As the casualties of rising gun crime mount, the odds are narrowing that they are known to the staff of the KEMH Accident and Emergency Department.

Dr. Edward Schultz says on an Island just 22 square miles in size, sometimes this means his staff have to treat members of their own family in the throes of horrific injuries.

"We've had employees in this department who have been related to victims or who are close friends, and in these cases they sometimes require counselling and assistance," he said.

"It is extremely personal working in this Emergency Room for Bermudian staff because we do take care of people we know.

"When you work in a major medical centre in a big city it is very impersonal and there's a lot of anonymity, but we don't have that in Bermuda because it's such a small community.

"It also means people are related to one another and so it does have a big impact on someone, to see a loved one seriously injured."

Fortunately, help is available for hospital staff who witness firsthand the aftermath of violent crime.

In the event of a murder or particularly traumatic event, the Bermuda Hospitals Board holds a critical incident staff debriefing, to engage Emergency staff on an emotional and psychological level.

Counselling by the Employee Assistance Programme (EAP) is also available for those who want it. Dr. Schultz says: "I think it's very disturbing to see someone shot or stabbed, to witness senseless acts of violence.

"I think it does bother staff as it disturbs all of us in the community. This year more events have occurred involving handguns and we're not used to this kind of violence in Bermuda. I think it causes us to question our own safety."

Commenting on the impact on his staff, he says: "People react in different ways. Some may be outwardly emotional, while others internalise it.

"In the past, particularly with some of the more grisly murders we've had, we have held a debriefing in which people have described their concerns and reaction to the event.

"Such incidents can cause problems with sleep patterns, flashbacks and emotional disturbances, so it's a good idea when a particularly notable event occurs to have a debriefing.

"It is helpful in keeping staff from internalising the experience," he says.

"Counsellors also offer advice on how to deal with the situation. Staff members can discuss their feelings and how it is affecting them."

When a trauma patient is admitted to A&E, medics treat them for shock and administer resuscitation while assessing them for life-threatening injuries and conditions.

It is then up to the operating surgeon to decide whether the patient needs to be airlifted to KEMH's partner hospital, Massachusetts General Hospital in Boston.

Certain types of head injury requiring neurosurgery are a typical example of when an air ambulance would be needed.

Although Dr. Schultz cannot comment on particular cases due to patient confidentiality, he said: "We approach gunshot wounds as we would any other trauma patient. There is an organised approach we take, whether it is dealing with a road accident or a stabbing or shooting.

"Gunshot wounds can be less bloody than other injuries. There may be a tiny entry or exit hole but the internal injuries can be severe, particularly as bullets can be deflected by bones.

"You could have a wound to the chest which could result in injuries to the abdomen. In comparison, someone attacked with a machete or a knife could be covered in blood, which can be a more emotionally disturbing injury to see.

"Gunshot wounds are a very small part of the violence in general which we see. Compared to inner city hospitals in the United States where they are a common sight, fortunately, gunshot wounds are still rare events in Bermuda."