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Gun Violence and a Growing Epidemic of “Second Injury”

Updated: Jun 20

Four people sitting on stage with microphones

[Editor’s Note: Since this February's session covered in this article, there have been mass shootings in Louisville; Nashville, Memphis; Tate Country, Mississippi; East Lansing, and Washington, DC and another in Los Angels just prior to the conference]

The definition of “shooting victims” has expanded to a much broader scope than those killed or wounded by bullets at the scene of the crime. This blog is intended in in no way to minimize the impact immediate families and the shooting victims.

However, it is intended to reinforce the long term effects “secondary injury” on those clinicians and physicians who respond to and care for those involved in response to shootings, whether mass or even at an individual level. This is also spilling over to the families of these front-line workers.

At a recent Burnout Symposium at UCLA, organized in partnership between ICD Healthcare Network and the Los Angeles Country Medical Association the topic of “Second Injury and Its Impact on Physicians and First Responders” was discussed by a distinguished panel sponsored by the Cooperative of American Physicians.

The panel moderated by Emily Alpert Reyes, Reporter, The Los Angeles Times included:

Omer Dean, MD, President, Los Angeles County Medical Association

Joseph V. Sakran, MD, MPH, MPA, FACS, Vice Chair of Clinical Operations for Surgery, Johns Hopkins Medicine

Babak Sarani, MD, Professor of Surgery and Chief of Trauma and Acute Care Surgery, George Washington University School of Medicine

Here are some key insights derived from the session:

[Omer Dean} This is a public health emergency…no just a gun issue…. Lest we forget, children have a higher chance of being shot than any other cause of death.

[Joseph V. Sakran] One of the greatest challenges with secondary trauma is that at first no one wanted to talk about it as a professional. This was compounded by the fact that everyone deals with grief differently.

[Babak Sarani] There is no break in these shootings …. raises the question…am I good enough…should this child have died ?

Our nurses raised a concern that “you pronounce people dead pretty quickly unlike a cardiac where you continue to give them resuscitation". You only spend 5 or ten minutes with shooting victims. Now they take a vote among the nurses and doctors on time of death to spread the sense of participatory decision. They then needed to talk about their feelings and emotions immediately afterward to begin the coping process in their own way. This never happened years ago because it’s a kinder gentler world than in the past. Otherwise, most of it happens alone with no support group.

[Sakran] In America, mass shootings get massive media attention, but that’s only 4% of the overall problem. The “daily toll of gun violence” also needs to be told. It simply doesn’t make the press unless it’s a mass shooting but when you add them all up, the consequence when aggregated are just as large, if not larger than the mass shootings.

[Sarani] How do we correct this second injury problem. In the old days the hospital chaplain used to come to speak with doctors and nurses. This rarely happens the same way anymore as its much more complicated and the stakeholders are more widespread.

[Sakran] Hopkins has instituted an RISE program (Resilience in Stressful Events) which is essentially emotional “first aid": for front line workers. So few workers initially utilized the program because there was still a lingering stigma.

[Dean} How can physicians speak out without being written off? If not physicians, who else? Programs are not well advertised compounded by stigma. For example, Project See Change at LACMA is a growing community of organizations around the country joining forces to provide non-partisan, evidenced-based solutions for addressing gun violence as a public health crisis facing our nation, physicians, first responders, parents and children.

[Sakran]We sometimes don’t think about our role in society beyond the bedside. So how do we communicate to everyday people!! We’re sort of wonky. Johns Hopkins.

[Sarani]This gun violence and second injury problem could not change in 20 years, not unlike smoking. But it will happen…like smoking.

[Emily Alpert Reyes] From the press perspectives you need to let more journalists in to tell these stories.

[Sakran] The reason 500 pieces of common-sense gun legislation happens is at the local level need to continue this because at it gets closer to federal regulation the challenges increase exponentially.

[From audience Q&A] Number one cause of maternal mortality in US is gun violence…higher than sepsis, hemorrhage and eclampsia.

[Sarani] More studies need to be done on the cost of survival of gun violence. At GWU there was increase from 8% to 25% of what is classified as penetrating wounds. The vast majority survive. But there are massive costs to rescuing them especially psychological costs. One of the most successful initiatives has been the Trauma Survivors Network for patients. This works especially well for people who lose limbs or are paralyzed. It also includes injury prevention programs where local survivors communicate with peers.

[Sakran] The problem of re-traumatizaton exists because children who have been in these settings albeit “uninjured” are simply afraid to go back to school. We are totally desensitized because these have become shootings when they are really disasters.

[Sarani] HIPPA laws make shooting shootings victims across hospitals invisible. New policies are being explored. If you come in with a non-fatal injury the risk of you coming back is 41% in cites.

[Sakran] Data and science are powerful, but anecdotal gets gun policies passed. Plus, data has been more about deaths than on all victims… injured or emotional. For example, for every death we have about 2-3 non-fatal injuries and that may not be collected.

[Dean} Elected officials are more afraid to talk to doctors/front line workers than doctors are to talk to them. To make the case stronger wouldn’t it be powerful to have the same data heat maps like we did for COVID.

[Sarani] Every death tears out my soul. What makes it more emotionally challenging is that different ethnicities react very differently to their loved ones or child’s death from somber/introspective to hysterical.

[Audience Q&A] All panelists agreed that there needs to be more study on the impact of second injury on the spouse of clinicians, physicians and first responders.

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