Doctors and Emergency Workers Tell Us About the Toll of Treating Gunshot Victims
Credit to Author: Jooyoung Lee| Date: Mon, 17 Dec 2018 20:43:06 +0000
About a month ago the NRA tweeted: “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in the Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.” This tweet went live eight hours before a gunman killed 12 people and injured several others inside the Borderline Bar & Grill in Thousand Oaks, CA.
This tweet has backfired in spectacular fashion. In the immediate aftermath, doctors from all over began tweeting stories about their work on the frontlines of America’s gun violence epidemic. Many have tweeted stories of resuscitation attempts that end in death. Others have posted photos of scrubs and operating rooms drenched in blood. And some have shared what it’s like to tell parents that their child isn’t going to make it. These tweets (and many others under the #ThisisMyLane) are a grueling snapshot of the work that goes into saving lives.
As someone who has studied gun violence for the past decade and spent time in the hospital with gunshot survivors and their families, I was inspired to see this response. The NRA’s tweet has helped shed light on the role that trauma doctors play in our ongoing fight against gun violence.
But, trauma doctors aren’t alone in this lane. EMTs, police, and nurses are also integral parts of rapid response trauma care. Their cooperation makes life-saving possible.
To learn more about trauma care, I reached out to colleagues at the University of Pennsylvania, where I was previously a postdoctoral fellow studying gun violence. The University of Pennsylvania is home to one of the nation’s busiest trauma bays for gunshot victims. Its three hospitals—The Hospital at the University of Pennsylvania, Children’s Hospital of Philadelphia, and Penn Presbyterian Medical Center—are leading research and training hospitals. The following stories reveal the everyday triumphs and challenges of trauma care providers.
The Teamwork in Life-Saving
“If you make it to the hospital, you have a very good chance of surviving,” said Dr. Elinore Kaufman, who is doing her trauma research fellowship at the University of Pennsylvania. Dr. Kaufman is referring to a well-known fact within trauma care: Most people who get shot don’t die. The Centers for Disease Control and Prevention estimate that about 1 in 6 shootings are fatal. The vast majority of gunshot victims survive and this is in large part because of the efficiency of emergency care.
Over the last 50 years, trauma doctors have learned that a person’s chances of surviving a shooting go up if they are treated in a timely manner. Some doctors refer to this window of life-saving opportunity as the “golden hour” after injury. The hour is not a precise interval, but it captures a larger push to get victims medical attention sooner rather than later. The underlying idea behind this approach is to stop bleeding, which is a leading cause of death from gunshot wounds. Once the victim is stabilized, they can undergo surgery to reconstruct damaged body parts.
Dr. Kaufman described the chaotic scene as doctors and nurses rush to save a life. “There are 10-12 people and they’re all doing something,” she said, running me through a roster of people who quickly assemble once a person is admitted into their emergency care. Someone is administering medication, another is putting in IVs, someone else is opening the person’s chest, another person is using a tube to drain out excess blood, another person is working the breathing tube, and the list goes on. All of this unfolds within minutes, as trauma teams race against the clock.
But, even when they successfully save a person from dying, trauma doctors and nurses are ambivalent about the long-term prospects of young people who leave the hospital with life-altering injuries. Dr. Kaufman told me about two recent patients who suffered spinal cord injuries and who would be paralyzed for the rest of their lives. Knowing what victims and their caregivers will face in the days, months, and years after the shooting is difficult to come to terms with.
Fighting Burn Out
Jake Weissenburger was an EMT before he became a nurse. These days, he’s a clinical nurse educator at Penn Presbyterian Medical Center, which is where many critically injured gunshot victims are treated in Philadelphia. I asked him what it was like to be an EMT and he described a fast-paced grind with repeated adrenaline dumps. “It’s very hard to go from being amped up and running at a hundred miles an hour to save a body, to then going to zero,” he said, describing the chaos of first response.
His voice got a little quieter as he remembered a gunshot victim who died after he and other EMTs tried to save his life. “We did everything we could and worked him very hard,” he said, describing the frantic efforts of his team. “…[A]nd then when we got to the hospital, the trauma surgeon came over, assessed the situation and said…there’s nothing we can do, let’s call it.’”
