Dr. Disaster

When the world is falling to pieces, emergency doctor Paul Pepe makes order from chaos

Clearly the need is there. But outside big cities, almost half of the physicians working in ERs are moonlighting family practitioners and specialists in other fields who may know little about trauma. Trained to recognize and respond quickly to life-threatening conditions, emergency physicians must have a broad grasp of many disciplines and the temperament to deliver quality care under pressure.

Pepe still follows his father's example. "We maintain low tones," he says. "We're caring. We tell you what we're going to do. We understand the creature comforts. Anything you can do to decrease apprehension is medically important."

In Seattle, Pepe simply wanted to be the best hands-on doctor in the world. He thought research and publishing was for laboratory docs. There were no emergency medicine journals, because little research was being done in the field.

Mark Graham
Dr. Ray Swienton shares a story with faculty member Dr. Dale Simmons at UT Southwestern.
Mark Graham
Dr. Ray Swienton shares a story with faculty member Dr. Dale Simmons at UT Southwestern.

But after working on a pioneering study of pulmonary critical care--hanging out all hours in the emergency room to identify patients, get families' permission and enroll them in the study--Pepe was hooked.

One of Pepe's first research projects was published in the prestigious New England Journal of Medicine. Board-certified in three specialties, Pepe has since published more than 400 papers; some have changed the way emergency medicine is practiced.

"He's been innovative and done some of the very difficult studies out in the field," Hudson says. For example, "there wasn't a consensus whether they should do stabilization in the field before they drove to the medical center or they should scoop and run." (The answer: It depends. When people are bleeding to death internally, it's "scoop and tube." Pepe moved the "golden hour" to a half-hour for blunt injuries and a quarter-hour for penetrating injuries.)

Pepe evolved into a scientist willing to question preconceived notions, committed to the idea of strengthening "the chain of survival."

In 1982, Pepe applied for a job running a critical care unit at a Houston hospital. Because of his experience in Seattle, he was offered a job as director of the city's EMS; recent legislation required cities with emergency medical services to have a physician supervising paramedics.

Pepe looked at Houston's survival rates for cardiac arrest. "They were essentially zero," Pepe says. "They had no enhanced 911 system. No one was doing CPR. There was no formal emergency training going on at the time, and no one was interested in it."

So of course he took the job.

When her overnight photographer ran the video of the pickup truck wreck, Linda Pepe knew she'd put it on the weekend news. Paramedics had saved the driver's life, and then someone noticed his badly injured Doberman on the side of the road. Onlookers were begging someone to do something. Linda watched as a young doctor who'd been riding with the paramedics ran an IV through a paw and resuscitated the dog, which was then rushed to a vet clinic. "Well, I knew the basics," said the doctor on camera.

"What a neat guy," she thought. In 1983, Linda was weekend news producer at KTRK-TV. Though Paul Pepe had only been in Houston a few months, her photographers knew him well. There were only 150 paramedics serving the entire city of Houston, and most nights Paul would be onboard an ambulance, observing while they worked, patting them on the back and, if necessary, quietly suggesting alternative ways to handle the patient.

Linda called Paul to get a few more details. Paul agreed to talk for something in return: He wanted Houstonians to learn CPR, and nobody wanted to write about it. Linda agreed to help him get publicity.

A few weeks later, Linda was listening to the police scanner and heard a report that seven or eight people had been shot at a restaurant, a big event even in Houston, which then had the highest murder rate in the country.

When Linda and her photographer arrived at the scene, it was mobbed by ambulances and two helicopters. Pepe was in the middle of the pandemonium, triaging. "He was very calm, very polite and soft-spoken, very instructive," Linda says. "Even in that kind of environment, I've never seen him ruffled."

Several weeks later, Linda helped Paul promote a major event: More than 5,000 people gathered at the Astrodome to learn CPR. At her advice, Paul held it on a Sunday to get maximum TV exposure. It was so successful, Pepe did two CPR mega-trainings per year, one for adults and one for children.

They didn't start dating until four years later, after each ended long-term relationships. "We'd go out to eat and then respond to ambulance calls," Linda says. "I'd start out in the passenger seat, he'd turn on the siren, and I'd end up on the floor. We'd go to fires and shootings. I got to see this guy in action. It made me fall for him."

Linda and Paul got married in Greece in 1990. They now have two children.

In Houston, Pepe says he learned how to deal with political turf wars. "There were fire chiefs and paramedics and other people who think they know how to do things better than you," Pepe says. "In the EMS system, the big problems were ego, financial issues or laziness."

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