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Yosif Al-Hasnawi's strong, young heart was the very thing masking signs that he was on the brink of death from a rare and devastating gunshot wound.

When the 19-year-old was shot downtown at about 8:55 p.m. on Dec. 2, 2017, the hollow-point bullet mushroomed after breaking the skin near his belly button, rupturing a critical artery and vein.

But even 30 minutes later, as Al-Hasnawi rapidly lost blood internally, paramedics recorded his heart rate at a vigorous 145 beats per minute, and he was moving his limbs.

This patient, being very young, was better able than most to mask the circulatory stress he was under, and maintain blood pressure until nearly the end."

Najma Ahmed, testifying as an expert in critical-care medicine, spoke via Zoom in court Friday, where two former Hamilton paramedics are on trial. Steve Snively and Christopher Marchant are accused of failing to properly care for the teen.

Ahmed, a trauma surgeon at St. Mike's hospital in Toronto, offered opinions on Al-Hasnawi's manner of death and what measures would have offered him a chance of survival.

In five minutes en route from the shooting scene to St. Joseph's hospital, his heart rate dropped to a critically low 45 and he stopped moving.

The patient's blood volume lost is not being replaced," Ahmed said. The heart muscle is failing to pump blood and it's an ominous sign."

She suggested that his chances of surviving the unusual destruction created by the bullet were slim: 10 to 15 per cent, if he had been treated at a regional lead trauma hospital" like Hamilton General.

That Al-Hasnawi was instead taken by ambulance to the St. Joe's ER - the same distance from the scene, and where trauma procedures are performed, but with less specialization - is one of the issues in the case.

Ahmed said the teen would have had a greater chance of survival at the General, but could not put a figure on the difference.

Even given his internal lacerations, if his blood pressure had remained relatively strong upon arrival at hospital, his odds of living would have climbed to about 50 per cent, she added.

His best chance of survival would have been immediate recognition of the seriousness of the penetrating wound, treatment at the scene, and expeditious transport to a lead trauma hospital."

Jon Wells is a Hamilton-based reporter and feature writer for The Spectator. Reach him via email: jwells@thespec.com