Trauma doctors treat mass gun violence in Philly

Working in Temple University Hospital’s trauma center, Dr. Zoe Maher knows more than anyone what it’s like to treat gunshot victims before their wounds turn fatal.

“We see what bullets do to people,” said Maher, a surgeon in the hospital’s Division of Trauma and Surgical Critical Care, which provides around-the-clock care for the most critically injured patients. 

“As a trauma surgeon, we see the worst of what society has to offer,” she added. “…We meet people who are often at the lowest part of their life.”

More than 20 percent of the approximately 14,000 gun violence victims treated in Philadelphia hospitals from 2005-15 were admitted within 15 minutes of one another, a report by Temple researchers found. 

Clusters of four or more victims were equivalent to if there were 54 mass shootings in the city, though there is no mass shooting event on record in the 2000s, based on Mother Jones’ definition of the killings — single acts of gun violence involving four or more victims, minus the shooter, and excluding “conventionally motivated crimes,” like armed robbery or gang-involved shootings.

The study, published by a team of medical professionals, including Maher and three other trauma physicians from the Lewis Katz School of Medicine, examined “clusters,” two or more gun violence victims who sustained injuries and arrived at the same hospital within a 15-minute time period.

Dr. Jessica Beard, a trauma surgeon at TUH, led the research and it was published in the Journal of the American College of Surgeons on April 10.

“There’s really only one study that has ever looked at this before,” Beard said. “The purpose of our study was really to understand the burden, the true public health burden of multiple-victim shooting events.”

Clusters of everyday gun violence victims have an impact similar to mass shootings on hospitals’ trauma wards because there are multiple victims being treated at the same time, Beard said.

Shira Goodman, the executive director of CeaseFirePA, a gun control education and advocacy organization, said the study is important because it helps people understand the work hospitals do to address gun violence.

“We need public health officials telling this story about what the realities of gun violence are in different communities, and then taking those stories and becoming advocates to policymakers as well,” Goodman said.

The Centers for Disease Control and Prevention were prevented from conducting gun violence research by the Dickey Amendment, a 1996 provision that barred federally funded reports that “advocate or promote gun control,” up until 2018, according to Mother Jones. Because of this, private sources have produced research that examines gun deaths, Goodman said.

“That’s a big burden for people who are already overburdened in their jobs in trying to make us healthier and safer,” she added.

Three unnamed hospitals in Philadelphia treated 77.8 percent of all gun violence victims, according to the study. This is typical for the city’s treatment system, Beard said, because larger hospitals are better equipped than smaller ones to deal with clusters of gun violence victims. TUH is one of five Level 1 trauma centers in the city, according to the Pennsylvania Trauma Systems Foundation.

“It just so happens that gun violence is a little more political than breast cancer,” Beard added. “But in our minds, as trauma surgeons, public health is really a basic science of trauma surgery. To us, it’s really about preventing disease.”

Saturday marked the 20th anniversary of the Columbine High School mass shooting in Colorado, where two student gunmen killed 12 students and one teacher. Since then, nearly every mass shooting in the United States has generated a national debate about the right to own a firearm and increased advocacy to change current gun laws. 

Yet mass shootings constitute a very small percentage of overall U.S. gun deaths. Less than 2 percent of the nearly 39,000 gun deaths in 2016 were part of mass killings, Vox reported. 

Violence in urban centers and suicides in suburban and rural areas do not receive as much public attention as mass shootings despite being the driving force of gun deaths, Goodman said.

“Our communities are suffering the equivalent of mass shootings really, really frequently,” Goodman said. “All of the emotional trauma, economic trauma, losses in that community are being suffered over and over again.”

Media organizations often perpetuate stereotypes about victims of gun violence and don’t report enough on the issue from a public health perspective, Beard said. She and Jim MacMillan, the former program manager for the Center for Public Interest Journalism at Temple, are collaborating to create a set of guidelines for journalists who report on gun violence to combat coverage that ignores victims.

“Seeking out sources that are different, trauma surgeons, hospitals, folks who care for patients, the victims of gun violence themselves, is an important first step for educating the public and then searching for solutions,” Beard added. 

The medical community has prepared more for mass casualty incidents, or MCIs, as of late, but produces few academic reports on the effect of clustered, everyday gun violence on hospitals, Beard said. But this is beginning to change.

“Large scale MCIs from firearm violence remain relatively rare,” the study on Philadelphia hospital trauma centers states. “More commonly, firearm-injured patients present to trauma centers as a single victim or in clusters of multiple casualties, which do not achieve the definition of mass shooting.”

From Jan. 1, 2015 to April 9, there have been 959 shooting victims in the North Philadelphia East and West neighborhoods, the Inquirer reported. The two areas had the most victims of any section in the city. TUH alone treats more than 400 gunshot victims every year, according to the hospital’s Cradle to Grave program.

Philadelphia health care providers are well-prepared to treat shooting injuries, but need to focus more on prevention methods, Beard said. As a physician, it’s her job to understand the root causes and solutions to the injuries she treats, she said. 

Some of those causes are a lack of educational and employment opportunities for those likely to be involved in gun violence and should be discussed alongside gun regulation and enforcement, Goodman said. 

“There have to be better economic opportunities than picking up a gun,” she added. “There have to be better ways to feel safe than picking up a gun.”

Robert Young, the editor of Doctors for Responsible Gun Ownership, a right-leaning national gun rights organization and publication led by medical professionals, said the focus of limiting gun violence should be improving mental health and tracking down criminals.

“I oppose the presumptions of organized medicine…[and doctors] who are trying to label guns as bad things, who want to impose increasing restrictions on perfectly responsible gun owners,” he said.

It’s part of doctors’ obligation as physicians to identify and study solutions to prevent gun violence and anything that causes injury to patients, Maher said. That involves creating more jobs, bettering education and eliminating poverty, she said.

“That’s part of our doctrine, to advocate for things that improve the health and wellness of our patients,” Maher said.