This is a typical day in the life of EMTs, who (along with police officers in Philadelphia) are often first responders at shootings. They are with victims in their last moments, as they bleed to death and cry out for their families. They are also potentially stepping into harm’s way whenever they arrive on scene.
Seeing young, otherwise healthy lives cut down in gunfire takes its toll on EMTs, who feel loss in the aftermath of a failed life-saving mission. Jake reflected on his experiences trying to save victims—who are overwhelming African American boys and men from dying—“It’s really hard to see 15, 16, 17 really able-bodied, once alive young men who probably could have been something great. They’ll never have that ability to change society, to make things happen in our society.”
Now, as a clinical nurse educator, Weissenburger helps create a healthier work environment for trauma nurses. “Burnout is a big thing,” he said, explaining how many nurses don’t even realize that they’re suffering from it. “You don’t realize how much it affects you until something happens and you’re not as emotional as you should be…when it’s your family members who’re injured and you’re just looking at them as the next victim you’re caring for.”
To fight against burnout, Weissenburger runs de-briefings with nurses after their patients have been cared for. These sessions give nurses a chance to talk to each other and share their experiences after caring for patients. Debriefings increase communication and knowledge sharing amongst doctors and nurses, which helps improve outcomes for patients. It also gives trauma teams a chance to regroup after a stressful life-saving effort. These are small tools that trauma teams use to cope with the stress of working in emergency trauma care.
Why Talking Matters
Caring for victims doesn’t stop in the ER, either. It extends into the everyday lives of survivors and their families long after a person has been released from the hospital. Life after the shooting is hard. In addition to physical disabilities, which are visible and easier for doctors to diagnose, survivors and their families often suffer from PTSD, anxiety, depression, and other lingering mental health issues that diminish their quality of life.
I saw this a lot during my research in Philadelphia and eventually became known to some families as a “psychologist.” I’d correct them and tell them that I was a sociologist. Most brushed off this distinction and explained how I had become someone they could talk to in the aftermath of a shooting. Even though I wasn’t a trained therapist, my willingness to listen was appreciated by survivors who were often trying to make sense of what happened to them months and years after the fact.
This is one of the key issues that gets overlooked whenever we talk about gun violence. Talking about trauma is a key part of healing and it’s at the core of many hospital-based interventions. Mary Rogers, who was formerly a nurse manager of the surgical trauma floor and is now in a clinical directorship role, told me about a mental health screening they try to administer to trauma patients. The screening invites patients to reflect on their mental health when they’re in the hospital. This screening encourages them to be more mindful and aware of how they’re doing mentally.
They also help nurses understand and empathize with their patients. Mary told me a story about a patient who confessed to her that he was afraid of the dark. This was a revelation. “It really deepened some of the nurse-patient relationships,” she said, explaining how these fleeting moments helped her understand why some patients were closed off and resistant to help.
Survivors also benefit from talking with other survivors. Dr. Joel Fein is professor of pediatrics and emergency medicine and co-director of the Violence Prevention Initiative at Children’s Hospital of Philadelphia (CHOP). Within this role he oversees the CHOP Violence Intervention Program, an intensive support program that connects wounded eight to 18-year-olds with violence prevention specialists who help the recently injured adjust to the demands of living after they are out of the hospital. These specialists help youth and their families navigate the various systems that are encountered after a violent injury, such as advocating for safe housing, handling police reports and accompanying the victims to court, and even petitioning schools to create independent education plans and safety plans.
“It’s not just behavior change that we’re talking about. It’s an entire system of care that needs to be instituted to prevent the next injury,” he said, explaining the intensive wraparound support that helps victims avoid re-injury and reclaim their lives. Part of the program involves peer-led support groups for the young victims. “It’s really a space where they can open up safely and be heard. And there’s a lot of support in these groups… they become more close in a way that they weren’t allowed to do in school or in another community setting,” he said, telling me stories about young people who benefited from being in this program.
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