Firearm injury continues to plague our country, with more people suffering nonfatal firearm-related injuries than firearm deaths. While much research has been done on fatal gun injuries, less is understood about nonfatal firearm injuries and interventions.
But that is about to change, thanks to a recent study from the American College of Surgeons (ACS) Committee on Trauma (COT) and a new hospital and community violence prevention and intervention program at MUSC Health, led by Ashley Hink, M.D., assistant professor of surgery in the College of Medicine and an acute care specialist.
"This large-scale research in an understudied area will provide a better understanding of what the true burden is for nonfatal firearm injuries," said Hink, who wrote the grant and is a key member of the four-investigator-led research team that includes the two co-principal investigators of the study - Deborah Kuhls, M.D., professor of Surgery at University of Nevada-Las Vegas School of Medicine and medical director of the trauma ICU at University Medical Center of Southern Nevada, and Avery Nathens, M.D., Ph.D., chief of Surgery at Sunnybrook Health Sciences Centre in Toronto, Canada.
Kuhls is the immediate past chair of the ACS COT Injury Prevention and Control Committee and Nathens serves as medical director of the ACS Trauma Quality Improvement Program (TQIP). Hink, along with Fred Rivara, M.D., professor and vice chair of Academic Affairs at the University of Washington and core faculty member of the Harborview Injury Prevention Research Center (HIPRC), round out this team of leading experts.
The study will leverage the ACS TQIP infrastructure to develop a dataset to understand more fully both individual and community-level risk factors. This will allow communities and health care systems to understand not only the impact of firearm injuries but also the potentially modifiable factors that can inform prevention and intervention strategies.
"This truly is a public health issue," said Hink. "By looking at circumstances such as poor social mobility, high rates of unemployment and other stressors, we can develop interventions to address these issues and decrease the victims' chances of recurrence and potential fatalities. Ultimately, we hope to break the cycle, improve their lives and communities and provide less of a financial burden on our community resources and health care systems."
The ACS Committee on Trauma multicenter prospective study is funded by a $711,218 grant from the National Collaborative for Gun Violence Research. Nearly 200 trauma centers that participate in TQIP are contributing their data to provide a more comprehensive perspective of the risk factors involved in nonfatal firearm injuries. "We will better understand both individual and community-level risk factors and how they vary between different populations, such as children and adults and those residing in urban and rural areas, so we can target our prevention strategies effectively."
"The Southeast is disproportionately burdened by homicide and nonfatal violent assaults, with South Carolina among the deadliest of states, currently tied for the 4th highest homicide rate in the U.S. for ages 0 through 24, and is the 6th highest overall," she added. "Unfortunately, while many states have seen decreases in homicide rates, South Carolina has demonstrated a 30% increase in homicide rates between 2008 and 2018."
At MUSC, Hink is leading the way for an MUSC Hospital and Community Violence Prevention & Intervention Program for patients and community members that will primarily serve youths and young adults that experience community violence. The MUSC Health program will provide direct services through intensive case management, mentorship and community outreach to reduce individual and community risks of violence and promote recovery for victims and their families.
Hink will serve as medical director of the new program, scheduled to open in April of 2021. A leading national authority on violence research, Hink is more than up to the task. She serves with other leading experts on the ACS COT Injury Prevention Committee, and her special research interests focus exhaustively on injury and violence prevention. Through her research, ardent advocacy efforts and this novel prevention and intervention program, she and her team will work to reduce violent injuries and suicides.
And the timing could not be better. This program is coming to fruition at a time when the Lowcountry has experienced a significant increase in violence: Based on 2019/2020 police data, the City of Charleston alone experienced increases in all forms of violent crime, including a 100% increase in homicides and 28% increase in aggravated assaults.
"Charleston, like so many cities in the last year, has seen a significant uptick in violence and more specifically gun violence. Violence prevention and intervention programs are demonstrably effective in preventing violence recurrence and have proved to be a cost savings to health care systems," said Hink. "This much-needed program at MUSC will provide an opportunity to address more than just treating the injury. It will promote resilience and recovery as well as prevent reinjury. Our goal is for MUSC Health to become a leader for community violence prevention programs in the South, where this type of care is desperately needed."
According to pediatric trauma surgeon Christian Streck, M.D., since MUSC Health is South Carolina's only Level 1 pediatric trauma center, he sees the devastating impact of firearm injuries on children throughout the Lowcountry and Pee Dee weekly. "The case numbers are increasing and, unfortunately, seem to involve younger children than in the past," he said. "These cases often include homicide, suicide, domestic abuse or the unintentional discharge of a firearm with devastating consequences. All of these cases are completely preventable and impact entire families and our region. Dr. Hink's program is innovative, patient-centered, preventive and designed to include the entire community that may be affected by the terrible scourge of firearm-related injury on our society. We all hope that this new program can truly break the cycle."
Anne Lintzenich Andrews M.D., is a pediatrician at MUSC Health, leading efforts to expand firearm safe storage screening and counseling and works with Hink on efforts to improve intervention and support services for victims of violence. "As a pediatrician, I remain incredibly troubled by the fact that gun violence is the second leading cause of death for children in this country and the leading cause of death for Black children in this country," she said . "It is a privilege to collaborate with Dr. Hink on this exciting new program that will bring much-needed services to children and families in our community who are at risk for firearm injury."
The Hospital and Community Violence Prevention & Intervention Program will be modeled after other successful programs across the country and supported by the Health Alliance for Violence Intervention, a national organization that provides training and technical support for new hospital violence intervention programs. In addition to Hink, key personnel will also include a program director, client advocates and a clinical psychology trainee dedicated to violence intervention support.
These types of injuries are preventable, and it is our duty as a health system to work diligently to combat this public health crisis, Hink explained. The program will partner with MUSC abuse and support services, including the MUSC Trauma Resiliency and Recovery Program and the MUSC National Crime Victims Center, as well as community and government organizations, including the City of Charleston, local police departments, juvenile justice departments, school systems, employment training programs, community parks and recreation programs and local nonprofits.
"We realize that community health and social determinants of our patients' health affect their outcomes far more than we previously thought," said Prabhakar Baliga, M.D., chair of the Department of Surgery. "Not only is Dr. Hink leading the way to improve patient outcomes, her tenacity and ability to navigate through complex health care and political systems in South Carolina to achieve these goals is admirable."
