"It's almost like a hard-wired response," said Najma Ahmed, assistant trauma director at St. Michael's Hospital in Toronto, of the work she and others in the field face in major trauma centres.

"You see a certain pattern of injuries, a clinical presentation, and you've got your top three diagnoses. And you rapidly have to include or exclude them."

The soft flesh and tissues of the body are no match for the hard steel of bullets, which rip gaping holes in vital organs and sever major blood vessels. Life-threatening injuries must be pinpointed, then prioritized.

It's a balancing act. The trick is to repair as much damage as possible without subjecting the weakened patient to too much time on the operating table.

In this world, gunshot wounds -- along with knife wounds -- are known as "penetrating trauma." Of the two, bullets far outstrip blades in terms of damage done.

"The damage it does is more crude and extensive," says Talat Chughtai, a Toronto trauma surgeon who divides his time between Sunnybrook Health Sciences Centre, where he has a surgery practice, and St. Michael's, where he works trauma shifts.

This is cache, read story here