Tackling injury prevention, MUSC seeks to reduce firearm injuries

November 17, 2021
three people stand in a hospital hallway chatting
From left, Christa Green, injury prevention coordinator for pediatric trauma with MUSC Children’s Health, and Turning the Tide client advocates Keith Smalls and Donnie Singleton talk about a patient. Photo by Sarah Pack

Firearm injuries are not inevitable. 

Whether they come about unintentionally or by an assault or through an attempted suicide, firearm injuries are preventable.

That’s the key message as MUSC Children’s Health and MUSC Health recognize National Injury Prevention Day on Nov. 18. This year, MUSC is using the awareness day to focus on gunshot injuries because of the increase in cases in both the adult and children’s hospitals in Charleston.

The number of adult gunshot patients treated by the MUSC Health Trauma Center hovered around 150 in 2017, 2018 and 2019 but jumped up to 194 in 2020 – and those figures don’t include adults who were treated and released from the Emergency Department without being admitted.

Last year, the Pediatric Trauma Center at MUSC Shawn Jenkins Children’s Hospital treated 19 gunshot wound patients. This year, with two months still to go, the hospital has treated 24 victims.

“The problem isn’t going away. It's getting worse,” said Christa Green, injury prevention coordinator for pediatric trauma with MUSC Children’s Health.

As an institution with a mission to preserve and optimize human lives in South Carolina, MUSC is taking a multi-pronged approach to preventing firearm injuries, rather than simply waiting for people to show up in the Emergency Department.

“A gunshot is a symptom of a larger problem. And with health care systems taking a more population-based approach, this is a population health problem that we need to address,” Green said.

To that end, physicians at MUSC Children’s Health are working to incorporate firearm safety screening questions into exams, in addition to other health and safety screening questions. Care team members can provide patients and families with gun locks. The American Academy of Pediatrics advises that guns should be stored unloaded and locked and ammunition stored separately; simply hiding a gun or instructing a child not to touch it aren’t effective methods of keeping children safe.

"Victims of violence are more likely to be revictimized and reinjured, and they’re also more likely to perpetrate violence. ...This is a strategy to break the cycle."

Christa Green
injury prevention coordinator for pediatric trauma

And in August, the MUSC College of Medicine Department of Surgery launched a hospital violence intervention program (HVIP) aimed at reducing the chances that gunshot patients will be revictimized and improving their outcomes and recovery after injury.

“Victims of violence are more likely to be revictimized and reinjured, and they’re also more likely to perpetrate violence,” Green explained. “If we simply patch them up and discharge them, we’re sending them right back to the same environment and the same risk factors that got them shot in the first place. This is a strategy to break the cycle.”

Called Turning the Tide Violence Intervention Program (TTVIP), the program is offered to patients between the ages of 12 and 30 who were intentionally shot by someone else. Program director Ronald Dickerson, Ph.D., and two client advocates, Donnie Singleton and Keith Smalls, are on call 24/7 to meet with patients and explain the program. It’s modeled after other hospital-based violence intervention programs that have successfully reduced the number of patients who are repeat victims of violence by providing wraparound services that address the root causes and risks of violence.

Though they can be seen at all hours in the halls of the adult and children’s hospitals, it’s when a patient is discharged that the advocates’ work really begins. They work with patients on whatever each individual needs to be successful, whether that’s finishing school, getting job training, getting housing in a different neighborhood or getting mental health treatment for the trauma of being shot or for preexisting trauma.

Ashley Hink MD 
Dr. Ashley Hink

"So many of our victims of gun violence have had a lot of trauma in their lives,” said trauma surgeon Ashley Hink, M.D., who spearheaded the creation of Turning the Tide and now serves as medical director.

As the program has gotten off the ground in these first few months, part of the process has been educating other staff members about how HVIPs work and about trauma-informed care.

Arriving at the Emergency Department via ambulance can be traumatic for any patient: You’re strapped to a gurney, often in pain, with strangers looking at you while taking off your clothes and yelling orders you don’t necessarily understand. For victims of violence, the trauma of being hurt by someone and, sometimes, the presence of police or detectives can add another layer of stress, Hink said. Perceived bias can also play a role in increasing the trauma, and victims sometimes feel like they are blamed or treated like they did something wrong.

Hink said this is why it is so important for all staff that work in health care settings to understand and practice trauma-informed care, which considers the totality of a patient’s experiences and seeks to provide aid in a collaborative manner so that the patient feels empowered rather than retraumatized.

Part of being thoughtful about providing care is having the client advocates come from the community they serve. Both Singleton and Smalls have been active in violence prevention since long before they were hired by MUSC – Smalls since his 17-year-old son was shot and killed in 2016.

Not every gunshot patient is ready to accept help and make changes, program leaders said. So far about 40% to 50% of those offered the program have signed up. The Health Alliance for Violence Intervention, which is providing guidance to MUSC’s program, said that’s typical for new programs, Green said.

But those who do sign up for the program do so with “arms wide open,” Hink said. She will be assessing program outcomes quantitatively, but at least anecdotally so far, the program is seeing success. Patients have taken steps forward in areas like getting a driver’s license, safer housing, mental health treatment and jobs.

“Six months ago, we didn’t have anyone doing this with these patients,” Hink said.

“We've had some patients say, ‘You made me feel like a human being,’” she added.

The advocates believe that is what the program is all about.

“It’s creating a connection,” Smalls said.