• ACS Highlight: Trauma on the South Side: The Origins of a New Trauma Center

    Dr. Priya S. Prakash & Dr. Jennifer T. Cone

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    Trauma on the South Side: The Origins of a New Trauma Center

    Priya S. Prakash, MD, and Jennifer T. Cone, MD

    “My sweet baby could still be alive today if the U. of C. had a trauma center. It’s just down the street.” These words were spoken by Sheila Rush, mother of Damien Turner, an 18 year old advocate and aspiring musician, who was gunned down in a drive-by shooting on August 15, 2010. Damien was a random victim in a senseless shooting that took his life, only 3 blocks from the University of Chicago’s medical campus. At the time, there was no adult trauma center at the University of Chicago. Damien was taken to the nearest Level 1 trauma center, 10 miles north of the shooting. Damien was pronounced dead less than 90 minutes after being shot. His death left a community grieving, wondering if treatment at a closer hospital could have saved his life.

    Tragic and senseless deaths like that of Damien Turner were not isolated occurrences on the South Side of Chicago. Over 2 decades prior, Benji Wilson, a talented high-school basketball player likely headed to the NBA, was tragically shot and killed. Benji was taken to a non-trauma hospital where he succumbed to his injuries. His death led to the creation of a formal trauma system in Chicago. (1)  Several hospitals, including University of Chicago, subsequently opened trauma centers. Ultimately bowing to financial pressure, the University of Chicago closed its trauma center after only two years in 1988 and Michael Reese Hospital discontinued its trauma care in 1991, leaving the South Side of Chicago a “trauma desert” for the next 27 years. (2)

    Unfortunately, these stories are not unique to the city of Chicago. Though Chicago has become synonymous with gun violence in the media, it is only one piece of the greater narrative in what is now a national epidemic of gun violence. Many studies have consistently linked this epidemic to socio-economic factors such as racial segregation, institutional racism, police-community relations, and sequela. (3) In addition, “trauma deserts”, communities that are at least 5 miles away from an advanced trauma care facility, have been linked to areas with predominately black populations, households below the federal poverty line and a high burden of firearm injury. (4) Even though designated trauma centers have been shown to significantly decrease mortality, there remains a large deficit in equitable access to trauma care in the country for areas of concentrated urban poverty. (5,6)

                An activist for social change himself, Damien’s death galvanized many community groups to take up the gauntlet for the University of Chicago to develop a Level 1 trauma center. Five years later, after tireless community advocacy and activism, and a city- and state-wide needs assessment, the Illinois Department of Public Health (IDPH) approved University of Chicago Medicine to become a trauma center. (7) On May 1, 2018, the University opened its doors as a state-designated Level 1 Adult Trauma Center, dramatically changing the access to trauma care on the South Side of Chicago. (8) The research, collaboration and planning for the opening of the trauma center spanned multiple years, as this was the first endeavor of its type. Never before had a Level 1 trauma center been birthed and implemented in an already well-established major academic institution. As the trauma center came to fruition, the institution was engulfed in a paradigm of cultural change, refocusing resources and institutional priorities to address a glaring inequity in access to trauma care on the South Side of Chicago.

                After the opening of its doors, the University of Chicago quickly grew to become one of the busiest trauma centers in the city, caring for over 15,000 acutely injured patients since its opening. What has made it even more unique when compared to many other trauma centers is the distribution of traumatic injuries cared for at the institution. With a 40% penetrating trauma rate annually, firearm injuries have consistently been the leading mechanism of trauma seen at the University of Chicago, quickly exemplifying the long-standing need for improved access to trauma care on the South Side. 

                Dedicated and passionate individuals, thoughtful planning and the drive to lead a cultural change were all needed in the development of the trauma center. This led to the recruitment of six trauma surgeons hired from other major academic trauma centers across the country to join one other surgeon already practicing at the University of Chicago, an experienced trauma program manager and multiple advanced practice providers (APPs).  We joined to share collective wisdom and create the “UChicago Way” of practicing trauma, with the common mission of not only improving trauma care nationally, but also addressing and decreasing inequities of care in marginalized populations.  With the future goal in mind to achieve American College of Surgeons Level 1 Trauma Center designation, the Resources for Optimal Care of the Injured Patient laid the foundation for the trauma center, setting new standards in staffing, quality of care, data management, resource availability, care protocols and operational processes. Though writing unified protocols, designing and implementing a new service line and operationalizing an already well-established medical center proved to be challenging at times, our teamwork and collaboration prevailed. By 2022, we expanded to 12 faculty members, including two US Army surgeons who were deployed to University of Chicago as part of the newly established Army Military-Civilian Trauma Team Training program.

