This year in Southwest Florida, medics patched up a man who was run over by a car then shot in the face by an adversary in Immokalee.
In October, Fort Myers police responded to a car crash and found a man and a woman inside with gunshot wounds. Both survived.
And later that month, a homeless man holding a gun — later determined to be fake — was shot at least 10 times by Collier deputies. He was released from the hospital less than two weeks later.
Violence isn't necessarily on the decline in America, but more people are surviving shootings because of advances in medical care, a number of crime experts told The Wall Street Journal in December. Local authorities and medical professionals say those same advances are also occurring in Southwest Florida.
Doctors at Lee Memorial Hospital now are saving 8 percent more patients with penetrating wounds than they were 11 years ago, said Dr. Ernst Vieux Jr., medical director for the hospital's trauma unit.
"We're recognizing that we have gotten better at handling stab wounds and gunshot wounds," he said.
Vieux said the hospital treats about 2,000 trauma patients per year, with about 18 percent of those patients having a penetrating injury like a gunshot wound or knife wound.
Of the 360 or so patients who come in each year with a penetrating injury, he estimates 70 to 80 percent are a victim of violence.
But a lack of state and national data makes it difficult to attribute increased medical care to a decline in homicides, other than anecdotally. Florida's violent crime rate decreased about 57 percent and its murder rate decreased by about 46 percent from 1991 to 2011. The Florida Department of Law Enforcement does not keep track of nonfatal shootings, spokesman Keith Kameg said.
While statistics show homicides decreasing, other data suggests an increase in the number of patients surviving gunshot wounds. About 31 percent more people nationally were treated for nonfatal gunshot wounds in a violent offense from 2001 to 2011, according to the Centers for Disease Control and Prevention.
The spread of trauma centers — which are available to treat severely injured patients around the clock — is considered a major factor in increasing patients' chances for survival, The Wall Street Journal reported. Before the trauma center at Lee Memorial opened in 1994, paramedics said flying patients to a trauma center farther away wasn't really an option. The local hospital would had to do.
"To be honest with you, we didn't go to a trauma center — really it came down to hoping the wounds weren't that bad," said Warren Panem, deputy chief of Lee County Emergency Medical Services. "Any surgeon in the area might be 45 minutes or an hour away, and hopefully (the patient) wouldn't bleed to death in that amount of time."
In other words, more patients in Southwest Florida are surviving gun or knife attacks simply because of their proximity to Lee Memorial Hospital. A person shot in the head in Collier County now goes to Lee's trauma center, even if he or she is shot in the parking lot of another local hospital, said Walter Kopka, chief of Collier County Emergency Medical Services.
"For the average citizen, that seems very odd," he said. "Not that there's anything wrong with other hospitals, but they're not geared for having operating rooms ready, CT scans ready and trauma surgeons ready 24 hours a day."
Like his peers, Vieux said those in trauma medicine have learned much from battlefield experiences in Iraq and Afghanistan.
"We know the closer you are to definitive care, the better your chances for survival," he said. "This is what the military has come to recognize, and this is what we have realized in civilian trauma. We understand what they're doing, and they understand what we're doing."
No more than 20 years ago, paramedics were taught to get on scene, start IVs and begin to give a patient fluids, Kopka said. But the conventional wisdom has changed.
"Over the years, we've determined that spending a lot of time on scene probably isn't the best thing. Fluids can just water down the blood, and watered-down blood obviously bleeds more," Kopka said. "Spending time on scene means not getting any closer to the definitive care that is the operating room."
Over the past couple of decades, Vieux said the medical community has developed a philosophy of damage control, in which doctors first stabilize a patient before treating his or her major wounds.
"You want to get them to an environment where you can get them back to some physiological state where their organ systems are functioning better and you can go in and go ahead and correct the major things that are disturbing this person's physiology or ability to live," he said.
Although people with gunshot wounds make up a small percentage of those treated at Lee Memorial's trauma center, Vieux said he knows their chances for survival are improved from the moment they come through the doors.
"One of the most rewarding things about being a trauma surgeon is that these patients would be dead in most people's hands," he said, "and you make the difference."