AL.com/The Birmingham Times
This is another installment in Birmingham Times/AL.com joint series “Beyond the Violence: what can be done to address Birmingham’s rising homicide rate.” Sign up for the newsletter here.
The emergency department that handles the largest number of gunshot victims in Alabama has added surgeons and staff to handle a flood of cases that has doubled in the last eight years.
Jeffrey Kerby, M.D., director of the division of trauma and acute care surgery at the University of Alabama at Birmingham, said the number of gunshot victims has increased from about 600 to 1,200 a year since 2013. In the last three years, the number of overall trauma cases increased by 40 percent.
To adapt, the hospital has added full-time surgeons and trauma fellows – trained surgeons receiving extra training to treat patients who have been shot, injured in car crashes or other accidents. In 2019, the hospital added the additional trauma surgeon in part to keep up with a sharp increase in attempted gun homicides and suicides.
Some weekends, the staff handles as many as 10-to-15-gun violence victims a night – the equivalent of a mass casualty event from shootings across the city and state. The care performed in the first hour after an injury, the “golden hour,” can mean the difference between life and death. It’s harder to provide such life-saving care if a surgeon is already busy working on another patient.
The hospital treats gunshot victims in the Birmingham area and across the state as the only nationally-certified Level I trauma center in the state. Kerby said the trauma team activates when a page goes out from the communications center that coordinates emergency medical services.
“So, the team assembles,” Kerby said. “And it’s not just surgeons. It’s respiratory therapists, it’s nurses, it’s pharmacists, X-ray technicians all show up in the room. It’s like a NASCAR pit crew.”
As quickly as possible, they begin their work.
“Everyone has their job and responsibility,” Kerby said. “Instead of changing tires and putting in gasoline, we’re identifying immediately life-threatening injury and intervening in that and deciding where they need to go.”
Rising Gun Violence
Birmingham has struggled with rising rates of gun violence in the last several years, mirroring trends from across the country. Kerby said trauma surgeons nationwide have struggled to handle and understand rising levels of violence. They have pushed for more funding for research into firearms injuries and implemented plans to help prevent victims from being shot again.
“We’re really trying to talk about treating this as an epidemic,” Kerby said. “Every one of us is dealing with this at our own institutions. If we can help one, two, however many, at least it empowers us to do more than just take care of them after an injury.”
If there is any silver lining to this epidemic of gun violence, it has been advances in trauma treatment. UAB operates as a kind of lab for trauma care, incorporating partnerships with the military and specially designed research trials to improve care for victims.
“If you get here with a pulse and you don’t have a lethal brain injury, you have a 95 percent chance of walking out of here,” Kerby said. “Studying what we do in the first hour and the first couple of hours has improved how we treat people.”
Dr. Daniel Cox, the medical director for trauma, said UAB works closely with surgeons in the military. UAB Hospital hosts the Air Force Special Operations Surgical Team when they are not deployed to combat zones. Military surgeons develop many advances in trauma care in the battlefield that can then help civilians.
“We talk about with war the only good thing to come out of it are the medical advances,” Cox said. “You often have young, severely injured patients and we are constantly looking at how we can do that better.”
One example, whole blood, has improved outcomes for people with heavy bleeding. Decades ago, during the Vietnam War, Cox said blood banks began separating blood into its component parts: plasma, cells and clotting factor. They would give patients IV fluids and cells to replace lost blood.
“The military experience was giving matched blood products was much better,” Cox said. “And we realized that whole blood was even better than that. Things we were doing in the military would translate to other teams.”
Civilian Trauma Patients
Doing research on civilian trauma patients is tricky. They often can’t give informed consent, so special research protocols have been created to exempt them from that requirement. When the trauma department conducts research, staff members try to reach out to the community with information. People who don’t want to participate can call the hospital to get a bracelet of something else they can wear to indicate they don’t want to be part of research trials.
Although UAB trauma surgeons are good at repairing gunshot wounds, they are powerless to prevent them. But UAB is trying to implement a program that could help some victims of gun violence.
The hospital violence intervention program will pair specially trained workers with survivors of gun violence to provide new housing, education or other resources to help them escape the cycle of violence. Many people who survive gun violence get shot again, often fatally. The program will start small, but Kerby said he hopes it can prevent some gun deaths.
Kerby said mass shootings attract most media attention, allowing people to ignore the daily toll of gun violence in cities like Birmingham.
“One of the messages that trauma surgeons across the country are trying to say are don’t just focus on the mass shootings,” Kerby said. “We’re seeing this every day.”
Previous installments of the series: