Trauma surgeons see effects of gun violence

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After a shooting in Ottawa, police sirens ring out, paramedics rush to the scene, try to stabilize the victim and speed towards the hospital. When they arrive, the victim enters the care of a trauma surgeon.

In the operating room, among blood transfusion bags and life-support equipment, doctors see the other side of a wave of gun violence that is affecting the city. Here, every moment is critical as surgeons devote all their skills to preventing an armed assault from turning into a homicide.

“The feeling in the room is actually a bit, I don’t want to say tense, because it’s our job and everybody is somehow comfortable with that, but there’s definitely a sense of urgency,” Dr. Jacinthe Lampron, a surgeon and the medical director of the trauma program at The Ottawa Hospital, said in an interview, “because in trauma every minute counts but in penetrating trauma it’s almost like every second counts in terms of keeping them alive.”

Gunfire has claimed the lives of seven people in Ottawa this year and there have been dozens of gunfire incidents, many of which leave victims with long-term injuries.

Lampron and her colleagues have noted the spate of shootings in recent weeks. It has resulted in more patients arriving in the operating room. But the statistics, so far, are not indicative of an unusual spike.

“We do appreciate that there may have been a cluster amongst ourselves, anecdotally,” said Dr. Maher Matar, a trauma surgeon at The Ottawa Hospital. “I think it flattens out over the year or over the month. We may have a little period of time where things are more intense than others.”

“It doesn’t take any of the drama out of that,” Lampron added. “Each one should not happen and is very dramatic.”

Some gunshot victims also never make it to the hospital: “We only see those who have been shot and injured as opposed to those who may have deceased on scene, or there could be shots that don’t even arrive at the hospital,” Matar said. “There are some patients that we probably don’t even hear about or gunshots that may have occurred and we don’t even know about.”

Both Matar and Lampron have extensive training and experience treating gunshot wounds and other serious trauma. Lampron has a military background. She deployed to Afghanistan twice and trained in South Africa, where, she said, “there is quite a bit of violence.”

Matar did his initial training in Ottawa and at McGill University in Montreal, then he worked in South Carolina in the United States in a busy trauma centre before returning. In South Carolina, some motorcycle drivers don’t wear helmets.

“There’s no helmet law, so you see some pretty bad injuries,” Matar said. “The gun violence is also pretty intense: higher calibre, more intention to kill, probably. Busy stuff.”

By contrast, gun violence in Ottawa, according to the Ottawa Police Service, remains low.

“When taking the recent shootings into consideration, Ottawa statistically remains one of the safest larger cities per capita in the country,” Acting Superintendent Carl Cartright with the investigations directorate said in a statement.

In an average year, penetrating trauma, which includes gunshot wounds and stabbings, accounts for 10 per cent of the injuries seen by Lampron and her team, which is about the same as any Canadian trauma centre. So far this year, they’ve seen slight upticks in their statistics.

“We’re slightly more than last year,” Lampron said, “but really not much. … It depends what the trend of the rest of the year will be, but so far it’s relatively similar to what we have seen in the past.”

But low overall statistics are cold comfort to those affected by gun violence. Even minor gunshot wounds can leave victims permanently disabled.

“There can be situations where what seems to be very small, like a gunshot to the arm, may seem like nothing but all of a sudden this individual has lost their ability to use that hand, right? If it’s their dominant hand, that’s a problem for them from a long-term perspective,” Matar said.

“Some of them walk away with a kidney missing,” Lampron said, “some could be paralyzed, some are disfigured or have a brain injury. It is definitely changing their future and their ability to continue education, work or family duties that they were carrying before. It’s pretty serious. It’s not because they’re alive that it’s all sorted out. There’s a good amount of work and adaptation even after they recover from those acute injuries.”

Stitches, blood transfusions and surgery can fix physical injuries, but gunfire often leaves marks that surgeons can’t address.

Matar recalled patients who, in the weeks after they were shot, feel anxious, flinch at loud noises and feel anxious in crowds. “There can also be mental situations, PTSD that these guys will have a hard time to deal with moving forward,” he said.

There has been a push in recent years to treat gun violence as a societal issue that requires a holistic solution. In February, the Canadian Medical Association updated its policy on firearms control to recognize firearms as a “serious threat to public health.”

“Gun violence is a disease and it should be treated like a disease,” Lampron said. “Before it was just ‘oh, it happens.’ It does not just happen … It has risk factors. It has demographics.”

Statistically, young men tend to be most at risk of gun violence, but when they’re rushing to the operating room, Lampron and Matar have no time to think about who they’re treating.

“You go into your zone, you stay focussed on the patient care at that point in time,” Matar said. It is only afterward that they learn about the person on the operating table.

“I think it’s important to realize that the people who are coming in who are shot or are injured due to gun violence are at the end of the day humans,” Matar said. “(When they don’t make it), we do our moment of silence to respect the patient in front of us and then only a day or two later in the news, we read about them. You realize it’s a 20-year-old or a 21-year-old, it does get to you, and it’s unfortunate that, at these young ages, they are being involved in these situations and this is the outcome that’s happening.”

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