Casualty team that specialises in the violent world of crime: Celia Hall visits a hospital that has learnt to cope with a rise in shootings and stabbings

'THERE IS a nasty gangland out there and when they are using guns those we are able to resurrect never say what really happened - and they never press charges.'

This is not the statement of a police officer but of a heart surgeon at King's College Hospital in south London, which handles more shootings and stabbings than anywhere else in the capital.

Andrew Forsyth, consultant cardio-thoracic surgeon, said yesterday: 'This hospital is in a violent area. The gang world may not be part of your world or mine but it clearly exists. There is nothing spur-of-the-moment about these attacks.'

With the Manchester Royal Infirmary, casualty teams at King's are the most experienced in Britain. They are confident that a victim of violence has as good a chance of surviving there as anywhere in the world.

But the most recent casualty of shooting arrived too injured and too late. Chris Bourne, a 34-year-old West Indian in the UK illegally and sought by police for drugs-related armed robberies, had been shot at least 15 times in the chest and legs from three separate guns.

In the casualty department Dr Gillian Park, a registrar trained in Advanced Trauma Life Support, said: 'If the heart has a hole in it from a stabbing or a shooting you will bleed to death in a couple of minutes. If we can get to those who are 'dead at the door' in four or five minutes we open up the chest in the emergency room and plug the hole. Then we pour in litres of blood to get the blood pressure up again.'

She estimates that of 150 men, women and children who go through the casualty doors every day, between 5 and 10 per cent are injured as a result of one human being attacking another. 'At the moment there does seem to be an epidemic of gang warfare so we do expect more shootings. The nature of a department like this is that you must be ready for anything.'

In King's casualty department major shooting and stabbings have been counted over the past three years. These are not surface, or lesser injuries to limbs, but life-threatening, penetrative injuries to the body, from the hips to the head.

There have been 90 of these massive injuries and about one of them a month is now caused by shooting. Dr Park said the rate is rising.

This is emergency medicine at its most dramatic - often with the patient moribund or 'dead on arrival'.

'Our job in casualty is to resuscitate the patient and keep him stable until the definitive surgery can be carried out. A bullet will be taken out eventually but not usually by us. A bullet carries its own energy and this energy is transmitted to the tissues. The injury is done along its track, there can be a huge amount of damage and internal bleeding,' she said.

Mr Forsyth and his cardio-thoracic team have little experience of shootings since the victims all too often die before they get to the operating theatre or are delivered dead to the hospital.

He said: 'If you want to kill someone a gun is much more effective than a knife. Guns make a real mess, the injuries are pretty dreadful.'

He has been at King's for 11 years. 'We used to see a few muggings. This change to guns is recent.'