Violence Prevention in a Clinical Setting

Dr. Edward CornwellNisha N. Branch
Chapter President,
2012 M.D. Candidate, Howard University College of Medicine

At the June 2010 SNMA National Leadership Institute the keynote speaker, Dr.  Edward Cornwell III, suggested that violence be considered as the top public health issue.  Traditionally, public health is thought of in terms of obesity, cancer prevention and environmental health.  However, the scope of modern public health has far exceeded its early beginnings of water sanitation, waste removal and vaccinations.

Just as public health has broadened its purview, so too are physicians and hospitals across the country. They recognize the intrinsic relationship between violence and negative health outcomes.   In 1998, the R. Adams Cowley Shock Trauma Center in Baltimore, Maryland established the Violence Intervention Program (VIP).  VIP’s primary goal is to decrease the number of patients who return to Shock Trauma as a result of intentional injuries such as beatings, gunshots and stabbings.  The victims of these events receive assessment, counseling, and social support to effect change in their lives.  While the dynamic still exists that some victims may be perpetrators of violence, the belief is that intervention immediately after a life-threatening event is the ideal time to intervene in hopes to prevent recidivism.

Three years after Shock Trauma introduced VIP, the Centers for Disease Control and Prevention (CDC) opened the National Youth Violence Prevention Resource Center (NYVPRC) targeting youth violence and suicide.  The following year, the CDC began tracking state-based surveillance data that links information from law enforcement, coroners and medical examiners, vital statistics, and crime laboratories via the National Violent Death Reporting System (NVDRS).  A four step public health approach to violence prevention is the guiding force behind many of the CDC’s efforts.  This approach entails defining the problem, identifying risk and preventive factors, developing and testing prevention strategies, and assuring widespread adoption.  NVDRS allows relevant stakeholders to utilize this data in concert with the public approach to violence prevention to develop and implement appropriate prevention programs.

While youth violence prevention has been recognized as a priority since the mid 1980s, the number of hospital-based violence prevention programs across the country has increased over the past decade.  Consequently, physicians are in a unique position to take an active role in violence prevention.  Psychological, trauma, physical trauma and even death are foreseeable symptoms and outcomes of youth violence. Employing prevention strategies rather than merely reacting to the problem will provide the most significant reduction in foreseeable negative outcomes.

Trauma surgeons and emergency medicine physicians in urban centers throughout the country understand the relationship between violence and negative health outcomes.  Exposure to violence, however, can take on many forms.  Seeing someone shot or stabbed, seeing a dead body on the street, witnessing someone being arrested, beaten or dealing drugs and hearing gun shots are common events in the lives of urban youth according to multiple studies.  It was found that exposure to community violence can be strongly predictive of involvement in relationship violence, increased subsequent aggression, and post traumatic stress disorder.

Spending a night in an urban emergency department during summer months personifies the negative health outcomes of violence such as gunshot wounds, stab injuries and other forms of physical violence.  The hours that follow these injuries serve as an optimal time to advocate for prevention or cessation of subsequent violent behavior.   Physicians can establish a mentor-mentee relationship, connect with concerned relatives, utilize the resources of other members of the health care team such as social workers, or simply take the opportunity to encourage a shift to positive behaviors.

Medical students will soon be in a position to make a similar impact on the lives of their patients.  However it is not necessary to wait for the title of ‘Doctor’ before becoming more involved.  Participation in formal mentorship programs or volunteering for YSEP and HPREP activities in SNMA chapters can make a positive impact in our communities.  It is active involvement in our communities that can encourage the next generation to pursue a career in medicine, and establish a culture of volunteerism all while reducing negative health outcomes associated with violence.

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