As the epidemic of firearm violence continues in the U.S., trauma surgeons will continue to be a critical part of the victim’s care team; however, other key members of the trauma community play an important part understanding and responding to violence. Moderated by Eileen Bulger, MD, FACS, chief of trauma, Harborview Medical Center, Seattle, WA, and Chair, American College of Surgeons (ACS) Committee on Trauma (COT), the Monday, October 25, Panel Session Social Determinants of Health and Firearm Violence offered the thoughts of an array of speakers, from firearm violence victims to leaders in violence intervention programs.
“The intersection between race, poverty, and gun violence is not coincidental,” said Scott Charles, MAPP, trauma outreach coordinator, Temple University Hospital, Philadelphia, PA, as he began a conversation with Cameron Stones, a victim of firearm violence in July 2020. In their talk, Mr. Charles, who oversees the Trauma Victim Support Advocates Program at Temple, asked Mr. Stones for his thoughts on the issues that led him and others to suffer from firearm violence, as well as some actions that health care providers and staff can take to bring about solutions. When asked what health care workers may not understand about the lives of victims, Mr. Stones said, “We live in a world of our own,” where violence can seem random. Before he was a victim, Mr. Stones thought that getting “war wounds” would make him feel like a hero, but he worried about his loved ones who came close to losing him. Mr. Charles asked about the importance of the violence support team in the hospital, and Mr. Stones said they were a valuable resource who briefed him and supported him through his life after recovery.
Albert Feaster, another victim of gun violence, described his experience with being wounded, his recovery, and his work with the Wraparound Project, a hospital-based intervention program operating through the University of California San Francisco. Mr. Feaster spoke of his initial entry into the hospital after the incident and how the treating physicians provided a balanced concern for his well-being, with some stern but concerned, whereas others were more soothing; however, his interactions with the police were negative, as he said they spoke to him as a potential perpetrator of a crime and not a victim.
“There should be some kind of prevention at the door, where there is a moderator, or a supervisor, or a program where they can interact with the police before they approach the client or patient,” Mr. Feaster said. But the medical treatment was very positive, he said, noting, “The doctors were very kind to me when I went into my surgeries.” He said the doctors treated him well at every step and talked to him to make sure he was all right.
“We want to make sure we understand violence in context, and particularly understand the role of structural racism,” said Fatima Dreier, Executive Director, Health Alliance for Violence Intervention (HAVI), noting that public policy, institutional practices, and other norms can perpetuate racial group inequity. HAVI and other hospital-based violence intervention programs (HVIPs) aim to address these root causes of violence to make a lasting difference. HVIPs address a range of services, from housing assistance, to job placement, to mental health counseling, and more, each of which disproportionately affect HAVI clients, who largely are minorities.
Ms. Dreier discussed the background of HAVI, which was founded in 2009 and supports more than 85 cities around the world with training and technical assistance to the more than 45 communities seeking to build or grow HVIPs, policy development at the state and federal levels, and partnerships with organizations like the ACS COT. “The [memorandum of understanding] with the COT allows us to have a very deep relationship that really helps us set a strategy that meets the needs of HVIPs,” Ms. Dreier said.
DeAngelo Mack, director of state policy, Public Health Advocates, Davis, CA, and senior advisor for HAVI, discussed an early role as lead violence intervention specialist at the first HVIP in Sacramento, CA. Mr. Mack said he met with young victims of firearm violence, stabbings, or other trauma, and helped to afford to them “a teachable moment—the moment when some patients are faced with the reality of their mortality and whether they need to make alternative decisions about their lives.” He would help patients and their families create “life plans” to change their circumstances, including finding a job, getting more education, attaining sustainable housing, and so on. His work in the role opened his eyes to how witnessing violence at an early age, domestic violence, and community violence can have lasting effects on a person’s life and circumstances and showed him the power of a patient advocate. “The role of a patient advocate is vital to the overall healing and wellness of a survivor of violence, who are often the products of a much deeper-rooted issue,” Mr. Mack said.
This and other Clinical Congress 2021 sessions are available to registered attendees for on-demand viewing for a full year following Congress on the virtual meeting platform.