VIOLENCE
FIREARM INJURY in Louisville
Brian G Harbrecht, MD, and Keith R. Miller, MD
Michael Murphy, Gun Country, 2014
T
he Trauma
Program at
The Uni-
versity of
L ou i s v i l l e
Hospital (ULH) admits
approximately 3,500 pa-
tients annually and the
majority (80 percent) are Kentuckians. Of those admissions, nearly
one in five is the result of violent injury. Stabbings, firearm injuries,
and blunt assault accounted for 600 admissions to ULH last year.
At least that same number of patients, and likely more, were treated
and discharged home from the ER by our ED colleagues. About a
third of the admitted patients are either severely or critically injured
based on injury severity scores and suffer significant morbidity
and high risk of mortality. Caring for multiple patients following
violent injury on a daily basis has left us with a perspective on this
issue that may be very different compared to other physicians and
community members. In this summary, we’ll focus predominately
on firearm injury and attempt to describe the relative incidence,
some common misconceptions, and what physicians can do to play
a part in implementing solutions.
First, let’s acknowledge the good news. According to the CDC,
statistically speaking Kentuckians (one in 457 persons) are less likely
8
LOUISVILLE MEDICINE
than the average American (one in 263) to be a victim of violent
injury. Unfortunately, when discussing firearm fatality (15 per 1,000
in Kentucky, 11 per 1,000 nationwide), the same statement cannot
be made. You have probably read that Louisville is the 11 th most
violent city in the US (murder per capita), surpassing cities such
as Atlanta, Philadelphia and New York City. Almost 600 firearm
injuries were treated at ULH in 2017, with 325 admitted to the
hospital and 268 treated and released from the ER. There has been
a substantial increase in firearm injuries treated at ULH over the
last four years, a trend that has been observed in many major cities
throughout our country.
The costs to individuals, families and communities are stagger-
ing. Analyses have suggested that the total cost of each fatality is
measured in millions, and each survivor is measured in hundreds
of thousands of dollars. Ten percent of patients who survive injury
require post-discharge inpatient rehabilitation, home health care,
or psychiatric admission, which contribute to the total cost of
injury. This cost is often borne primarily by urban communities.
Regionalization of trauma care in America has successfully result-
ed in funneling critically injured patients to high volume trauma
centers. The majority of firearm injuries treated at ULH are from
Jefferson County, but many are transferred in from surrounding
counties and states. Following firearm injury, the full capabilities of
the trauma system are instrumental to ensuring optimal outcomes.