Better trauma care may help explain Pittsburgh's drop in homicides
A shooting that might have ended up as another homicide statistic a few years ago might now be a story of recovery, thanks to advancements in trauma care, particularly in the minutes before a victim arrives at the emergency room.
“A small number of injuries are always going to be lethal just because they're so devastating from the moment of wounding,” said Dr. Patrick Kim, trauma program director and associate professor of clinical surgery at Penn Medicine in Philadelphia. “But we're making progress on other types of severe (gunshot wounds).”
One of the most important — and simplest — advancements is the knowledge that controlling bleeding is crucial, he said.
“It's a very, very important mindset,” Kim said. “By and large, statistically (gunshot victims) are most likely to die from uncontrolled hemorrhaging.”
Such treatment advancements could help explain at least partially why a rise in gun violence has not resulted in an equal jump in homicides.
In 2015, aggravated assaults with a gun in Pittsburgh jumped 23 percent to 316, compared with 257 in 2014. Shootings went up to 189 from 148 (up 28 percent), and calls for shots fired rose to 3,059 from 2,330 (up 31 percent). There were 60 homicides in the city last year, down from a five-year high of 71.
The term among criminologists is case-fatality ratio — the number of people who die out of all aggravated assaults with a gun.
David Kennedy, director of the National Network for Safe Communities at City University of New York's John Jay College of Criminal Justice, stressed that rates of aggravated assaults and shootings can vary for a number of reasons, and it's not possible to pinpoint a factor.
“Patterns of crime can change, weapons used and lethality of weapons used can change — there are a lot of things that can affect case fatality,” Kennedy said. “But medical treatment is absolutely one of them.”
In Pittsburgh, knowledge over the past decade has changed the way EMS personnel treat trauma victims in the first minutes of on-scene care.
Mark Pinchalk, patient care coordinator for Pittsburgh EMS, said one emphasis is on spending as little time at the scene as possible.
“We can control external bleeding, but an uncontrollable internal hemorrhage we really can't do anything for,” Pinchalk said.
The past decade has shown that flooding patients with fluids — namely saline — can do more harm than good, he said. On the other hand, tourniquets — once thought to do more harm than good — are one of the first measures that should be used to control bleeding.
“Fifteen years ago, you were the worst person in the world” if you used a tourniquet, Pinchalk said.
While a police officer's first priority is securing the scene, they're encouraged to — and do — render aid if there is no active threat, he said.
In June, a detective who was one of the first on the scene of a shooting on Federal Street on the North Side used a passer-by's belt to help stop the victim's bleeding.
Pittsburgh officers learn advanced first aid as part of their training.
Advancements in treatment once a victim arrives at the hospital have helped, particularly when it comes to blood loss, according to Dr. Raquel Forsythe, associate trauma medical director at UPMC Presbyterian.
“When someone is bleeding, what they need is blood,” Forsythe said. She said the trauma center has been running trials in which patients in need of blood receive whole blood rather than fractionated blood — red cells, platelets and plasma separately.
She credits advancements in battlefield trauma treatment, especially in the past decade in Iraq, with helping civilian doctors better understand how to stabilize patients quickly.
Advancements in techniques and technology in neuroscience have increased the survivability of head wounds, she said. For example, surgeons are now able to remove a portion of the skull to allow for the brain to swell without the pressure causing more injury.
“A decade ago, that wasn't done in neurosurgery,” she said.
Megan Guza is a Tribune-Review staff writer. Reach her at 412-380-8519 or email@example.com.