After tragic events like the mass shooting last week in Parkland, Florida that left 17 dead, well-meaning people are fast to praise the skill of the doctors and surgeons who treated the victims. Days after the horror at Marjory Stoneman Douglas High School, the Trump family visited Broward Health hospitals, which received more than a dozen Parkland shooting victims, “to pay their respects and thank the medical professionals for their life-saving assistance.”
As a trauma surgeon for a Level 1 trauma center in St. Louis, Missouri, I commend these teams for their ability to provide quick and effective care and prevent additional casualties. However, the medical staff in Broward County ― and in any other city that has experienced a mass shooting ― should never have had to deal with the aftermath of such a horrific event to begin with. The American health care system is simply not equipped to adequately handle the devastation following an incident involving assault weapons.
Regardless of where you stand on gun control, one thing is not up for debate: If a person is shot, they will need to be evaluated by a doctor. If geography permits, which is to say if the shooting occurs in close enough proximity to a trauma center, that doctor will be a trauma surgeon.
No hospital in America has enough trauma surgeons and enough operating rooms to properly deal with what happened in Parkland.
A Level I trauma center is the highest designation a hospital can receive. These centers are designed to treat the most complicated trauma cases, and they also serve as referral centers for other hospitals that lack the capacity to deal with the range of severe injuries that mass trauma ― like motor vehicle accidents and gunshot or stab wounds ― produces. Many cities, and some states for that matter, don’t even have hospitals with Level I trauma centers.
After more than 13 years of surgical training, fellowship and practice, I have a better understanding than most of a hospital’s trauma capabilities. Even the best trauma centers cannot adequately handle the injuries that assault weapons inflict upon human bodies. Any medical institution or individual that states otherwise is sorely misguided at best and in denial at worst. In a mass casualty situation, these centers may be able to provide appropriate and equal care to one, two, maybe three gunshot victims at a time, but they cannot promise this same degree of care to additional victims.
Simply put, no hospital in America has enough trauma surgeons and enough operating rooms to properly deal with what happened in Parkland. Or in Las Vegas. Or in Orlando. Or in San Bernardino. Or in Newtown.
In addition to staffing and equal care issues, a significant distinction exists in the medical field between blunt trauma, which includes injuries sustained in a car or other vehicle accident, and penetrating trauma, such as stab and gunshot wounds. The vast majority of blunt trauma can be treated without requiring any surgery and without the use of an operating room. Penetrating wounds, on the other hand, and gunshot wounds in particular, almost always require surgical exploration.
Most institutions only have one trauma surgeon on call at any given time, plus a backup surgeon if needed, so an influx of multiple gunshot wound victims quickly exceeds what a health facility can accommodate. As a result, patients have to either wait for treatment or be transferred to another facility.
After the shooting at Marjory Stoneman Douglas last week, Broward Health North, a nearby Level II trauma center, received eight victims. Two of those patients died. I cannot speak for this team’s specific experience, but I know the responsibility and guilt I feel when I look into the eyes of a patient or loved ones and tell them they have to wait for me to operate on someone else first. It is a conversation I continue to struggle with, even after so many years in this field.
And if the victims survive these mass shootings? What then? I regularly witness firsthand the devastation that gun violence can wreak on the human body. The patients’ names often do not appear in the news, though their suffering is tremendous. These victims go through multiple surgeries, undergo bowel resections, experience ongoing nerve damage and suffer through wound complications ― and this doesn’t even take the psychological suffering into account.
But the aftereffects of gun violence do not easily stick in the minds and hearts of the public or our politicians. They don’t even find a home on social media in people’s messages of thoughts and prayers. Vigils are not held for survivors with colostomy bags.
If our health care system is not designed or prepared to absorb the consequences of assault weapon injuries, why are they legal to begin with? Contrarians will immediately argue that we see mass casualty motor vehicle accidents all the time, yet we have not banned cars or buses. The difference here lies in the fact that the lawful possession of assault weapons is born out a desire to possess firearms, not out of a daily necessity that ensures our society can function properly.
Many cities, and some states, for that matter, don’t even have hospitals with Level I trauma centers.
As the gun control debate rages on, the individuals and institutions that treat and manage the outcomes of assault weapon-related injuries must be given a seat at the table. I am only one medical professional of many, but I strongly advocate for the ban of assault weapons on account of the inability to provide timely and equal care for the number of victims these weapons can produce.
As countless others have already said, the time is long overdue to have a serious discussion about gun violence, especially as it pertains to assault weapons. As each day passes, the likelihood of mass shootings like what happened in Parkland occurring again is a foregone conclusion. In the meantime, all I can do is prepare myself and our trauma team to the best of my ability for what may soon happen in our own community.
Jason Rhee is a board-certified trauma surgeon in St. Louis, Missouri. He received his undergraduate degree at Columbia University, attended Albert Einstein College of Medicine in New York and completed his residency at Tufts Medical Center in Boston and his surgical critical care at Washington University in St. Louis.