Savings Lives through Hospital Intervention Program

As trauma surgeons in Chicago, we are often faced with tragedy.  But truly, there is nothing more tragic than having to tell a mother that her son or daughter has been shot and killed – or has suffered a devastating head injury or spinal cord injury and will now be permanently disabled.

While people talk about “senseless violence,” violence is really predictable.  As trauma surgeons, we can tell you that the people we treat are likely to come back again as a victim of another shooting.  This happens not because they are “bad” kids, but because they are caught up in a cycle of violence.

Because violence is predictable, it is also preventable.  Northwestern Memorial is a Level I trauma center committed to compassionate, evidence-based care.  For that reason, we have contracted with CeaseFire to provide hospital response services to every patient who has suffered a gunshot wound (GSW) or other assault-related injury.  CeaseFire workers are called immediately when violently-injured patients present.  These highly trained health workers arrive quickly at the Trauma Center, staying with the patient and actively working to de-escalate traumatized and angry family members and friends who show up at the hospital already planning retaliatory violence. Simultaneously, they work with those most likely to instigate retaliation in the neighborhood, to keep the peace and prevent further shootings and deaths.  Each staff member has completed extensive training in crisis intervention, mediation, alternative dispute resolution, social work and case management using public health protocols.

In 2014, CeaseFire’s specially trained hospital responders served over 1,300 patients suffering from GSW or blunt trauma injuries at Northwestern, Stroger, and Advocate Christ Community hospitals.  The CeaseFire team remains on call 365 days a year and responds to all in-bound Level 1 trauma center patients and families when an act of violence is the cause of the injury.

CeaseFire uses the Cure Violence epidemic control approach to violence prevention, providing primary interventions from credible messengers that prevent injuries by identifying and interrupting violence before it occurs, working with high-risk individuals to change behavior and convincing whole communities of the need for norm change in order to successful break the contagion of violence.

From the physician’s perspective, this model is the only community-based approach that has been shown through multiple, independent scientific studies and evaluations, to decrease the likelihood of being shot and reinjured as a result of retaliatory violence.  (CDC/Johns Hopkins Evaluation; National Institute of Justice/Northwestern University Evaluation; McCormick Foundation Evaluation; USDOJ/BJA/Center for Court Innovation Evaluation)

Cities across the US including New York City, Baltimore, New Orleans as well as two dozen others adopted this health approach, focusing highly trained credible messengers on interrupting and stopping the cycle of retaliatory violence. Given the strong scientific evidence to support the health approach and the expansion of this model across the globe, Chicago is under-utilizing this health interruption model.

In the course of just writing this letter, another young man was rushed to our Trauma Center with a GSW that sadly proved to be fatal.  Our trauma team saw the power and efficacy of an epidemic control health approach again.  Our highly-trained CeaseFire health workers were informed of the shooting and arrived at the scene of the incident before our trauma team had even been alerted that the patient was en route.  (Unfortunately in all likelihood, there was no health program operating in the community in which the shooting occurred.) Only a team of trained, credible messengers can truly know the pulse of a high-risk community.  We need this work, just as we need the work of law enforcement.

The average cost of a GSW to Illinois trauma centers is $50,000, and that’s just the initial cost of hospitalization.  If a patient has a brain or spinal cord injury, the cost frequently escalates above $1 million.

To be sure, cost-efficiencies in government are important.  Simple math proves the efficacy of a health approach to violence prevention. While cost savings should be considered, sparing families the tragedy of loss of life or permanent disability is incalculable. CeaseFire Illinois absolutely saves lives.  And there are many more lives to be saved.

Marie Crandall, M.D., M.P.H. is Associate Professor of Surgery at Northwestern University Feinberg School of Medicine. This article was co-authored by faculty colleagues Drs. Nabil Issa, Mamta Swaroop and Steven Schwulst in the Department of Surgery, Division of Trauma and Critical Care at Feinberg School of Medicine. 

CeaseFire is the Illinois-based program partner to Cure Violence; CeaseFire operates a growing hospital intervention program in partnership with Chicago’s Level 1 Trauma Centers to provide support and prevent retaliatory violence when people are caught within a cycle of violence.