Myron Yaster MD
Another week and more mass shootings…I received several emails from readers asking for more information about the University of Washington (UW) Harborview Injury Prevention and Research Center from Monica S. Vavilala, MD. I asked Dr. Wendy Binstock and her (“civilian”) husband Eddie Rush who were at the 4th of July parade massacre in Chicago and provided first aid to the victims to recount some of their experiences. Finally, Justin Lockman sent some of his thoughts on intranasal naloxone.
From Monica Vavilala
The University of Washington (UW) Harborview Injury Prevention and Research Center (HIPRC) exists to reduce the harm and suffering from injury and violence on all people’s lives. Founded in 1987, the HIPRC is a vibrant and worldwide leader in injury and violence research, outreach, education, and training. The HIPRC is one of nine Centers for Disease Control and Prevention’s centers across the United States, and for 35 years, the HIPRC has made high priority contributions to our communities, our region, nationally and globally. Located on the Harborview Medical Center campus where the region’s level 1 adult and pediatric trauma center provides care to our most vulnerable populations, the HIPRC not only prevents community injury and violence but also helps improve patient outcomes after injury and violence through development of evidence that drives best practice clinical care and through wrap around support of patients most affected by injury and violence. The HIPRC is a vibrant interdisciplinary ecosystem where injury and violence prevention scholars across the UW, practitioners at Departments of Health and policymakers come together to reduce the harm from injury and violence. Our faculty and trainees bring critical perspectives from Medicine, Nursing, Public Health, Engineering, Public Policy, and Social Work.
The HIPRC focus on injury and violence related health equity since 2017 is visionary and grounds our research, training, and outreach to address systemic racism and health disparities. This focused approach to addressing injury and violence prevention is unique and the HIPRC is a national leader the field of injury and violence related health equity. The HIPRC supports the research, training, and outreach work of over 80 core, associate and affiliate faculty, 12 trainees through effective partnerships with over 40 diverse community partners. Our research teams conduct rigorous and cutting-edge injury science to address societal challenges such as firearm violence, the opioid crisis, traumatic brain injury, safe and active transportation, elderly falls, suicide prevention, and how best to care for injured patients. Through community led approaches, the HIPTC emphasizes research translation so that our communities maximally benefit from our science. As a hub for development of injury scientists, HIPRC trainees learn how best to conduct rigorous translational injury science. The HIPRC has trained over 100 injury control scientists and leaders over its 35 year history.
As an interdisciplinary think tank, The HIPRC provides creative solutions to complex injury and violence challenges faced by our communities. Please visit Year in Review to see notable highlights, core achievements, and project highlights for 2021, and please visit www.hiprc.org to learn more about HIPRC. Please also follow us on social media, @HIPRC.
From Wendy Binstock
Story of a Beautiful Day Gone Horribly Wrong
Monday the 4th of July 2022, was a day to celebrate for our small community of Highland Park, IL. Life was getting back to normal after two years of pandemic living – our community 4th of July festivities were back. The day kicks off at 10:00 am with our parade. The parade route is always jammed with families holding “prime” viewing spots for hours. I was holding excellent spots, awaiting the arrival of my 6 grandchildren, who love coming to the parade, mostly to see their grandpa (Zadie), Eddie Rush and uncles Shane Selig and Marc Rush riding bikes along the parade route as members of our local CERT (community emergency response team).
Fifteen minutes into the parade, horror struck. Somebody yells, “There’s an active shooter at Port Clinton Square!” which is a large area on the south side of Central Ave., the best spot for families. Suddenly things started to go in slow motion. I saw swarms of people behind the high school’s marching band running down the street and sidewalks. My family had not yet arrived at the parade. Knowing my family was safe, my doctor “instinct” immediately took over, I knew I had a skill set that could help.
