Inside Melbourne trauma unit treating stabbing victims as Victoria‘s knife crime crisis fuels youth violence

The phone rings at 2am. A stabbing victim is on the way.

They may be haemorrhaging internally. They may be slipping towards cardiac arrest. They may have only minutes to live.

Waiting for them is one of the world’s leading trauma teams, primed to respond with extraordinary speed and precision.

Associate Professor Joseph Mathew jumps out of bed and heads to work.

By the time the ambulance arrives, an entire trauma team has mobilised. Blood is ready. Imaging is ready. An operating theatre is on standby. Doctors, nurses, anaesthetists and surgeons converge on the resuscitation bay.

Then the trolley rolls in.

Dr Mathew, deputy director of trauma services at The Alfred in Melbourne, compares what happens next to a Formula One pit stop.

“The car comes in. Everybody is aware that it needs a tyre change,” he said.

“Each person has allocated roles and the team runs so smoothly that in four seconds they change four tyres and go.

“So that’s how it is.”

Except here the stakes are life and death.

As paramedics perform their handover, doctors and nurses simultaneously assess and treat the patient while the team leader — the “puppet master” — decides within seconds whether they need scans, blood, surgery or an emergency procedure on the spot.

Research inside the unit found a critical intervention can occur every 72 seconds during a major resuscitation.

“All those decisions have to be made in a few seconds,” Dr Mathew said.

“That’s why we train for these sorts of scenarios.”

The response has been honed inside the largest trauma centre in the Southern Hemisphere and one of the busiest in the developed world.

The Alfred has helped develop trauma systems from India and China to Saudi Arabia and trained clinicians who now lead trauma services overseas.

Dr Mathew has helped lead that work across Asia and is himself a global leader in trauma care. But the 55-year-old remains, first and foremost, a frontline clinician.

“It can be challenging at 2am because some of us have to come in,” he said.

“Sometimes we don’t sleep for a few days.”

During almost three decades in trauma medicine, Dr Mathew has watched the violence coming through hospital doors change.

Born in Kerala, southern India, he studied medicine in Punjab during a period of Pakistan-linked terrorism, treating mass casualties from bombings and shootings.

Wanting to learn trauma medicine within a more structured system, he moved to Melbourne in 2003, aged 32, to train at The Alfred — then regarded alongside centres in Baltimore and Seattle as among the world’s best.

He never left. Now he is seeing the devastating consequences of Victoria’s knife crime firsthand.

Victoria Police intelligence shows 619 stabbings were recorded in the past year, down 13 per cent from 718, while officers seized a record 17,438 knives and edged weapons in 2025. Half of all stabbings occur in homes and one in five are family violence-related.

Among non-family violence stabbings, almost 80 per cent of victims have prior criminal offences, with criminal disputes a common theme.

About a third of stabbing victims are aged under 25. And Dr Mathew has noticed that younger cohort becoming increasingly prominent.

“Over the last few years, we are concerned by the serious bladed weapon injuries presenting to the trauma services, particularly with young people and adolescents,” he said.

“There has been a pattern of slow increase over time.

“We are also seeing the broader effects of fear, retaliation and ongoing vulnerability.”

Assaults have risen from about 3 per cent of The Alfred’s trauma workload two decades ago, to about 5 or 6 per cent today, with knives and other penetrating weapons accounting for the majority.

“The medical consequences of a blade have not changed in the last five to 20 years,” Dr Mathew said.

“What has changed is the social environment surrounding the violence, the weapons involved, the speed at which confrontations escalate.

“The younger group is more overly represented now.

“We are seeing more and more of these 13-year-olds and 14-year-olds getting involved with this.”

A wound that looks small on the skin can conceal catastrophic damage.

“A blade can cut major arteries, lungs, the heart, abdominal organs, nerves and tendons,” Dr Mathew said.

“A machete can also cause devastating injuries because it’s got a blunt force along with the penetrating force, so they can tear through muscle and bone too.

“Wounds to the chest, neck, abdomen, groin or areas containing major blood vessels can be immediately life-threatening.”

A single accurately placed wound can be fatal.

Some patients deteriorate so quickly there is no time to reach an operating theatre. Up to 25 times a year, the trauma is so critical that surgeons must operate in the emergency department itself.

“If they are dying right in front of you, we have to do damage-control surgery,” Dr Mathew said.

“Classic is heart stabs, where you just don’t have time.

“Sometimes up to 20 to 30 people are involved over the night or over a few hours to try and resuscitate these patients and bring them back to life.”

When those young patients die or are left severely disabled, Dr Mathew may be the one who has to tell their parents.

“It is hard. It is very hard,” he said.

“There’s a lot of regret. There’s a lot of missed opportunities … they think they missed something that could have prevented this.

“There’s a lot of guilt, a lot of emotions.”

A young man who survived against extraordinary odds convinced Dr Mathew hospitals could do more than repair the physical damage.

The 22-year-old arrived with his heart stabbed in two places and went into cardiac arrest six times.

At one point, his medical team believed there was nothing more they could do. But they persevered and he survived.

Days later, recovering on the ward, the young man told Dr Mathew he planned to take revenge.

He had survived a previous stabbing and thought himself virtually indestructible.

“He said, ‘I’m Teflon. I survived it’,” Dr Mathew recalled.

So the doctor showed the patient footage of his resuscitation.

On screen was his own beating heart, blood pumping from the wounds.

In the background, clinicians could be heard saying they believed he was gone.

“You could see how it sank in,” Dr Mathew said.

The young man abandoned his plans for revenge.

Dr Mathew connected him with a TAFE, which gave him a scholarship to train as an electrician.

He moved away and, according to Dr Mathew, helped several siblings and cousins escape the same cycle.

Dr Mathew began informally approaching other young patients.

Of about 21 people he approached, he says five completely stepped away from violence.

The experience helped inspire Victoria’s new $2.5 million hospital-based early intervention pilot, led by the Government’s violence reduction unit in partnership with The Alfred and the National Trauma Research Institute.

It aims to seize what Dr Mathew calls the “teachable, reachable moment”.

“A near-death experience sometimes makes a person reflect intensely on where their life is heading,” he said.

“During that brief period, they may be more open to help than they were before the injuries.

“Some of them are hardened by the cycle of violence and it takes a vulnerability and a chink in the armour to make the difference.”

The pilot, still being established, will connect young patients with social workers, youth workers and people with lived experience, with support extending into housing, education, training and employment.

Dr Mathew stresses intervention does not replace accountability.

“Criminal consequences address an offence,” he said.

“Intensive intervention addresses the factors that may lead to another victim, another offence or another hospital admission.”

After everything he has seen, Dr Mathew urges young people to rethink carrying knives.

“I understand that some young people carry a knife because they are frightened and believe it offers protection,” he said.

“But carrying a knife does not make you safer. It makes a dangerous situation far more likely to become fatal.

“In the trauma unit, we see how a decision made in a few seconds can permanently change many lives.”

For a man who has spent decades resuscitating people on the brink of death, Dr Mathew is reluctant to claim credit.

Trauma, he insists, is “a team game”, involving paramedics, nurses, surgeons, anaesthetists, allied health staff and community workers.

“What gives me hope is that violence is preventable,” he said.

“Young people are not defined by the worst decision they have made.

“In trauma care we sometimes meet people at the most frightening moment of their lives but that moment can be a turning point.”