DOCTOR LEADS IN TREATING GUNSHOTS.

Byline: Associated Press 

Bloody gauze litters the slippery floor inside the emergency room of an inner-city hospital as Dr. Mark Krieger and other medical workers frantically work on a teen-age victim of a drive-by shooting lying motionless on a gurney.

The boy suffered several gunshot wounds, including one in the head. But the victim has at least one thing going for him: Krieger is an internationally known expert on civilian gunshot wounds to the head.

Krieger, 31, has extensive hands-on experience from the seemingly endless stream of young victims of street violence who find their way into the doctor's care at Los Angeles County-USC Medical Center.

There is no better training ground for head bullet wounds because the hospital sees more such wounds than any other in the world, including war-torn places such as Afghanistan, Bosnia and Belfast, Northern Ireland.

Brain surgeons from around the world have looked to Krieger for guidance, attending his slide show on ``penetrating cranium injuries'' at a medical conference in Moscow last summer.

``When it comes to treating gunshot head wounds, they all look to America,'' Krieger said. ``Everybody knows the prognosis usually isn't too good, and our treatments have been changing dramatically.''

Gunshots to the head are 90 percent fatal, Krieger said.

``In a lot of places like Bosnia or Rwanda, the victims never make it to the hospital'' because many victims of ethnic strife are shot in the head at close range, execution-style, he said.

The Los Angeles-style drive-by has created a new kind of head wound, one that isn't fatal as often. In these shootings, gang members and others often use a high-velocity rifle from a getaway car, as far as 100 yards from their intended victims.

Because damage depends on velocity, ``we've seen more survivors because victims are being shot from a distance,'' Krieger said.

Some bullets lose some speed as they travel, while other bullets ricochet and break into fragments before striking the head.

In 1993, the height of the drive-by epidemic in Los Angeles, 150 cases of gunshot head wounds were treated at the hospital. Last year, about 100 people were treated. Increased police patrols have helped.