving lives.” Innate to being a trauma surgeon, says Schwab, is an interest in injury prevention. Early in his career as a trauma surgeon at the Eastern Virginia Medical School, where many of his patients were victims of automobile crashes, Schwab became an advocate for motor vehicle safety. Working through organizations such as
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Page 3 and 4: Upstate Trains Physicians in a Sett
Page 5 and 6: generation. We are very proud to
Page 7 and 8: Andrew M. Cuomo. “By spending alm
Page 9: Triggered by V olence Bill SchwaB,
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Page 17 and 18: care. Due to lack of education and/
Page 19 and 20: Tales from the front robert Dracker
Page 21 and 22: Peter J. Adasek, MD ’65 Barry Kut
Page 23 and 24: Zaven s. Ayanian, md ‘59 Teacher,
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Page 27 and 28: SAVE THE DATE Reunion Weekend 2010

10 Alumni Journal - SUNY Upstate Medical University

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