Close to Home: How the pandemic changed trauma care
Trauma surgeons are trained to deal with the most difficult and life-threatening situations in the emergency room. When an ambulance delivers the driver of a serious car crash, or a helicopter brings in a hiker who has fallen down a steep cliff face, we go to work in a sprint to save a life.
Even for those of us accustomed to treating trauma, COVID-19 has created a frightening change in our work. It’s not the virus itself that needs the skills of a trauma team — but the spike in traumas from domestic abuse, suicide attempts and violent crimes that has come on the heels of the pandemic.
Just such a case came through the doors of Santa Rosa Memorial Hospital recently.
At about 2:30 a.m., an SUV pulled up to the emergency entrance. The frantic driver jerked open the passenger door to reveal a young man slumped in the back seat. The driver yanked him to the pavement and sped off, leaving the trauma team to tend to a patient with two serious stab wounds, no blood pressure and no pulse.
The trauma team did everything possible, working feverishly to revive the patient. But the wounds were too severe. He died on the operating table — only minutes before a helicopter approached bearing a patient suffering from gunshot wounds.
While the team set up another trauma room, police arrived to photograph the wounds of the last patient and interview the staff. The patient, we were told, had been involved in a botched home-invasion robbery; the SUV driver was part of the gang, having found the intended robbery victim on a dating app. Fortunately for the victim — and unfortunately for our patient — the target was a veteran just returned from overseas duty and was able to overpower his assailants.
Just as often, though, the patient on the trauma table in the COVID era is the target of a violent crime — sometimes by strangers, sometimes by their own family members. In other cases, our task is to save someone who has tried to take their own life. This sudden and unexpected increase in nonaccidental trauma began a few months after last year’s lockdown, and the statistics are frightening.
Early this year, NPR reported that a massive one-year rise in murders coincided with the pandemic. A report from the National Commission on COVID-19 and Criminal Justice found that while property and drug crimes plummeted, homicides, aggravated assaults and gun assaults rose significantly. Beginning last May, homicide rates were up 42% in the summer and 34% in the fall, compared to 2019. The numbers are worse in many large cities, including New York, Chicago, New Orleans and Los Angeles; Chicago police reported more than 750 murders in that city in 2020, up 50% over 2019. Domestic violence also increased markedly beginning shortly after lockdowns began.
Trauma surgeons saw this in their daily work. COVID almost instantly led to a steep drop in the kind of cases that usually come to us — traffic accidents, sports and outdoor traumas, serious worksite injuries. But within three months, we were handling a shocking number of cases of domestic partner and child abuse, firearms injuries involving related parties, attempted suicide, alcohol-related falls at home – and a soaring number of homicides.
We can’t blame all of these changes on the pandemic. But it’s impossible to ignore the fact that the kinds of trauma we’re seeing followed in the wake of the virus. And it underscores the need to focus on the causes of the increases as we emerge from lockdown, and on long-standing failures that enabled many of them.
Many of these traumas can be traced to mental health issues. Our system has historically failed to devote the needed resources to mental health care. Now, add the huge stress from increasing levels of homelessness and unemployment caused by the pandemic, and many people can no longer cope. Too often, that results in violence against their friends, their families, or themselves — or behaviors that endanger them.
At the same time, we have seen police budgets cut and restrictions placed on law enforcement that hamstrings their ability to deal with criminals, who in turn are taking advantage of the situation to become more brazen and more deadly.
In either case, it is the trauma team that must try to put those bodies and lives back together — and, as with the patient dumped on the cold tarmac at 2:30 a.m., sometimes we can’t, no matter how hard we work.
It’s up to all of us to acknowledge and address this situation. As we see the COVID-19 pandemic fade and society emerges from its draconian lockdowns and devastating economic fallout, we must increase our focus on mental health. We will need to pay special attention to societal, cultural and work stressors and create a careful and planned approach to reduce them. We will have to reconsider how we fund law enforcement and how to align our expectations of them with the rules we make about how they can do their jobs.
Most importantly, we should bring renewed focus to those things that can bring us together, rather than those issues that polarize and tear us apart. That’s an injury no trauma surgeon can fix — and one that guarantees trauma surgeons will continue to see more victims of violence.
Robert White is a board-certified trauma surgeon. He practices medicine with his son, Dr. Keith White, at Providence Santa Rosa Memorial Hospital.
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