Morrison

Dr. Chet Morrison

Lancaster County can be a pretty nice place to live, with its scenic countryside, bucolic rivers and farm-fresh produce.

The unemployment rate is significantly below the state average. The median wage is higher, and the housing values are better. The schools are reasonably good, and the poverty rate is lower than it is statewide.

As comforting as these facts are, Lancaster County is not immune to violent crime, as readers of LNP are well aware. Indeed, statistically, crime rates are higher here than in Pennsylvania as a whole, due mostly to Lancaster city, which seems to have a level of violent crime and homicide — half of it due to gunfire — that fluctuates from year to year but never really recedes.

I am a surgeon who takes care of the injured and critically ill. I have done so since moving here from Michigan. Along with my colleagues and a team of incredibly dedicated physicians assistants, nurses and support personnel, we treat the victims of violence: the stabbings, the shootings and the domestic assaults.

We mend their injuries, and take them through their often painful and prolonged recovery. Sometimes we have to tell their families that, no, they did not survive. It is intense, rewarding, bloody, sometimes grim work. And it is a good way to get a close-up view of the consequences of violence in America — consequences, I would argue, that impact all of us.

A recent LNP article (“The who, how and why of homicide,” Feb. 3) laid it out in terms of the statistics, and the reading was troubling: Nearly 200 Lancaster County residents were the victims of homicide over a 16-year period, or an average of one a month. Half of those were firearm-caused.

The perpetrators and victims are primarily young men, many of them from Lancaster city. And of course there are many others who are injured but survive, often with disabilities and an expensive hospital bill that is ultimately shared by all of us.

Add to this the burdens of domestic violence and suicide (roughly two- thirds of annual firearm deaths are due to suicide), and the costs of all this violence — particularly gunfire violence — becomes quite clear.

Modern science and trauma care have helped those wounded by gunfire immeasurably, with advances in resuscitation, surgical care, post-operative critical care and rehabilitation. Many of these care principles were learned in military conflicts and brought back to the civilian world.

That being said, I don’t anticipate that we will stop losing lives to acts of violence, particularly those involving firearms.

We recently published a study looking at 12 years of gunfire trauma cases treated at Lancaster General Hospital. We found that overall mortality was 15 percent (71 deaths per 478 victims) for the entire patient population. There was no change over the study period, despite Lancaster having a mature trauma system that uses all available medical advances and spending more than $10,000 per patient.

I am not sure there are really any medical breakthroughs that will significantly alter this rate. The damage inflicted on the human body by a bullet is sometimes just too great. There is very little evolutionary pressure or divine guidance that will fix a human heart that has just had a hole blown through it by a .44-caliber slug.

So, since we are doing all we can in the medical community, what else can be done about this endemic violence affecting us all? I believe there are three broadly focused efforts we can collectively make that would go a long way toward making Lancaster County, and the country as a whole, much less violent.

First, enhanced law enforcement — with training for police officers in on-the-scene hemorrhage control, focused policing, enhanced community support and cooperation on the part of an enlightened citizenry — must be part of the solution.

We ask much of our police force, and the professionalism and motivation found in the vast majority of the force make it equal to the task. As members of the public, we should be vigorously supportive of police efforts to reduce violence, which include controlling the drug trade and gunrunning.

Second, research into what is essentially a public health problem also ought to be vigorously pursued, funded and supported on both sides of the political aisle. Given the magnitude of the problem, it is surprising how little research has been done on the best ways to combat it. This is largely but not exclusively caused by political restrictions placed in the way.

More broadly, it is the failure to see the issue in this way that has been costly. We lose many people to motor vehicle accidents every year, yet cars are essential transportation. Therefore, there is a major research effort — which has been very effective — to reduce deaths from crashes. That effort touches many areas: engineering, public policy and changing societal attitudes. There is no reason we cannot do the same with weapons of homicide.

Finally, Pennsylvania and its cities, townships and municipalities should be free to innovate and test programs that would protect citizens from the worst effects of firearm violence. They should not have to worry about being pre-empted by lawsuits or injunctions from outside pressure groups that care little for Pennsylvania or its citizens. As always, there is a balance and a tradeoff among personal liberty, cost to society and public safety.

I see firearm violence is an assault on public health, and I think every enlightened citizen, regardless of political orientation, can agree on this and work toward a solution.

Believe me, I would be OK if I had to spend less time in the operating room and the intensive care unit caring for the victims of violence in our fair countryside. Chet A. Morrison, M.D, FACS, FCCM, is an attending trauma surgeon and critical care intensivist with Penn Medicine/Lancaster General Health.