My husband’s story is one of civilian altruism. The CERT program “educates volunteers about disaster preparedness for the hazards that may impact their area and trains them in basic disaster response skills, such as fire safety, light search and rescue, team organization, and disaster medical operations.” This team of volunteers immediately shifted gears from directing traffic and smiling at the parade goers to using the training that they had been given. My husband saw a family with a mother, father and twin 8-year-old boys. The mother had thrown herself over her sons, one of whom had been shot in the back. The mother was shot multiple times in the leg and was bleeding profusely both above and below the knee. Having no gloves or equipment he quickly put as much pressure as he could on the sites that were bleeding the most, as the mother was already beginning to lose consciousness, awaiting arrival of medical grade tourniquets from the paramedics. A 1st responder tossed these to him, where he was able to use the training he had received to appropriately place 2 tourniquets one above and one below the knee. I’m happy to report that this woman was transported to the hospital in stable condition and should make a physical recovery.
My story does not have the same happy ending. My position at the parade was underneath the shooter, and the victims were across the street. I ran to the other side of the street, identified myself as a physician, specifically an anesthesiologist, and asked for the most critical person. I was directed to an elderly gentleman lying on the ground. One of the police commanders was doing chest compressions, and another person was applying pressure to an abdominal wound. I asked EMTs for an AMBU so we could begin ventilation as CPR had been in progress for at least 5 minutes. I noticed a previous tracheostomy scar on the patient as well as he had a very long face with a prominent nose, making me believe that mask fit would not be the easiest. I was successful in bag-mask ventilation, and the color of this man’s face rapidly turned from grey to more normal. Another local Advanced Practice Nurse, Jacquie Toia, who also works at Lurie with transplant patients, inserted an IV. This man briefly opened his eyes and moved a hand. The ambulance arrived and when placed on the monitor he had a wide complex rhythm, we transported him to our closest hospital, while continuing CPR and bag-mask ventilation. Once at the hospital, which is not a trauma center, I informed the ER attending that he was not the easiest bag-mask and that there appeared to be a previous tracheostomy, he then deferred to me for the intubation. Unfortunately, I am sadden to say that after 20 more minutes of intense resuscitation in the ER, this husband, father and grandfather was pronounced dead.
Note from Myron: This is happening so often, should we be routinely carrying a medical grade combat tourniquet with us when we are out of the hospital? And if so, which one? More on this in future PAADs and maybe at a future SPA meeting.
From Justin Lockman on intranasal naloxone
Thank you to Drs. Yaster, Maxwell, and Agarwal for again raising the important issue of naloxone in our practice. I would like to add an additional perspective as a pediatric critical care anesthesiologist who has cared for countless opioid overdose patients. Some of these were intentional suicide attempts, some were accidental overdoses among post-op patients or known addicts, and some were young toddlers who found a pill under the sofa. To really put the numbers into perspective, consider this: In 2021 alone, 107,600 people died from drug overdose [according to the Drug Policy Alliance]. For comparison, according to US National Archives. 40,934 US soldiers were killed in action in the ENTIRE Vietnam War.
There is much work to be done to decrease opioid addiction across our nation. Many of our colleagues are pioneering ways to perform pediatric surgery without opioids and are decreasing the number of opioids prescribed after surgery. We are also working to provide easier ways for people to dispose of their leftover opioids, and we applaud efforts at changing systems to allow for co-prescribing of naloxone.
As indicated in the PAAD, California now allows purchase of naloxone without a prescription. Importantly, all 50 states as well as the district of Columbia now have laws in place to increase layperson access to naloxone (although there is variable scope). I personally keep intranasal naloxone in my house – I have two teenagers in the house and many on my street, so how could I not! I am writing to encourage all SPA members to learn about their own state laws here [https://www.safeproject.us/naloxone-awareness-project/state-rules/] and purchase naloxone if possible. As far as I can tell, there is no downside and a huge upside to having it around.
I’d be remiss if I didn’t acknowledge my partner Wynne Morrison for convincing me years ago to carry naloxone and for helping me to draft some fo the above language.