Metro Health's trauma center also treats the wounds doctors can't fix

Cleveland-based Metro Health’s trauma center doesn’t just treat a patient’s gunshot wounds. It also helps the patient avoid getting hurt again.

The health system has partnered with a number of Cleveland social service agencies to counsel victims of gun violence and connect them with services to try to change the course of their lives.

As part of that effort, the health system last November embedded two “violence interrupters” from the Cleveland Peacemakers Alliance in its level 1 trauma center emergency department (ED) to help prevent retaliation among stabbing and gunshot victims ages 15 to 25.

The alliance – largely made up of former gang members and reformed criminals – is dedicated to reducing violence in the city’s most dangerous neighborhoods. The violence interrupters leverage their “street credibility” to diffuse tensions in the ED, giving the victim and their family someone to talk to other than a social worker. They try to keep victims and their friends and family calm after a shooting and talk them out of retaliation.

“The bedside is a great opportunity to stop retaliation,” says Andrea Martemus-Peters, the health system’s violence injury prevention coordinator. “And the violence interrupters build rapport with the patient and family. They are their advocate, and they do an excellent job of calming fears and stopping retaliation.”

The health system recently expanded its violence-intervention efforts with the support of a $545,000 grant from the Ohio Attorney General’s office. The grant was awarded to Metro Health and the May Dugan Center – a nonprofit organization that provides health and human services programs – to create a trauma recovery center and services that steer all victims of violence away from further harm.

Launched in April, the program offers trauma screening and crisis intervention for victims of violent crime when they arrive in the ED. As patients heal and return to their community, social workers and trauma specialists link them with a variety of services, including short-term safe housing, legal advocacy, referrals to substance abuse treatment, mental health counseling and essentials like food and clothing.

“We need to find a way to address their needs and to recognize they are in crisis and they are not going to be able to pull themselves up by their bootstraps even if we give them brand new shoes,” says program director Sarah Hendrickson, who manages the health system’s survivor recovery services. “We have to help them even if that literally means walking them where they need to be.”

Metro Health’s ED treated more than 500 gunshot patients in 2016.

Gun violence is responsible for more than 33,000 deaths and 84,000 injuries a year in the United States, according to the Centers for Disease Control and Prevention. While many victims don’t make it to the hospital alive or die before getting discharged, others survive and go back into violent neighborhoods where they are reinjured or killed often in retaliation or from continued criminal activity.

Metro Health’s trauma recovery program seeks to break that cycle.

Under the program, the May Dugan Center provides some 400 clients with ‘wraparound” support like mentorship, job training, assistance with court advocacy, transfer to safer schools and connections to mental health services. Case managers follow their progress over four months.

Violence is a treatable health care issue, says Sue Marasco, the center’s education director.

“I can’t tell you how many times my staff have told me about going into the house for the first time and everybody is ready to re-arm and go out and find justice,” she says. “And after one or two discussions where we say, ‘let me tell you about what trauma looks like, let me tell you what trauma feels like, let me tell you about this great prosecutor that you’ve been assigned to already and who we’ve worked with on other cases,’ it lowers the temperature in the room and they feel like they’ve got control and choices that don’t involve violence.”

Metro Health’s Hendrickson says the violence afflicting inner-city neighborhoods should be treated like a chronic illness. She says hospitals need to work with others in their communities to treat the wounds doctors can’t fix.

“If you are diagnosed with diabetes, you can make adjustments in your life to manage it and you will do a whole lot better,” she says. “We feel the same way about trauma. People need to be diagnosed when it happens, and it needs to be managed like a disease.”