By Maureen Gilmer, IU Health senior writer, firstname.lastname@example.org
“We don’t want kids to get shot.”
It’s not a political statement, Dr. Cory Showalter says. It’s something everyone should be able to agree on.
But as medical director of the emergency department at Riley Hospital for Children in Downtown Indianapolis and regional medical director for pediatric emergency medicine, Dr. Showalter sees far too many young patients with gunshot wounds.
Just last week, an errant bullet fired on the street penetrated the wall of an eastside home, striking a young girl who was inside. She survived. A 16-year-old boy was killed in a shooting outside Castleton Square Mall on the northside this week.
Other incidents of gun violence include suicide attempts, accidental discharge, intentional acts and seemingly random violence.
Firearms are now the leading cause of death for U.S. children under the age of 18, according to the American Academy of Pediatrics. More than 1,600 children 17 and younger were killed across the country last year in shootings – accidental or intentional, according to Gun Violence Archive. This figure does not include suicides.
In all, 41 pediatric patients suffering gunshot wounds came through Riley’s ED in 2022, according to trauma epidemiologist Jodi Raymond. Of those, 32 were violent or intentional, which include drive-by shootings.
The remainder were classified as unintentional, where a child gets hold of a gun and it goes off accidentally.
The violence takes a toll. Not just on patients and families, but on friends, neighbors, healthcare workers and the community.
TALKING ABOUT TRAUMA
Last month, Dr. Showalter was joined by trauma surgeon Dr. Matt Landman and Riley clinical psychologist Zach Adams in one of Riley’s trauma bays for a discussion about the toll of trauma in general, but more specifically gun violence.
Gunshot wounds may reflect a comparatively small percentage of overall trauma cases, but they have a huge impact, Dr. Showalter said.
“This is literally a lifechanging thing for the patient and family and something that really sticks with the team. I’m very fortunate to work at a place where we support each other.”
Of the more than 50,000 patients who came through the emergency department at Riley last year, about 2,000 suffered from traumatic injuries, Dr. Landman said. Loosely, 40 to 60 of those are typically gunshot-related, he said.
“Gunshot wounds are by definition all-hands-on-deck,” he said, “our highest level of activation.”
He’s referring to a paging system that notifies all team members who need to be involved with this level of trauma.
When EMTs and paramedics alert Riley, Indiana’s only Level 1 pediatric trauma center since 1993, that a gunshot victim is headed to the hospital, it’s not just surgeons who answer the call. It’s specialized nurses, technicians, radiology, the charge nurse in the operating room, chaplains, social workers … the list goes on.
“All of those people will get a notification at the same time,” said Dr. Landman, who has been a surgeon at Riley for seven years and trauma medical director for the past two. “That’s our signal to stop what we’re doing and immediately come down to a room like this one.”
They will immediately get to work evaluating and treating the patient’s injuries before determining if the child needs surgery and/or admission to the hospital’s intensive care unit once he or she is stabilized.
“It’s a pretty impressive response for each of these patients, and because we do trauma care a lot in this hospital, we’re pretty good at bringing all of those resources to bear 24/7,” Dr. Landman said.
“What’s difficult about all trauma patients is that the injury could be relatively minor, or it could be something where we’re doing maximally invasive surgery, even in a room like this one to try to save a life. And you don’t always know what that’s going to be.”
It takes an enormous infrastructure to support the care of one of these patients, Dr. Showalter added. That includes skilled team members, of course, but also technology and planning.
“And like Matt said, you don’t know ahead of time which patient will need hours of immediate acute care or which one will be ready to go home. So, we’re always ready.”
ANXIETY AND PTSD
As a clinical psychologist who focuses on the behavioral health of children and families, Zach Adams knows that anxiety and some degree of post-traumatic stress is real for the patient, the family and the Riley team.
Often, when patients have more serious injuries that require long-term recovery, including physical therapy and pain management, not only are there physical hurdles, there are daily reminders of what happened, he said.
“It’s a disruption to people’s lives. It can change kids’ sense of safety. How they feel at home or in their neighborhood can dramatically impact their behavior and their relationships,” Adams said.
Roughly a third of kids impacted by trauma continue to have trouble coping even months after an event. Signs include difficulty sleeping, clinginess, anxiety, irritability, stomach aches and regressive behavior.
And it’s not just those kids who are affected. It’s their siblings, their cousins, their friends and classmates.
“Those ripple effects are not reflected in the numbers that get reported out,” Adams said. “These waves (of violence) are really doing a number on how people are able to go about their lives. It’s not just the kids who show up at the hospital. It’s very important to take care of them, but there are hundreds and thousands of other kids affected.”
CARING FOR EACH OTHER
And being exposed to horrific, emotionally draining work day in and day out is tough for team members – those who are directly responsible for care and those who are part of the process that prepares the response.
“Not only are we prepared to take care of the patient and family at the hospital, we are also prepared to support each other,” Adams said.
“This is what we all train to do – take care of anyone that comes through the door, but it’s a hard thing to see sometimes,” Dr. Showalter said. “I have four kids, and some of these kids look a lot like my kids.”
Besides the immediate trauma team that shows up in the emergency department, there is a large team of professionals who will care for the patient if he or she goes to the ICU, and a trauma team will follow that patient, Dr. Landman said.
In addition, inpatient rehab, case managers and mental health professionals will come alongside the patient and family, not only in the acute care setting, but in the long term. Support staff, including environmental services team members, also play a critical role, he said.
“Without them, the whole thing falls apart. It takes an entire team to care for these patients, and I feel very fortunate to be a part of that team.”
YOU CAN HELP
There will always be accidents that put kids in the hospital, but gun violence shouldn’t be among them, Dr. Landman said.
“There are all kinds of reasons why people get shot,” he said, including unsafe storage of a firearm in the home, “but the downstream effects are horrific.”
“There’s a consequence for a bullet going in the wrong place,” Dr. Showalter added. “A whole community is affected. People are struggling to reach their full potential because they’re held back by exposure to violence. People must be aware of these consequences.”
According to healthychildren.org, powered by the American Academy of Pediatrics, roughly a third of U.S. homes with children have guns. An estimated 4.6 million kids live with unlocked, loaded guns every day.
It’s not enough to hide a gun. Firearms should be locked in a safe with the ammunition stored separately.
Rather than feeling helpless, Dr. Landman suggests working together to decrease incidents of gun violence, first by advocating for safe storage of weapons.
“It’s easy for us to sit here and prescribe solutions, but I don’t think anything’s going to happen unless communities rise up and start doing what they feel is important in their community to decrease these kinds of injuries.”
If you’re looking for other ways to help, donate blood, he said.
“Some of these patients require an incredible amount of blood to save their lives. Even a simple act of donating blood really does help us care for not only trauma patients, but all patients who are going to need that type of resource.”
Photos by Mike Dickbernd, IU Health visual journalist, email@example.com