The Windy City is now The Wounded City, thanks to a spate of carnage that has Chicago ranked tops nationally in violence for several weeks in a row. Violent crime costs Chicago about $5.3 billion a year, according to a new report from the Center for American Progress. Homicides have risen about 35 percent compared to the same period in 2011. "As a level 1 trauma center, Loyola is used to caring for the worst of the worst, but things have escalated to the point where the worst now is often lying dead in the streets," said Thomas Esposito, MD, MPH, Chief of the Division of Trauma, Surgical Critical Care and Burns in the Department of Surgery at Loyola University Medical Center. "It's not just the weather that is heating up this public health problem; the reasons are multifactorial."
Ninety-two people were shot, 14 fatally, during the consecutive weekends of June 9 and 10 and June 16 and 17 in the third largest city in the United States. At least 240 people have been shot dead in Chicago since January compared to the 144 U.S. troops killed while on duty in Afghanistan in the same time period. Violence in New York and Los Angeles, however, is reportedly down.
"It's drugs, it's gangs and it's guns all in a close, urban environment," said Mark Cichon, DO, FACEP, FACOEP, Division Director, Emergency Medical Services and Professor of Surgery and Emergency Medicine at Loyola. "But trauma and burn patients from downstate Illinois, Wisconsin, Michigan and Indiana are regularly flown in to Loyola for care and I can tell you a rise in violence is everywhere." In 2011, the Loyola Level 1 trauma center received 123 gun-related cases; 21 were mortal.
Violence Is A Disease
"Just like cancer, violence is a disease and it has to be treated through constant education, prevention, treatment and rehabilitation," says Hieu Ton-That, MD, Assistant Professor of Surgery and a trauma surgeon at Loyola. Since 2008, Loyola has partnered with CeaseFire, a national, non-government program dedicated to violence prevention. "CeaseFire works! Their people are incredibly connected to the community we serve and communicate effectively to help end violence," says Ton-That. "In cases of violence, Loyola chaplains connect with CeaseFire and they put the right members in contact with everyone involved to try to interrupt the cycle of violence."
Voted one of the top 100 Non-Government Organizations, CeaseFire uses proven public health techniques through a three-prong approach:
• identification & detection
• interruption, intervention, & risk reduction
• changing behavior and norms.
A popular slogan for gun proponents is "Guns don't kill people, people kill people." Esposito adds the qualifier"but it's much more effective if you use a gun!"
He explains "There are all kinds of dangerous weapons including knives and even bottles, but guns are the most lethal." In fact, gun-related injuries are fifteen times more likely to be fatal than those incurred by knives. Recent national data reveal that 70 percent of murders involve a firearm.
"Every day in America, 65 people are killed by handguns; one child is killed each day by a handgun," he says. Esposito also notes that there are now more wounds per body, more tissue destruction, more deaths and death at the scene of the incident are up threefold. Even the engineering and technology of guns, right down to the bullets, contributes to the rise in fatalities, according to Esposito.
"The controversy in the United States focuses on the gun itself being a bad thing, and a ban on guns being the only solution," said Esposito. He concedes this is a narrow view of the problem and the solution. For example, despite disagreeing on many issues with the National Rifle Association (NRA), he cites, "The NRA actually has one of the best education programs I have seen that focuses on respecting guns, using them safely and responsibly."
"Gun violence and firearm injuries must be approached as a disease which is preventable, diagnosable, treatable and survivable," said Esposito. He points out that the Centers for Disease Control and Prevention (CDC) sees this in the same light and is concerned with this as a public health issue that is epidemic, much the same as Polio or West Nile Virus. He also explains that is why the CDC offers numerous potential countermeasures for the control of gun violence besides just gun control laws. Generally, these involve strategies related to technology, enactment and enforcement of laws, economic incentives and disincentives, and finally, education. Esposito mentions some of these which include:
Taxes on the purchase of guns/ammunition
Promoting use of trigger locks and safe storage
Bullet-proof vests and glass
Gun buy-back programs
Providing alternative conflict resolution education in schools
Setting and enforcing curfews
Creating safe-havens where no gang activity is allowed by mutual agreement
Support of trauma centers and trauma systems
Esposito, who has a masters degree in public health, concludes,"The more, and varied, countermeasures that are implemented, the better the chances of successfully reducing and controlling the problem."
The Center for American Progress also reported $4.2 billion for pain and suffering for violence in Chicago with $1.1 billion attributed to direct costs ranging from medical expenses to lost income of victims and incarcerating criminal perpetrators. Esposito agrees that the negative effect of violence is widespread. "Violence drives up the cost of medical care, police protection, the judicial system, to name just a few. The costs are simply astronomical," he said. From the standpoint of health system resource consumption, for each death, 19 persons are hospitalized and 370 are medically attended injuries.
"Each of us is a respected and powerful force in our communities and each of us can make a difference in violence prevention and control," he said. "Do we want to continue to spend our money on violence? I don't."
As a Level 1 trauma center, Loyola is equipped to provide comprehensive emergency medical services using multidisciplinary treatment and specialized resources to patients suffering traumatic injuries -- car and motorcycle crashes, stabbings, athletic injuries and falls.
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