VIOLENCE
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markedly improved delivery of care following injury , regardless of where geographically the patient is injured .
As an extension , civilian bystanders in the field can initiate life-saving adjunctive measures such as tourniquet application and direct pressure to hemorrhage . However , these interventions are not intuitive and require some level of training in order to be successful . In conjunction with many trauma centers , the American College of Surgeons offers “ Stop the Bleed ” training targeted for general public education . Nationwide , efforts are underway to equip public facilities with hemorrhage control kits ( tourniquets , bandages , etc .) in a fashion similar to cardiac defibrillators . Much like CPR initiatives , we encourage the integration of this information in to common public knowledge and physicians can encourage at-risk populations to engage in this training .
Finally , there is significant opportunity for impact in the post-injury setting . We are well aware that we care for these patients for a very short period of time , whereas many of you care for them for a lifetime and will have a much greater impact on their future well-being .
2 . PUBLIC EDUCATION AND PRIMARY INJURY PRE- VENTION
Primary injury prevention encompasses strategies devised to prevent injury from ever occurring . These strategies will typically fall under the purview of providers with regular contact in the outpatient setting , and thereby prevent patients from ever seeing a trauma center .
Implicit in injury prevention is clear characterization of the problem with accurate and detailed data . It ’ s worth noting here that the quality of data surrounding firearm injury is , at current , abysmal . Statistics provided in popular media are generally pieced together from various porous databases . The lack of research funding over the years as a result of various legislative initiatives is likely in part a byproduct of the political narratives so closely intertwined with this issue . This hearkens back to the discussion regarding firearm injury not traditionally being perceived as a public health issue . Dramatic reductions in mortality from motor vehicle accidents were only realized following significant investment by stakeholders in characterizing the problem with quality data . Ongoing advocacy from physicians both as individuals and within various societies / organizations is of key importance in addressing this data gap .
Primary care providers , pediatricians and other frontline providers are essential in encouraging gun owners to seek training in both the operation and storage of firearms . Accidental injuries often result from insufficient expertise / training or unintended access to a firearm by an untrained individual . In our experience , the majority of accidental injuries occur either during cleaning of the firearm or in transportation . Ricochet injuries are often discussed but are exceedingly uncommon (< 3 percent of all accidental injuries ). It is estimated that a quarter of firearms are stored loaded and that nearly half are kept unsecured within the home . Given that 50 percent of Kentuckians own firearms , all physicians with patient contact can proactively discuss these issues , with this short conversation having the potential to save a life .
3 . COMMUNITY AND HOSPITAL VIOLENCE PREVEN- TION PROGRAMS
Hospital-based violence and injury prevention programs are increasing in frequency in trauma centers throughout the United States , including at ULH . Education , outreach and intervention are key principles . These programs attempt to take advantage of “ teachable moments ” following injury where patients may be more apt to incorporate new behaviors into everyday life . Specially trained personnel engage patients in structured discussions in an attempt to reduce recidivism . Newer collaborative models such as the Cure Violence Initiative approach violent injury in much the same way that infectious epidemics are managed . Here , interruption of transmission , prevention of future spread , and the alteration of group norms are key principles . These models incorporate “ violence interrupters ” into the framework of the community , facilitate resources and social services to individuals at risk , and actively participate in outreach efforts . This model has achieved significant global success in urban areas , and is evolving here in Louisville . Substantial and sustainable investments of time , finances and resources from communities are barriers .
Violent injury , and firearm injury in particular , are increasing in incidence in our community and represent a significant public health issue . Misconceptions persist regarding the management and nature of these injuries . The scope and magnitude of the problem can often trigger feelings of helplessness amongst health care providers , and we know that feeling all too well . However , together we as providers in our community can both improve the care of patients following violent injury and , optimally , work together with other stakeholders to prevent these injuries from occurring in the future .
Dr . Harbrecht is a professor of surgery at the University of Louisville and the practicing Trauma Medical Director of the UofL Dept . of Surgery .
Dr . Miller is an assistant professor of surgery at the University of Louisville and a practicing surgeon at the UofL Dept . of Surgery .
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