Northwestern Memorial Hospital's emergency department treats approximately 1,000 traumas annually, one third of which are related to shooting or stabbing incidents. In response, Northwestern Memorial has become a CeaseFire site and has staffed its emergency department with violence interrupters who are specially trained to intervene and minimize the risk of retaliation or repeat injury following a violent incident. CeaseFire is an evidence-based national violence prevention strategy.
"We frequently hear emergency department staff express frustration that they would like to have the resources to better serve our patients and their families," said Northwestern Medicine trauma surgeon Marie Crandall, MD, MPH. "Violent injury is devastating for people; grief, retaliatory anger and even occasional threatening behavior are not uncommon. This program provides the tools necessary to not only treat the physical injuries of these patients, but also address their psychosocial needs."
When an individual has been shot, trauma surgeons immediately stabilize the patient and evaluate their injuries. After life-threatening injuries are addressed, a member of the trauma team calls CeaseFire to provide basic demographic information, including where the incident occurred and where the patient lives. A violence interrupter is then dispatched to the hospital while concurrent intervention takes place at the street level.
"The violence interrupters are familiar with the different neighborhoods and ongoing issues," Crandall explained. "They will determine who else in the family might be affected; the intervention isn't always intended for the patient. Another important goal is to decrease retaliation and repeat injuries."
Northwestern Memorial's emergency department is designated as a Level I trauma center, meaning it can care for critically injured patients with life threatening conditions 24 hours a day. According to Crandall, there are "trauma deserts" in the city, where the nearest trauma center capable of caring for gunshot and stab wounds may be up to five miles away. Patients treated in Northwestern Memorial's trauma center are often from neighborhoods located far from the hospital, which according to Crandall may make follow-up care after discharge challenging.
"The goal is to bring the resources available at the hospital directly into the community," said Northwestern Medicine hospitalist Luke Hansen, MD. "By partnering with communities and medical centers around the city, we hope to create a network to coordinate care for individuals injured by violence."
CeaseFire partners with community-based organizations to implement street-level outreach and conflict mediation, with the goal of impacting violent behavior and changing of community norms. Violence interrupters work with individuals at highest risk for involvement in violence and their families to promote alternatives to violence located directly in the individual's neighborhood. This can include offering resources for education, job training and securing employment and safe housing.
"Trauma is a teaching opportunity," said Crandall. "These patients have touched mortality, which helps them reflect. The violence interrupters can use this opportunity to reach the patient and help them down another path."
Often patients with violence-related injuries are at risk for perpetrating violence or are associated with individuals who will retaliate on their behalf. By offering immediate intervention to minimize the risk factors associated with a shooting, Northwestern Memorial and CeaseFire hope to reduce violence.
"Many times these patients don't realize that violence isn't the norm," Crandall explained. "They have no idea what else is available in the city. CeaseFire shows them what is outside of their street and gives them the ability to do something."
As a CeaseFire site, the hospital will be better equipped to respond to the social aspect of violence-related injuries using an evidence-based public health approach to preventing shootings and killings.
"Violence is a public health problem, but unfortunately there lacks an institutional response like there is for domestic abuse or child welfare, that can remove people from a situation that threatens them," said Hansen. "We consider a patient injured by violence to be in a high risk category for repeat violence, just as a person who has had a heart attack is at a much higher risk for future heart problems."
The two physicians plan to track the patients following their treatment at the hospital to follow the impact of the social support services. The hope is that by better understanding patient demographics, they can connect the resources of Northwestern Memorial to the home communities to better ensure outcomes. They are currently in the process of surveying all the Level I and Level II trauma centers in the state of Illinois on their violence support services to complement their data. The doctors will also examine how staff perceptions of violence evolve after the introduction of CeaseFire.
"We firmly believe that if we can provide an alternative to patients with a high risk for violence that will help prevent them from being injured again, they will take advantage of it," said Hansen. "The introduction of CeaseFire will help the hospital serve the larger Chicagoland community and hopefully minimize the cycle of violence."
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