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There is a reason why Paul Pepe became a doctor, and not in some relatively tame specialty such as dermatology. Or radiology. But the high-stress field of emergency medicine--where he is an innovator, a pioneer, one of the nation's foremost experts. At 55, he is chairman of emergency medical services at UT Southwestern and, by extension, director of the famous Parkland Hospital ER--which round the clock staples and stitches the casualties of one of America's most violent cities.
But his choice of career all goes back to a summer day at the beach near his grandfather's house in Milford, Connecticut, when Pepe was 11 years old.
He remembers playing, then stopping to watch some men use a car to pull a boat ashore. He hears a sudden, high-pitched twang--time stops.
Then no pain, just falling to the ground in shock. An awareness that something bad has happened. He looks down, sees a gaping red hole in his leg.
Blood gushes onto the sand. People gather over him, horror in their eyes.
He gasps out his address. A man, the boat owner, wraps a towel around his leg, then scoops him up and drives him home.
His mother sees the wound--muscle and sinew hanging from bone--and screams. Neighbors hover around him nervously.
"I'm going to die," he thinks.
Then the doctor--his father--arrives from his office 20 minutes away. He walks in, and instantly the vibration changes. Chaos lines up; loose ends fall into place.
His father looks into his eyes, smiling calmly. "Hi," he says. Paul has seen that expression before--at a bad car accident, with one of the victims screaming in pain.
But his father never gets flustered. He just takes control.
Speaking in warm, low tones, the doctor pulls off the towel and examines the leg. He hears the story: A rope snapped, hurling a foot-long anchor into Paul's leg. One of the iron prongs ripped the flesh from his shin, front to back.
The doctor instantly computes the cause, the result, the prognosis.
"We can take care of this," he says. "You're going to be OK."
"So I'm not going to die?" Paul says.
At Southwestern, where he's been for five years, Pepe has taken the fledgling EM residency training program at Parkland and put it on the map. With another emergency medicine expert, Dr. Ray Swienton, a colonel in the Texas Medical Rangers, part of the Texas State Guard, he has also founded a national disaster medical training course created in response to September 11. Faculty at Southwestern and the Medical College of Georgia got together in 2002 and devised a family of courses in Basic and Advanced Disaster Life Support, which have now been adopted by the American Medical Association. The goal: a uniform, interdisciplinary and "all-hazards" approach that allows an ICU nurse in Seattle to work with a police officer in Chicago and a paramedic from Dallas.
In three years, Southwestern's faculty has trained 75,000 health-care providers in disaster medicine.
Pepe calls his approach to emergency medicine the "chain of survival." It's also the title of a 1991 treatise he co-wrote for the American Heart Association--and it begins with bystander response to a medical emergency, continues with the dispatcher's instructions, treatment by paramedics and delivery to the ER. It ends when the patient is treated and released by emergency physicians or admitted to the hospital for further care by specialists. At each step, research is ongoing to improve outcomes.
In Dallas, the benefits are direct: Parkland-trained emergency physicians go on to staff local ERs. Citizens learn CPR and how to use automatic defibrillators. Paramedics get state-of-the-art training. And research keeps the ER on medicine's cutting edge. Pepe has brought in millions of dollars in research grants related to studies in clinical emergency medicine. "Here in Dallas under Dr. Pepe, we are truly in the forefront of watching turbulent winds of change sweeping across this field," says Dr. Ray Fowler, assistant professor and co-director of EMS/Disaster Medicine at Southwestern. "He sees things on the highest level. People who come to know Paul find that very exciting. Emergency medicine faculty come here now because there is an opportunity to participate in very important missions under Paul's guidance."
Fowler points to Farmers Branch. Under Pepe's leadership, the city's paramedics keep more than 30 percent of people who suffer cardiac arrests alive long enough to reach the hospital.
Pepe's methods have generated controversy, however. Some accuse him of being a showboater who cultivates media attention, who loves rubbing shoulders with high-profile people; he met his wife, a TV producer, after giving life-saving treatment to an injured dog on camera.
"Paul's a peculiar character and probably misunderstood," says Parkland CEO Ron Anderson, who once ran the ER. "He's about pragmatism."
And if that means doing TV in the morning to emphasize injury prevention during Halloween trick-or-treating or meeting with a politician who can sponsor legislation, Pepe will make time.
"Some people are turned off by his grandstanding and playing to the media," says one of his mentors, Dr. Len Hudson, professor of medicine at the University of Washington. "But I've been impressed that he uses it pretty well--to accomplish something."
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