The authors note that having two different definitions of trauma can lead to a fragmentation of care. The TIC curriculum takes into account the full scope of trauma and can “foster a sense of empowerment, autonomy, and partnership in the injured person to help patients thrive, not just survive.”
Focusing on at-risk communities
The authors address violence and the social determinants of health with a broad lens, noting the risk of perpetuating a cycle of inequity, disparity, and inequality if underlying causes of death and ill health are not addressed. The authors suggest a strategy to invest directly in at-risk communities to treat patients with a full scope of understanding the underlying factors.
“It is important that people have access to trauma centers, but the other piece is hospitals investing in their communities,” Dr. Dicker said. “For example, putting in place vocational training programs so that the community is part of the employment process in a hospital itself. Also, whether the hospital uses local vendors for food; that’s an investment in the local community. Investment truly is the ability to put dollars into the communities that are in such great need.”
Health and wealth are inextricably tied to one another, the authors note. “Black and Brown communities suffer heavily from a racial wealth gap relative to white communities, although rural white Americans are also deeply impacted by this gap and share a common lack of access to mechanisms to build financial security,” they write. “Creating opportunities for financial and educational inclusion may not be seen on the surface as a health-related matter but, in fact, it is at its core.”
Advocacy is the overarching theme that informs the strategies proposed by ISAVE. The authors note that it is an intrinsic duty for trauma center personnel to use advocacy to address the social determinants of health that lead to violence. Specific policy suggestions include engaging hospital and health system administrators to leverage the Affordable Care Act’s Community Health Needs Assessment to encourage hospitals to engage in addressing poverty and unemployment.
“Physical trauma leads to psychological trauma and psychological trauma predisposes to physical trauma. Optimally addressing one, requires addressing the other,” the authors conclude. “Although complex, effective interventions for violence are not as complex as those required to combat a novel corona virus pandemic, and as the COVID-19 pandemic has plainly demonstrated, we are all in this together. What affects one of us, affects all of us.”
The ISAVE workgroup was established in 2019 by the ACS Committee on Trauma (COT) and first outlined steps the medical community must take to understand and address the root causes of firearm violence at a panel presentation during the 2020 ACS Clinical Congress virtual. The ACS COT has been working to prevent firearm related injury, death, and disability by working together to address the root causes of violence and simultaneously making firearm ownership as safe as possible. Learn more about the ACS COT’s efforts that focus on treating firearm violence as a public health problem.
Article coauthors with Dr. Dicker are Arielle Thomas, MD, MPH; Eileen M. Bulger, MD, FACS; Ronald M. Stewart, MD, FACS; Stephanie Bonne, MD, FACS; Tracy A. Dechert, MD, FACS; Randi Smith, MD, FACS; Altovise Love-Craighead, MS; Fatimah Dreier, MA; Meera Kotagal, MD, FACS; Tamara Kozyckyj, MPH; and Holly Michaels, MPH.
The article authors have no relevant financial relationships to disclose.
“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.
Citation: Strategies for Trauma Centers to Address the Root Causes of Violence: Recommendations from the Improving Social Determinants to Attenuate Violence (ISAVE) Workgroup of the American College of Surgeons Committee on Trauma. Journal of the American College of Surgeons. DOI: doi.org/10.1016/j.jamcollsurg.2021.06.016.
