ST. PAUL, Minn. (AP) - The first bullets whizzed past Jason Gatrell’s foot and he jumped. Then, the St. Paul gas station clerk heard another gunshot - this time by his ear. He hit the ground.
He couldn’t get up. He couldn’t call out for help.
Blood was spurting from Gatrell’s neck and he believed he was dying. When Gatrell was able to muster some words to his younger brother by his side, he asked him to say goodbye to his son and told him he loved him.
Gatrell wasn’t alone in thinking he was going to die last Thanksgiving, after a man tried to rob the station. Everyone from the first responding officer, to a paramedic, to Gatrell’s surgeon thought his prognosis was dire.
But quick responses and collaboration between police, the fire department and Regions Hospital staff made a difference for Gatrell, according to Dr. Michael McGonigal, the St. Paul hospital’s director of trauma services.
Even though Regions Hospital in St. Paul has seen an increase in patients with serious gunshot wounds since 2016, more patients are leaving the hospital alive.
McGonigal credits advances in medical care and technology with saving patients. Some advances have come from lessons learned in battlefield conflicts, he told the Pioneer Press .
For Gatrell, now 22, he thinks it was meaningful that he was shot - and survived - on Thanksgiving Day.
“It’s another thing to be thankful for,” he said recently. “People tell me, ’I’d hate that dude,’ but I say, ’No, I’m alive.’ I’m not going to spend the rest of my life being mad now. I’m going to live my life now.”
Since the 1990s, Regions medical staff treated about 80 people each year for serious gunshot injuries.
“We were kind of like the sleepy stepsister of the Twin Cities, where all the heavy duty stuff was happening over in Minneapolis, but just in the last few years, we’ve seen that start escalating quite a bit,” McGonigal said.
Regions is the only Level 1 trauma center in the east metro - they have specialists to handle the most complicated cases around the clock.
Between 2013 and 2015, Regions treated 247 people with serious gunshot injuries. Nearly 15 percent of those patients died.
In the nearly three years since, Regions has treated far more patients with serious gunshot wounds - 371 through September of this year. Almost 9 percent of those patients died.
Much of living through a shooting depends on a bullet’s path. There are some places in the body, such as a gunshot wound to the head, where doctors can only do so much, McGonigal said.
But McGonigal highlights four areas he says are making a difference, quickly getting patients blood transfusions, rapidly taking people to surgery, using a large hybrid operating room that opened at Regions about four years ago and has advanced X-ray technology for the “worst of the worst” gunshot cases and limiting the amount of time patients undergo an operation.
On the streets, there’s been a resurgence in first-responders carrying tourniquets. They help patients from losing too much blood before getting to the hospital, McGonigal said.
Last Nov. 23, Jason Gatrell was washing dishes in the back of the SuperAmerica Express on Snelling and Minnehaha avenues when his brother came into the room. Jason Gatrell didn’t see a gunman following Jordan Gatrell, now 20, who also works at the station.
Suddenly, the would-be robber ordered Jordan Gatrell to open the cash register and Jason Gatrell to lie on the ground.
“I couldn’t put myself in the position to be helpless, to where I get on the ground and he just shoots us both anyways,” Jason Gatrell said. “I kind of got halfway to the ground and then tried to jump for the gun and we were wrestling for it.”
After Jason Gatrell was shot, his brother put a towel on the gunshot wound, ran to get help and called 911 at 4:39 p.m.
Officer Alex Graham was patrolling near the gas station and arrived almost immediately. He quickly checked to make sure the shooter wasn’t still in the store.
“When I went to Jason, I remember seeing what looked like a Bic pen coming out of his neck and it was just a steady fountain of blood.” Graham said. “The thing about an arterial gunshot wound is you don’t wonder if it’s an artery, you know it is from the amount of blood.”
Graham grew up learning about medical matters from his father, Dr. Kevin Graham, a cardiologist who was president of Abbott Northwestern Hospital’s Minneapolis Heart Institute. And he’s taken first-responder courses.
Graham used a towel to apply pressure to Gatrell’s wound and he said his fellow officers would have done the same. “I see daily acts of kindness and heroism in the city,” he said.
Gatrell told Graham, “I’m dying,” the officer recalled. Graham thought the same thing.
“If the medics wouldn’t have got there when they did, this would have been a totally different story,” he said.
Graham wanted to calm Gatrell, so his condition wouldn’t worsen, and told him over and over again, “You’re just nicked. It’s not a big deal.”
