After a mass shooting occurs – in a school, in a movie theater, at a workplace – discussion typically focuses on the victims, the shooter, and the circumstances or motivations surrounding the event. Less consideration may be placed on the medical care needed to ensure the best possible outcomes for the victims of a mass shooting event, beginning with where they are treated immediately following the shooting.
In a research letter published this month in JAMA Surgery, my CHOP colleagues and I sought to establish the proximity of trauma centers (TCs), with the appropriate staff and resources to care for critically injured patients, and local hospitals/non-trauma centers (NTCs), where such patient loads are more likely to overwhelm capacity and advanced care options may be limited, to mass shooting events; this is important to understand as the victims are often taken to the closest healthcare facility for immediate treatment rather than a verified trauma center.
We analyzed data surrounding 187 mass shootings (defined as events involving 5 or more injuries or deaths by a firearm) in 38 states in 2019. Using Google Maps, we calculated driving distance from the geocoded address of the event to the nearest NTC, adult level 1 or level 2 TC, and pediatric level 1 or level 2 TC.
NTC hospitals were the nearest hospitals for 71% of mass shooting events, involving 845 patients. Additionally, more than 50% of events occurred more than 10 miles from a pediatric TC. The fatality rate for patients involved in mass shooting events analyzed was nearly 24%. To put that in perspective, the mortality rate for combat wounds is 10%.
So what makes the difference? A lot comes down to preparedness. Medical military personnel are trained in combat, wear protective equipment, and can expect their patients to be involved in violent interactions. The same cannot – and should never – be said for American citizens going about their daily lives when they become the victims of a mass shooting event. The same sentiment can be applied to NTC hospitals, which have limited resources available to treat traumatic injuries in several patients simultaneously, particularly pediatric patients who require specialized considerations and medical expertise.
Until we can stem the tide of mass shooting events in the US, NTCs need to be ready to receive mass shooting victims, quickly stop bleeding, and prepare to connect these patients with a higher level of care. For pediatric care specifically, resources such as the National Pediatric Readiness Project can help emergency departments improve their preparedness to care more effectively for children.
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