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For more than a year, emergency room staff treated patient after patient rolled through the doors on the edge of death with COVID-19, barely able to catch a breath or scarf down their dinner.
Now that serious cases of the disease are on the decline, these frontline workers are triaging another wave of patients — many of them younger and otherwise healthier — whose bodies are pierced with bullets.
Dr. Steven Mitchell, the medical director of the emergency department at Seattle’s Harborview Medical Center, told Insider that so far this year, the hospital has seen a 40% increase in the number of gunshot victims coming into the ER compared to 2020.
“We had been in a downward shift for the last few years,” Mitchell said of the hospital’s intake of gunshot victims. “Beginning in April, we have seen a clear trend where each month we have exceeded the previous few years in the number of cases that arrive in our emergency department from gun violence.”
In the past year cities across the US have seen a significant increase in homicides and gun violence, the rarest forms of violent crime, even as rates of other crimes remain stable or are decreasing in comparison to previous years.
Emergency room physicians have a front row seat to the surge, and treating gunshot wounds is taking a toll on them.
Mitchell said that the increase in gun violence trauma comes at a time when hospitals around the country are already struggling to maintain adequate staffing.
Nurses and care staff took leaves of absence or left for new jobs because of the strain that the pandemic took on them, leaving emergency rooms with fewer workers to treat an increasing number of gunshot victims.
“Most of our nurses, when they are on their days off, they wake up to a page in the morning saying, ‘Hey, can you please come in to work overtime?’ And you can only do so much of that,” Mitchell said. “That’s happening all throughout our state, as well as at my hospital.”
ERs that saw a wave of black and brown COVID patients are now seeing gunshot victims from those communities
Dr. Cedric Dark, a Houston emergency room physician and member of Baylor College of Medicine faculty, told Insider the number of patients being treated for COVID-19 in his department is slowly decreasing at the same time that more gunshot victims are coming into the ER.
“I like to think of gun violence as to two different types of diseases. Black and Hispanic — urban — that’s largely interpersonal violence,” Dark said. “And then there tends to be older white male suicides, and that make up two-thirds of gun deaths. We tend not to see that population in the ER, but the other third we see.” (More than 80% of attempted suicides by firearm are successful, so those cases rarely make it to the ER for treatment.)
The gun violence victims Dark has seen coming into the ER recently are largely Black and Hispanic, and are in their teens through 30s.
Dark is seeing a parallel shift in the kind of patient coming into the hospital with coronavirus. Early on, he said the disease tore through multi-generational homes, especially those that housed both young essential workers with more exposure and seniors with comorbidities. Dark is now seeing more patients who are white, middle-class, young people.
“The first wave decimated the Black and Hispanic population,” he said, noting those are the groups his hospital primarily serves. “Now, it’s more younger people who are out and about.”
Physicians’ ‘I can deal with this’ attitude only goes so far
Dark and Mitchell both emphasized the need for healthcare workers to seek help as they continue to face trauma on the job.
“Pretty much everybody who works in emergency services tends to have sort of, ‘I can deal with this’ attitude, and yet that only goes so far,” Mitchell said. “You have to take care of yourself and make sure that the trauma you’re experiencing at work caring for these patients who are injured or who are really sick, does not come home with you and it doesn’t manifest in unhealthy forms.”
The physicians said healthcare institutions also need to do more to prioritize their staffers’ mental health. That could come in the form of making counselors available, improving trauma de-briefing policies, or ensuring that nurses and doctors are not being overworked, Mitchell said.
Dark also recommended abandoning the practice some hospitals have of asking job candidates to identify any mental health conditions they may have when applying for a position.
“That encourages people not to treat things,” Dark said. “One of the most important things that could be done is de-stigmatize taking care of for mental health care because there are many physicians out there that are feeling problems like this and want to act on it, but because of how we’re treating them in medicine, it puts up a barrier.”