Firearm injuries are not inevitable.听

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

That鈥檚 the key message as MUSC Children鈥檚 Health and MUSC Health recognize 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鈥檚 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 鈥� and those figures don鈥檛 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鈥檚 Hospital treated 19 gunshot wound patients. This year, with two months still to go, the hospital has treated 24 victims.

鈥淭he problem isn鈥檛 going away. It's getting worse,鈥� said Christa Green, injury prevention coordinator for pediatric trauma with MUSC Children鈥檚 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.

鈥淎 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,鈥� Green said.

To that end, physicians at MUSC Children鈥檚 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 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鈥檛 effective methods of keeping children safe.

"Victims of violence are more likely to be revictimized and reinjured, and they鈥檙e 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听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.

鈥淰ictims of violence are more likely to be revictimized and reinjured, and they鈥檙e also more likely to perpetrate violence,鈥� Green explained. 鈥淚f we simply patch them up and discharge them, we鈥檙e 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.鈥�

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鈥檚 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鈥檚 hospitals, it鈥檚 when a patient is discharged that the advocates鈥� work really begins. They work with patients on whatever each individual needs to be successful, whether that鈥檚 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.

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"So many of our victims of gun violence have had a lot of trauma in their lives,鈥� 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鈥檙e strapped to a gurney, often in pain, with strangers looking at you while taking off your clothes and yelling orders you don鈥檛 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鈥檚 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 鈥� 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. , which is providing guidance to MUSC鈥檚 program, said that鈥檚 typical for new programs, Green said.

But those who do sign up for the program do so with 鈥渁rms wide open,鈥� 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鈥檚 license, safer housing, mental health treatment and jobs.

鈥淪ix months ago, we didn鈥檛 have anyone doing this with these patients,鈥� Hink said.

鈥淲e've had some patients say, 鈥榊ou made me feel like a human being,鈥欌�� she added.

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

鈥淚t鈥檚 creating a connection,鈥� Smalls said.