Do Chicago’s Trauma-Care Deserts Increase Deaths From Firearms?

A new study looks at how proximity to trauma care affects gunshot victims in the city. It’s a different take on a surprisingly divisive medical subject.

John J. Kim/Chicago Tribune

One of the better pieces I’ve read in the wake of the Boston Marathon bombings comes from the typically interesting Atul Gawande, the New Yorker’s journalist-slash-doctor. He’s a doctor in hospital-rich Boston, so he had a direct view of the bombing’s aftermath. Given the circumstances, it seems something of a miracle that “it now appears that every one of the wounded alive when rescuers reached them will survive,” insofar as a sophisticated system of human design acting as intended is miraculous. Gawande asked his hospital’s chief medical officer why:

“I mostly let people do their jobs,” he said. He never needed to call anyone. Around a hundred nurses, doctors, X-ray staff, transport staff, you name it showed up as soon as they heard the news. They wanted to help, and they knew how. As one colleague put it, they did on a large scale what they knew how to do on a small scale.

Gawande believes that 9/11 created a different mindset in the medical community: “A decade earlier, nothing approaching their level of collaboration and efficiency would have occurred.” But his primary example isn’t systemic, but emotional—not being shocked by such an incident means that the system can work as intended. (I did wonder, and Mother Jones’s Tim Murphy was already on it, whether a decade of war in Iraq, where improvised explosive devices are a primary weapon, has also improved domestic trauma care; historically, domestic and war-zone trauma methods build upon one another.)

It’s an excellent tribute to evolutions in trauma care. And I thought about it when I heard Natalie Y. Moore’s piece on WBEZ this morning about the research of Marie Crandall, a Northwestern trauma surgeon, about Chicago’s trauma deserts. I’ve been awaiting Dr. Crandall’s research, and it’s forthcoming; Moore got an early look:

Dr. Marie Crandall, a professor in surgery/trauma care at Northwestern University, analyzed 11,744 gunshot patients from 1999–2009. The data found 4,782 people were shot more than five miles from a trauma center. Those patients were disproportionately black and less likely to be insured.

Read on for the results of Dr. Crandall’s study (it’s in the June issue of the American Journal of Public Health), and not yet online.

Dr. Crandall asked: does distance from a trauma center make a difference in mortality, specifically when it comes to gunshots? It’s not as obvious an answer as you’d think. When Moore’s colleague Gabriel Spitzer looked into the issue in 2011, Dr. Crandall was in the early stages of her research. Then, the study of note “examined records for 3,656 trauma patients at 51 hospitals, and found, surprisingly, differences in transport times really don’t affect survival. This may have to do with the quality of care people get in the ambulance on the way.” (A good Medill Reports piece from 2012 has more.)

The two studies do not necessarily conflict. The 2010 study looked at many different types of injury, of which gunshots were only one, and in different cities; Dr. Crandall’s is specific to gunshots wounds in Chicago. As such, it could indicate that gunshots are sufficiently unique as to require different protocols, the sort of incremental change medicine is built on.

 

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1 year ago
Posted by Liz L.

I also found this NPR piece, that talks about how they handled the distribution of trauma patients, interesting:
http://www.npr.org/2013/04/16/177507495/doctors-remove-nail-fragments-pellets-from-boston-victims
DR. STEPHEN EPSTEIN: We have five level-one trauma centers in Boston. Any one of those trauma centers could've been overwhelmed had they received all of the patients who were critically injured. By distributing them throughout the city, we gave each one of those patients the maximum chance of survival because we were able to match the available resources in the city to all the victims. And I'm certain that that, you know, contributed greatly to minimizing loss of life and limb.

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