STORY BY

Imelda Gott

Around election time, the media fills us in on dropping murder rates. Flip that newspaper page, and we can read about the rising crime rates. Down the page you spot a story on the dire conditions of emergency rooms from funding cutbacks. Somewhere among these three news items, there’s a story to tell.

Statistically, murder rates seem to be down across the country. In 1985 in Houston, Texas for instance, 457 murders were recorded. In 2000, the number dropped to 230. While it may appear that there is less violence, it seems that medical care--more than modified behavior—may have redirected the finger of fate.

A recent Harvard University study asserts that the national murder rate has dropped 70 percent over the last 30 years, declining an average of 2.5 percent a year from assaults by firearms and knives and 3.5 to 4 percent from assaults by other means.

A 2002 study at the University of Massachusetts claims the national murder rate would be 45,000 to 70,000 rather than 15,000 to 20,000 for the past few years if not for improvements made in emergency medical care over the past 20 to 30 years.

The Impact of Emergency Services

Marjorie Lygas, RN, trauma program coordinator at Houston’s Memorial-Hermann Hospital, says, “I don’t think violence is down. I think trauma care has improved.” Lygas says that she has looked at the number of “penetrating traumas”– gunshot or a knife wounds (the majority being assaults rather than accidents), in the last three years at Memorial-Hermann, “and they are about the same.”

She added that the number was slightly higher in 1999. The Texas EMS/Trauma Registry recorded 144 gunshot and knife wounds in 1997 in Houston. That number has risen each year, and by 2002, the number was 664.

Yet survival rates from some of the worst traumas—head injuries—are up.

Dr. Guy L. Clifton, chairman of the Department of Neurosurgery at the University of Texas Medical School at Houston and chief of neurosurgery at Memorial-Hermann Hospital says that in 1975 the mortality rate from severe head trauma (more from car wrecks than violent crime) was about 50 percent. “Today, it’s down to 25 to 30 percent.”

These improved recovery rates, he says, are largely due to rapid transport and more major city level-one trauma centers that can service large regions.

Trauma centers also have progressively improved post-trauma intensive care treatment. For conditions like brain swelling, post-traumatic nutritional management, electrolyte balancing, “a whole constellation of management techniques,” are now in place to handle patients after they have left the trauma unit, Clifton says.

“I don’t know if the mortality rate from multilevel trauma dropped at the same time, but I’d be willing to bet that it did,” Clifton explains.

The “Golden Hour”

Dru Ware, assistant professor of surgery at UT Houston Medical School sees the drop in murder rates and other traumatic deaths as a “tripartite issue.” In other words, there are those who die at the scene, those who die from their injuries weeks later, and those whose lives depend on what happens in “the golden hour.” That is when emergency medical services and trauma care have their greatest impact.

“The golden hour is that period of time that you have to intervene with a patient on a specific injury, in order to recognize it, rectify it and begin the recuperative phases for the patient. [That’s why] getting someone to the hospital quickly in order for the trauma surgeons to intervene is so critical,” Ware explains.

Golden hour traumas can involve head trauma, stab wounds to the heart or lung, ruptured spleens or near amputations of arms or legs.

Both physicians credit UT-Houston Medical School trauma surgeon James H. “Red” Duke for the foresight in the 1970s to recognize Houston’s need for organized emergency services and the helicopter ambulance system, Life Flight. The three helicopters can and do rescue patients up to 150 nautical miles away, but in a city the size of Houston, they are kept just as busy in their own backyard.

ERs Need Rescuing, Too

Whether a victim is on the gurney from an attempted murder or a head-on collision makes little difference statistically, if the ER itself is in danger from funding shortages.

Clifton, who is a founder of and crusader for the organization “Save Our ERs,” points out that, “The system that halved the mortality rate is in jeopardy. On days that the trauma centers are ‘on divert’ [not taking new patients], it’s as if you were injured in 1965.”

In the Houston area, Clifton says, if both Memorial Hermann and Ben Taub Hospitals are on divert status on the same day, the mortality rate—from attempted homicide to vehicular injury—doubles. “Then we are back to a time when a patient is taken to whatever hospital is in the vicinity and whoever happens to be available at the time takes care of you, if anyone is available,” Clifton says.

According to Ware, Memorial Hermann’s ER served over 100,000 patients in 26 months.

The physicians agree that emergency care will continue to advance in spite of budgetary and logistical obstacles. Ware foresees the greater survival rates among persons with multiple injuries and those who tend to die within days or weeks of an assault or accident.

Clifton says, “The huge leaps [in trauma survival rates] were made from system organization and concentration of resources. We’re not going to see another 50 percent reduction in mortality rate, but I do believe that we’re going to see a further shift toward better patient outcomes and recoveries.”

For more information about the status of Houston’s emergency care system, visit www.saveourers.org.

UPDATED: 3-31-2003

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