What Is the Institutional Duty of Trauma Systems to Respond to Gun Violence?

Abstract

In the past, trauma centers have almost exclusively focused on caring for patients who suffer from physical trauma resulting from violence.However, as clinicians' perspectives on violence shift, violence prevention and intervention have been increasingly recognized as integral aspects of trauma care.Hospital-based violence intervention programs are an emerging strategy for ending the cycle of violence by focusing efforts in the trauma center context.These programs, with their multipronged, community-based approach, have shown great potential in reducing trauma recidivism by leveraging the acute experience of violence as an opportunity to introduce services and assess risk of re-injury.In this article, we explore the evolving role of trauma centers and consider their institutional duty to address violence broadly, including prevention. A Missed Opportunity?A 19-year-old woman is rushed to the trauma bay after sustaining a gunshot wound to the thigh.She is clinically stable.Neurovascular examination of the affected extremity is within normal limits.X-rays rule out a fracture.As part of her evaluation, a brief social history is obtained-she is asked about alcohol and drug use, her marital and employment status.However, no one on the trauma team asks about the circumstances of her injury or whether she feels safe returning home.A nurse instructs her regarding basic wound care, and she is discharged with a plan to follow up in the trauma surgery clinic.The encounter lasts 45 minutes.Within an hour, the same patient re-presents to the trauma bay in cardiac arrest after sustaining a gunshot wound to the head.Most trauma centers do not possess the resources, workforce, or systematic approach necessary to address the social underpinnings of violence.In many cases, a decision to either screen for risk of violence or offer social support or referral to resources that could provide support is not standardized and is left to the discretion of treating clinicians.In this article, we explore the institutional duty of trauma systems to respond to the social causes of violence and how clinicians' conceptions of this duty might be influenced by attitudes on violence.Additionally, we discuss the use of hospital-based violence intervention (HBVI) programs as a preventive strategy designed to break the cycle of violence and reduce trauma recidivism, which is associated with an increased risk of How the Health Sector Can Reduce Violence by Treating It as a Contagion, January 2018 What Are Ethical Implications of Regionalization of Trauma Care?, May 2018 Youth Violence: Effective Screening and Prevention, February 2009The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.

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