Trauma Care in the Era of 'Guns Everywhere'
NOW THAT the dust has settled in the wake of America’s most recent mass shooting, the odds seem high that history will repeat itself and our legislature will again fail to enact any meaningful reform.
Like it or not, we as a country, through our elected representatives, have decided that we value unfettered access to deadly weapons over an individual’s right to feel safe in public spaces. Why this is, and what can be done about it, are topics for another day.
The more morbid—but, I believe, essential—question to ask is, When a citizen is struck by a bullet from one of those sacred guns that the NRA and its allies in Congress have worked so hard to protect, what rights do we extend to that person?
An ambulance in under two minutes? A hospital within 10? A fully-equipped trauma center with surgeons and anesthesiologists and nurses and techs?
While access to guns remains free
and easy, access to acute trauma
care is on the decline.
If it were me, I would find some comfort in knowing that these resources were nearby and ready. But, as it turns out, while access to guns remains free and easy, access to acute trauma care, which offers gunshot victims the best chance of survival, is on the decline.
Trauma centers nationwide are shutting their doors. Some of the best—and only—research on this phenomenon has been carried out by Dr. Renee Hsia and Yu-Chu Shen. They have found that not only do these closures result in increased mortality, they disproportionately affect minorities and the poor.
The reason these centers are dropping like flies mostly has to do with cost. Since trauma care is unpredictable, these hospitals must have a multi-disciplinary team of surgeons, doctors, and support staff on call at all times, which gets expensive. What’s more, many trauma patients are uninsured or on Medicaid, which means their hefty hospital bills are reimbursed at low rates, or not at all.
There were many stories about the heroic efforts of trauma physicians at Orlando Regional Medical Center on June 12 and the days and weeks that followed. By all accounts, the victims of this massacre received top-notch care. They were fortunate to have a hospital nearby with the capability to activate enough personnel in the pre-dawn hours on a Sunday morning to save as many lives as they did. Different circumstances might have yielded even more devastating results.
There’s no telling where the next mass shooting will happen. A movie theater in a town with one or two ambulances? A crowded lecture hall at a college 20 minutes from the nearest highway? Whereas guns are everywhere, trauma centers are few and far between. The capacity of assault-style weapons to take life is outstripping our ability to save it.
Americans deserve better. Congress should make up for its inaction on gun control with efforts to guarantee timely care for those afflicted by gun violence, especially in poor, rural and minority communities. Hospitals providing trauma care must get the support they need to keep their doors open, whether it comes in the form of increased government subsidies or higher reimbursements. It’s scary enough to live in a world where virtually anyone can buy a deadly weapon. It’s even scarier to think that in the event of the next tragedy, care may not be there when you need it most.
Note: A version of this article appeared on KevinMD.com on August 4, 2016.