Shock Trauma Chief speaks about gun violence and the ripple effects in Baltimore City

By Mylika Scatliffe,
AFRO Women’s Health Writer

Dr. David Efron has seen it all. 

While millions across the country are debating gun laws, mass shooting prevention and public safety, doctors like Efron are called on a daily basis to stop the hemorrhaging of a nation obsessed with gun culture. 

As a former trauma surgeon for Johns Hopkins University and current chief of trauma and medical director of the R. Adams Cowley Shock Trauma Center, he can give first hand accounts of what it means to save a life or lose one to gun violence. 

With more than two decades of trauma work at various Johns Hopkins Hospital campuses, Efron is more than familiar with gunshot wounds and far-reaching effects for victims and their families.

“We almost never find out how they end up here, and it’s not our place to ask. We just work hard to save them,” Efron said.

According to the Centers for Disease Control and Prevention (CDC), there were 45,222 gun-related deaths in the United States in 2020, meaning roughly 124 people per day died from gunshot wounds.  The CDC also noted the following:

• Men account for 86 percent of all violent gun deaths and 87 percent of non-fatal gun injuries.
• Homicides committed with guns are highest among teens and young adults aged 15 to 34.
• Gun related deaths are also highest among Black, American Indian or Alaskan Native, and Hispanic or Latino populations.

Prior to four people being shot to death at a hospital in Tulsa, Okla. on June 1, there had already been 232 mass shootings in the U.S. More than 20 shootings have happened since the elementary school massacre in Uvalde, Texas that left 21 people, including 19 children dead, according to The Gun Violence Archive. 

Though not a expert on crime, Efron reported that a large part of the homicides and non-fatal shootings he encounters in Baltimore are wounds created from handguns- not assault rifles.  However, the spate of mass shootings over the last three weeks leaving victims scattered in a church, supermarket, elementary school and hospital in varying corners of the country, conversations about assault weapons are once again reaching flashpoint.

“We don’t see as many shooting victims with wounds from assault weapons as we do handguns, but we have seen some,” said Efron. 

The elite medical team at Shock Trauma have a 97 percent overall success rate when it comes to saving the lives of those who come through their trauma bays because in the words of Efron, “We usually ‘win’ because we go very hard at it.” 

While both can absolutely kill and maim, assault weapons and handguns differ, particularly in the types of wounds they cause. 

“When the ammunition leaves the barrel of an assault weapon there is a lot more velocity behind it, which likely means more damage to the body – shredded tissues and shattered bones,” said Efron. “Handgun bullets are often conical and smaller than those in assault weapons, and they are more likely to make a clean hole.”

A victim’s time in Shock Trauma doesn’t necessarily end with treatment in the trauma bay and then discharge. A patient might remain in Shock Trauma a few hours, weeks, or months.  

Efron and his staff know that violence prevention is paramount in trying to prevent recidivism among victims, and they may not have a large window of time to encourage victims to change risk taking behavior.  Their audience is most captive while still recovering in the hospital. 

Efron said that over 90 percent of the gunshot victims that come into Shock Trauma are young Black men with a median aged somewhere between 20- and 30-years. 

“I was somewhat surprised. The median age is a bit higher than I would have thought,” said Efron. “It’s all tragic, but you take note of the young teenage victims of gun violence.”  

The Shock Trauma team is overwhelmingly successful at saving lives, but as noted above, the success rate is not 100 percent. ,

Efron said the worst part of their job is notifying family members and loved ones when they are unable to save a patient.  

“We handle the notifications with compassion, but we’re direct,” Efron said. “Family members have been on pins and needles waiting to hear about their loved ones and no one wants to hear how we shed blood, sweat and tears.”

“It’s an emotionally charged situation not only for the victim’s family but for the staff as well. We don’t get used to it, but we have to be a little numb to it, because in 15 minutes we’ll have another patient.”

For victims who survive, a stack of discharge paperwork and instructions awaits.  A young person who has always been strong and healthy, might not have much health literacy and now needs to navigate the complex health and legal systems while recovering from injuries.  

For some who survive, life might be starting anew with a wheelchair,  a colostomy bag or traumatic brain injury. Support is key in getting through the difficult time.

The Rebuild, Overcome, and Rise Center at the University of Maryland, Baltimore (ROAR), is an organization that provides wraparound services such as legal and health assistance to Baltimore City residents. 

According to the UMB ROAR webpage, “crime often impacts survivors’ mental and physical health, and overall.” 

 Lydia Watts, executive director of ROAR, spoke with the AFRO about the support her team offers victims of violence and their families.  

“The phenomenon of gun violence is deeply rooted in racism and poverty and the minimization and dehumanization of Black families is a real problem,” said Watts.  

Trauma and pain are often not recognized for Black families, which often means Black families might not seek help when needed, according to Watts. 

Victims might need support navigating the health system in the aftermath of being shot, or might need help combatting bias from health care providers. 

“Sometimes our clients come to us  three, six, even nine months after being shot and discharged from the hospital. They haven’t been back to the doctor or kept up with any of the discharge instructions they received, and now their prescription for services may have expired.”

Watts said, “ROAR will assist their clients in getting paperwork completed, so they can have access to mental health care, physical checkups and rides to follow-up appointments.”  

She pointed out the startling difference between reactions to mass shootings and reactions to the gun epidemic plaguing the Black community.

“The whole country mourns for national victims such as Uvalde or Buffalo, but no one is raining money for young victims and their families at a local level,” said Watts.

Help us Continue to tell OUR Story and join the AFRO family as a member – subscribers are now members!  Join here!