St. Paul firefighters respond to emergency medical calls in the city - they’re all EMTs and some are paramedics.
The first EMTs arrived to Gatrell four minutes after they were dispatched. Paramedics were there a minute after that.
For those shot in the arm or leg, firefighters or officers can use tourniquets to control the bleeding, but there’s not many options for neck wounds, other than holding steady pressure with a thick gauze pad, which a paramedic did, said St. Paul Fire Capt. Jerry Gilbert, who led the ambulance crew. They started IVs for Gatrell.
Gilbert’s other priorities were alerting Regions, so the hospital could activate their trauma team, and getting Gatrell to the hospital quickly.
They arrived at the hospital at 5:03 p.m., 24 minutes after the 911 call.
When a shooting victim is heading to Regions in an ambulance, the hospital typically gets three to 10 minutes notice from paramedics.
A 12-member trauma team - comprised of doctors, nurses and technicians - “drops everything and goes,” McGonigal said. They call the hospital’s blood bank and a cooler of donated blood is on the way almost immediately.
“The thing that kills people after most trauma is blood loss,” McGonigal said. “What we’ve learned over time is that we need to get the blood mobilized early” for a transfusion.
After a quick decision in the emergency room about whether the patient needs surgery, “it’s typically about eight minutes and we’re in an operating room ready to start,” McGonigal said. “That’s one of the key things because the sooner we can control whatever bleeding is occurring, the better chance they have of making it through.”
In Gatrell’s case, when Dr. William Mohr learned Gatrell was shot in the neck and had dangerously-low blood pressure from losing a large amount of blood, he requested that paramedics bring Gatrell directly to the operating room. Gilbert said that was a first for him in his 21 years as a paramedic.
The bullet entered Gatrell’s neck under his ear, struck his spine and fractured a vertebrae, passed behind major blood vessels that connect to the brain and tore through his esophagus, said Mohr, a Regions Hospital surgeon who is a trauma and burn specialist. If the bullet traveled a millimeter in any other direction, Gatrell could have been paralyzed, brain damaged or killed, Mohr said.
In surgery, Mohr saw the bullet had hit branches of Gatrell’s carotid artery and he clamped them to stop the bleeding. Gatrell’s vertebral artery was struck and his jugular vein also damaged.
“We couldn’t find the bullet anywhere, so we did X-rays,” Mohr said, which showed the bullet had traveled with enough force that Gatrell swallowed it.
In his 22 years as a surgeon, Mohr said he’s never seen a similar case.
The recent rise of shooting victims at Regions Hospital coincides with an increase in killings statewide.
The years 2015 and 2017 saw more murder and manslaughter deaths in Minnesota than any single years in the previous decade. That FBI data includes all homicides, not just those involving a gun. It also counts those who died before making it to a hospital.
Still, the long-term trend is a positive one. The state has counted an average 100 homicides per year over the last decade, down from an average 123 the previous decade.
Most people who die from gunshot wounds have not been shot by another person - more than three-quarters of 432 firearm deaths in 2016 were suicides, according to the Minnesota Department of Health’s Injury and Violence Prevention Section.
When Gatrell left the hospital after about six days, he felt overwhelmed by needing a feeding tube - he couldn’t eat solid foods for a month.
At first, Gatrell was in so much pain he could barely sleep, but it got better every day. He’s just been able to return to the gym and is working to build his strength back.
Gatrell’s cousin’s girlfriend established a GoFundMe account, which is still active, and Gatrell said he’s thankful for all the people who’ve donated $34,000 collectively. He said it helped when he wasn’t receiving his full salary and with medical expenses not covered by insurance; he plans to use it for future medical bills.
Gatrell is back to his full-time work at the gas station, where he’s been employed since he was 16. He said he’s always felt safe there and he still does, though he’s a bit more cautious now.
In January, prosecutors charged a man in Gatrell’s shooting; the 37-year-old pleaded not guilty and his case is ongoing.
Surviving the shooting felt like a second chance at life for Gatrell.
“Life’s so short,” he said. “That could have been the end of it. Now I don’t take anything for granted. Every bite of food is delicious. I’m more of a happy person.”
Not everyone who worked to save Gatrell found out the outcome, including Ramsey County Emergency Communications Center public safety dispatcher Ariana Garrick. She was focused last year on getting help to him quickly and heard this week that Gatrell survived.
“It gives us an extra boost of hope that he’s still here,” she said.
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Information from: St. Paul Pioneer Press, http://www.twincities.com
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