Becker's Hospital Review

38 POPULATION HEALTH 38 CEO/STRATEGY down homicides in the 2000s and early 2010s have failed to keep shootings at bay in recent years. A Chicago Tribune analysis cited 4,369 shootings in Chicago in 2016 and 3,567 in 2017. e success of Chicago's trauma network is likely the reason a general increase in shoot- ings hasn't translated to a surge in homicides, an analysis of Chicago homicide and shoot- ing data published in February reveals. In collaboration with e Atlantic's CityL- ab and the Center for Investigative Re- porting's Reveal, reporters from the Chi- cago-based Data Reporting Lab found gun-related homicides in Chicago trended downward 30 percent from 1995 to 2015. However, the number of people shot did not decline during the same period, according to the report. CityLab used only CPD data and hospital data in its analysis. In 1995, about 726 people died from gun violence in Chicago. at same year, Cook County hospitals discharged 677 gunshot victims, according to the report. at puts the total of known shooting victims at 1,403. Compare that to 2015, when Chicago counted 1,377 known gunshot wound victims — just 26 fewer people than 1995. However, of those shot in 2015, gunfire killed about 507 people and Cook County hospitals discharged 870. Although shootings didn't decline signifi- cantly over the 20-year period, the survival rate of known gunshot wound victims in- creased from 48 percent to 63 percent. Chicago hospitals and emergency providers reduced gun-related homicides through co- hesive collaboration. Emergency responders work together to route patients to the facilities best equipped to deal with gunshot wounds. ese patients not only need to reach a hospi- tal — they need the right hospital. e Illinois Department of Public Health appoints four hospitals — including Stroger — to provide trauma oversight for emergency medical services. Emergency medicine physi- cians from these hospitals serve as medical di- rectors and establish field triage protocols for all regional EMS providers. e protocols are adapted from national standards developed by the CDC, American College of Surgeons and National Association of EMS Physicians. When it comes to triaging gunshot wound patients, the main challenge is "we see too many of them," Joseph Weber, MD, an EMS medical director at Cook County health sys- tem and an emergency medicine physician at Stroger, told Becker's. "e paramedics are highly trained and adept at assessing and caring for victims of penetrat- ing trauma, specifically from handguns," he added. "ey roll up on scene, they do a quick assessment — a patient's vital signs, what type of wound they have — and then [decide where to direct the patient] based on our algorithm." Processes and algorithms help pair patients with hospitals, but this is Chicago — a city that spans 237 square miles and has nearly 3 million residents. is makes the proximity of trauma centers a strong determinant of patient survival. In 2010, 18-year-old Damian Turner died en route to the nearest level 1 trauma cen- ter at Northwestern Memorial Hospital, more than 9 miles from where he was shot on the South Side in a drive-by shooting. Mr. Turner was shot just four blocks from the University of Chicago Medical Center. At the time, its level 1 adult trauma cen- ter had been closed for 19 years. e inci- dent sparked a national conversation about the layout of level 1 trauma centers in Chica- go, which had been clustered around the city's North and West Sides. is composition le the southeast corner of the city in what some called a "trauma desert," according to CityL- ab. e University of Chicago reopened the trauma center aer 27 years in May. Stroger's trauma center: An expen- sive community asset e high cost of trauma care is what forced University of Chicago Medicine to close its trauma center only two years aer it opened in 1986. It lost $2 million both years. "Contraction of trauma services in this area is in no small part related to the fact that [trauma] costs health centers money," Dr. Shannon said. At the time of Becker's interview with Dr. Shan- non, UChicago Medicine had not yet opened its new $39 million level 1 trauma center. Chicago hospitals treated 12,000 document- ed gunshot wound patients between 2009 and mid-2016, billing patients and payers more than $447 million. Nationwide, hospi- tals spend nearly $2.8 billion annually treat- ing firearm-related injuries. e Cook County health system spends, on average, between $30,000 and $50,000 to treat each gunshot patient at its trauma center. Col- lectively, the system spends $30 million to $40 million annually treating gunshot wounds — and this total only covers initial hospital care, not rehabilitation or other outpatient services. Why, then, can Stroger lean into its trauma center as a strength? One grim reason is that demand for gunshot wound care continues to rise, Dr. Shannon said. Another is Illinois' ex- pansion of Medicaid in 2014. Now, 75 percent of Stroger's gunshot wound patients are insured — and their services are largely paid for by Il- linois taxpayers. A third "troubling" reason the trauma center is an asset, Dr. Shannon said, is an increasing amount — now 10 percent — of his hospital's gunshot wound patients are chil- dren, 90 percent of whom are insured. Stroger also leverages its reputation in trau- ma care to increase patient volume across the hospital, according to Caryn Stancik, ex- ecutive director of communications at Cook County health system. One of Stroger's re- cent marketing campaigns highlighted its six-week training program for Navy hospi- tal corpsmen, during which corpsmen treat gunshot wound patients alongside Stroger's trauma physicians. An ad from the campaign showed a physician caring for an older wom- an with the text, "Look at us now. Training the Navy and treating your grandmother." "e crude philosophy behind that is if we're good enough to train physicians [in the Navy], people should look at us for other ser- vices," such as orthopedics, anesthesiology and radiology, Ms. Stancik said. But Stroger's trauma center is more than a na- tional resource for physicians in training, it's a bridge to the surrounding community. "We look at our trauma experience as an asset — in an unusual way, it is a community asset," Dr. Shannon said. 'A lot of our patients, we've known them for 20 or 30 years' For the staff at Stroger, Chicago's gunshot violence statistics aren't just numbers — they're neighbors. "In our trauma unit, we have staff that live in the communities where gunshot wound victims come from," Dr. Shannon said. "Staff tend to be activists and outspoken," drawing the system's care philosophy beyond its four walls, he said. ere aren't many avenues for formal fol- low-up care that address the environmental "If we're good enought to train physicians [in the Navy], people should look at us for other services." — Caryn Stancik, executive director of Communications, CCHHS

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