                 In addition to faculty and staff hiring, changes were made to the general surgery residency curriculum as well as other training programs at the University. This ensured the service line was adequately staffed for patient safety and optimal trainee education. As we matured, we realized the need to redistribute the resident’s exposure to the trauma service, as long work hours and exposure to a high volume of injuries due to interpersonal violence led to provider burnout and secondary traumatic stress.  Our section formalized agreements with two other residency programs as well as incorporated residents from four other service lines, hired additional APPs and implemented wellness initiatives to address some of these issues.

                Another major consideration when opening the trauma center was the impact it would have on other service lines as well as the workflow in various phases of care including the Emergency Department, the Operating Room and the Inpatient areas. Countless hours were spent collaborating with core consulting service lines such as Emergency Medicine, Neurosurgery, Orthopedic Surgery, Otolaryngology, Plastic Surgery, Ophthalmology, Anesthesia, OB/GYN and Interventional Radiology in order to establish clinical care pathways focused on providing not only the standard of care for the traumatically injured patient, but also providing trauma-informed care. Non-clinical service lines across the institution, including Environmental Services, Social Work, and Chaplaincy played an equally important role in the care of the trauma patient. All were impacted by the opening of the trauma center, requiring increases in resources and personnel support. In addition to the creation of clinical care pathways and incorporation of various service lines, protocols such as Massive Transfusion and OR Case Classifications were created to optimize the utilization of resources to support the care of not only the trauma patient but all patients seen at the University of Chicago.  As we learned very quickly, the presence of a trauma center expanded resources and clinical support to non-trauma patients as well.

                We also took into consideration the transition of our violently-injured patients back into the community, leading to the creation of a hospital-based violence recovery program (VRP) and wrap-around services.  Providing crisis intervention, risk assessment, psychologic first aid, and navigation of health and social services, the VRP was implemented to holistically support our patients and their families.           

               The human cost of gun violence is felt daily in areas such as the South Side of Chicago. The University of Chicago Trauma Center is the sum of many interwoven parts that developed from a community’s commitment to advocacy, the dedication and passion of countless individuals, and a shift in the cultural paradigm of a nationally renowned institution. The violence we have experienced since opening the trauma center is representative of a larger national crisis, particularly in predominantly black and brown neighborhoods. The opening of our trauma center was associated with a significant reduction in racial and ethnic disparities in timely access to trauma care for black patients on the South Side of Chicago. (8) But this is only one piece in addressing the larger, growing public health crisis of gun violence. Intensive research, legislative attention, and combating socioeconomic disparities are required to address the root causes of gun violence to prevent tragedies, like those of Damien Turner, Benji Wilson, and countless others, from occurring in the first place.

      

    References

    1. Gross D. Chicago’s South Side Finally Has an Adult Trauma Center Again. The New Yorker. May 1, 2018. https://www.newyorker.com/news/dispatch/chicagos-south-side-finally-has-an-adult-trauma-center-again Accessed 4/30/22
    2. Crandall M, Sharp D, Unger E, et al. Trauma deserts: distance from a trauma center, transport times, and mortality from gunshot wounds in Chicago. Am J Public Health. 2013;103(6):1103-1109. doi:10.2105/AJPH.2013.301223
    3. Johnson BT, Sisti A, Bernstein M, Chen K, Hennessy EA, Acabchuk RL, Matos M. Community-level factors and incidence of gun violence in the United States, 2014–2017. Social Science & Medicine. 2021;280: doi: 10.1016/j.socscimed.2021.113969
    4. Tung EL, Hampton DA, Kolak M, Rogers SO, Yang JP, Peek ME. Race/Ethnicity and Geographic Access to Urban Trauma Care. JAMA Netw Open. 2019;2(3):e190138. doi:10.1001/jamanetworkopen.2019.0138
    5. Nathens AB, Jurkovich GJ, Cummings P, Rivara FP, Maier RV. The effect of organized systems of trauma care on motor vehicle crash mortality. JAMA. 2000;283(15):1990–1994. doi: 10.1001/jama.283.15.1990.
    6. MacKenzie EJ, Rivara FP, Jrkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Eng J Med. 2006;354(4):366-78). doi: 10.1056/NEJMsa052049.
    7. Hasbrouck L. State of Illinois Trauma Center Feasibility Study. Illinois Department of Public Health, 2015. https://dph.illinois.gov/content/dam/soi/en/web/idph/files/publications/trauma-center-feasibility-study.pdf. Accessed 4/30/22
    8. Abbasi AB, Dumanian J, Okum S, Nwaudo D, Lee D, Prakash P, Bendix P. Association of a New Trauma Center With Racial, Ethnic, and Socioeconomic Disparities in Access to Trauma Care. JAMA Surg. 2021 Jan 1;156(1):97-99. DOI: 10.1001/jamasurg.2020.4998

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