Baltimore confronts an epidemic of gun violence

38_Special_mushrooming_side_viewA lethal epidemic is sweeping Baltimore neighborhoods, costing taxpayers millions of dollars, as well as demoralizing caregivers who struggle with its casualties daily. Researchers, tragically, are barred from developing detailed data about this scourge to try to curb its increasingly deadly harm.

Kudos to the Baltimore Sun and reporter Justin George for investigating for a year the gun violence that torments the city, sending at least 200 patients to area hospitals already just in 2016. The Sun says hospitals in the poor city have spent in five years more than $80 million caring for patients involved in gun crimes. Hospitals have seen their gunshot caseload double, and the costs of this care increase by 30 percent. Taxpayers end up footing most of the bill under Medicaid, the federal-state insurance for the poor.

The Sun’s multi-part series looks at gun violence from many aspects but the violence’s effects on the city’s health care is tragic and distressing.

George studied data on several cities nationwide and finds that Baltimore shooters are becoming especially malevolent and lethal: Physicians, though they’re adapting and employing every kind of state-of-the-art medical treatments, are seeing more and more patients they can’t save. That’s because Baltimore gunmen are firing multiple shots, aiming for spots like their victims’ heads and hearts. They’re using powerful weaponry, including the hollow point bullet, that inflicts incredible carnage.

A national expert on gun violence decries its harms, and its poor survival rates. Dr. Angela Sauaia, professor of public health, medicine, and surgery at the University of Colorado Anschutz Medical Campus, tells the Sun: “What’s surprising to me is that we’re a society that is willing to live with this. This would be a scandal if it was happening with breast cancer or heart attacks.”

The Sun says that Baltimore hospitals, during awful peaks, can be as chaotic and as under siege as if they were providing emergency care on military battlefronts, with families and gang members mixing and arguing in waiting areas as doctors try to treat multiple gunshot patients, including children. (I’ve written about the risks these situations can pose, especially if hospitals decide to add armed guards.)

Trauma surgeons in Baltimore have become among the nation’s finest in caring for gunshot wounds, managing complex surgeries with big medical teams and many learning lessons from U.S. fighting overseas. Sadly, battlefield advances−such as highly effective, relatively low-cost and easy to carry Velcro tourniquet−have become ubiquitous tools now for local law enforcement officers and caregivers.

But Dr. Thomas M. Scalea, physician-in-chief at the R Adams Cowley Shock Trauma Center, tells the Sun: “We spend every night trying to row upstream against” gun violence and the reality that so many patients’ lives will be saved or lost in mere minutes of care. “You get outraged for a while. Then you get the next one and you go—what are you going to do?”

To be clear, the Sun story also points out that, unlike TV or movie depictions where the wounded recover in the time of a 60-second commercial break or two, gunshot patients face long care, commonly with extensive hospitalizations and multiple, sometimes painful follow-up surgeries or procedures. Then they must undergo challenging rehabilitation and physical therapy. Many never fully recover. Many who do survive face lifetime debilitation, including paralysis and lives wheelchair-bound. The cost for all the bloodshed and havoc rises annually.

Caregivers express huge frustration that so little data and research occurs about gun violence. The Sun said it launched its investigation, including collection of 10-state incident data, partly because of the paucity of reliable information. Health care experts and the paper underscore that this differs from most other public health scourges but that Congress, under pressure from gun advocates, has restricted funding and told federal agencies to keep away from research on gun violence, which some figures show claims 90 American lives each day.

I’ve written about the distressing reality that caregivers are learning all too well from outbreaks of terror-related violence on how to provide better emergency treatment for gunshot and other trauma patients. But the daily mayhem detailed in the Sun series raises issues that demand responses, not the least of which is that lawmakers and policy experts get out from under the thumb of special interests, and, at the very least, they robustly support research on gun violence.

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