Trauma surgeons detail horror of mass shootings in Uvalde’s wake, call for reform

June 10, 2022

[This article by Andy Miller and Lauren Sausser first appeared in Kaiser Health News, republished with permission]

When Dr. Roy Guerrero, a pediatrician in Uvalde, Texas, testified before a U.S. House committee on gun violence on Wednesday, he told lawmakers of the horror of seeing the bodies of two of the 19 children killed in the Robb Elementary Massacre. They were so pulverized, he said, that they could only be identified by their clothes.

In recent years, the medical profession has developed techniques to help save more gunshot victims, such as the rapid evacuation of patients. But trauma surgeons interviewed by KHN say even these improvements can only save a fraction of patients when military-style guns inflict the injury. Suffering from gaping wounds, many of the victims died at the scene of the shooting and never made it to the hospital, they said. According to surgeons, victims arriving at trauma centers seem to have more injuries than in the past.

But, the doctors added, the weapons used are not new. Instead, they said, the problem is that there are more of these particularly deadly weaponsand these weapons are be used more frequently in the mass shootings and daily violence that plagues communities across the country.

Doctors, frustrated by the carnage, are calling for sweeping measures to curb rising gun violence.

Weeks after the Uvalde school shooting, it remains unclear what steps the country will take to prevent another attack of this magnitude. The House passed measures to reduce gun violence on Wednesday and Thursday, but approval in the Senate appears uncertain at best.

Many doctors agree that something substantial needs to be done. “One solution will not solve this crisis,” said Dr. Ashley Hink of Charleston, South Carolina, who was working as a trauma surgery resident at the Medical University of South Carolina in 2015 when a white supremacist killed nine black members of the Mother Emanuel African Methodist Episcopal Church. “If anyone wants to hang their hat on a solution, they clearly aren’t knowledgeable enough about this issue.”

Weapons fired in mass shootings — often defined as incidents in which four or more people are shot — aren’t just military-style rifles, like the AR-15-style weapon used at Uvalde. Trauma surgeons said they are seeing an increase in the use of semi-automatic handguns, like the one used in the Charleston church shooting. They can hold more ammo than revolvers and fire faster.

Overall, gun violence has increased in recent years. In 2020, firearm injuries have become the leading cause of death among children and adolescents. Firearm-related homicides increased nearly 35% in 2020, the Centers for Disease Control and Prevention reported in May. Most of these deaths are attributed to handguns.

Yet trauma surgeons such as Dr. Rob Todd at Grady Memorial Hospital in Atlanta blamed military-style rifles and the end of the nationwide ban on assault weapons in 2004 for higher levels of deadly gun violence.

A recently published study by JAMA Network Open revealed that for every mass shooting death, approximately six more people were injured. Trauma surgeons interviewed by KHN said the number of injuries per patient appears to have increased.

“I feel like we’re seeing an increase in the intensity of violence over the past decade,” Dr. Joseph Sakran, trauma surgeon at Johns Hopkins Hospital in Baltimore. He cited the number of times a person is shot and said more gun victims are shot at close range.

Survival rates in mass shootings depend on several factors, including the type of firearm used, the proximity of the shooter, and the number and location of injuries, Dr. Christopher Kang of Tacoma, Washington, who is president-elect of the American College of Emergency Physicians.

Several recent shootings left few survivors.

The perpetrator of the Charleston massacre shot each of the nine people who were killed multiple times. Only one of these people was taken to hospital and when he arrived he had no pulse.

Last year, shootings at three Atlanta-area spas left eight people dead – only one person shot survived.

Chaos at the scene of a mass shooting — and the presence of an “active” shooter — can add crucial delays to getting victims to the hospital, Dr. Jean Armstrong, professor of surgery at the University of South Florida. “With high-energy weapons, you see more injury, more tissue destruction, more bleeding,” he added.

dr. Sanjay Guptaa neurosurgeon who is chief medical correspondent for CNN, wrote about the energy and force of gunshots of an AR-15 style rifle, the type also used in the recent mass shooting in Buffalo, New York. This energy is equivalent to dropping a watermelon on cement, Gupta said, citing Dr. Ernest Mooredirector of surgical research at Denver Health Medical Center.

Medical advances over the years, including lessons learned from the battlefields of Iraq and Afghanistan, have helped save the lives of shooting victims, said Armstrong, who trained Army surgical teams American.

These techniques, he said, include the proper use of tourniquets, rapid evacuation of casualties, and the use of “whole blood” to treat patients who need large amounts of all blood components, such as those who have lost a significant amount of blood. some blood. It is used instead of blood which has been separated into plasma, platelets and red blood cells.

Another effective strategy is to train bystanders to help shooting victims. A protocol calledStop the bleedingteaches people how to apply pressure to a wound, dress a wound to control bleeding, and apply a tourniquet. Stop the Bleed came after the 2012 shooting at Sandy Hook Elementary School in Newtown, Connecticut, where 20 children and six adults were killed.

The CDC, which for the past two years has been able to conduct gun research after years of congressional bans, has funded more than a dozen projects to address the problem of gun violence from a perspective of public health. These projects include studies of gunshot wounds and the collection of data on gunshot wounds in emergency rooms across the country.

For some doctors, gun violence fueled political action. dr. Annie Andrews, a pediatrician at the Medical University of South Carolina, is running as a Democrat for a U.S. House seat on a platform to prevent gun violence. After the school shooting in Uvalde, Andrews said, many women in her neighborhood asked, “What can be done about this? I worry about my children. »

dr. Ronald Stuart, chair of surgery at San Antonio University Health, told KHN that those shot at Uvalde had wounds from “high-energy, high-velocity” bullets. Four of them, including three children, were taken to University Hospital, which provides high-level trauma care.

The hospital and Stewart had seen such carnage before. In 2017, San Antonio Hospital treated victims of the Sutherland Springs church shooting that left more than two dozen people dead.

Two of the four Uvalde shooting victims have been released, University Health spokeswoman Elizabeth Allen said, and the other two remained hospitalized Thursday.

It will take a bipartisan effort that does not threaten Second Amendment rights to make meaningful changes to what Stewart, a gun owner, called a “significant epidemic.” Stewart noted that public safety measures have reduced unintentional injuries in car crashes. For intentional violence, he said, no progress has been made.KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.

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