Adam Interviews local trauma doctor about gun violence

Adam Interviews

Rochester, N.Y. (WROC) — As director of the Kessler Trauma Center Dr. Mark Gestring has a firsthand view of the surge of gun violence in our area.

The FBI recently awarded Gestring the FBI Director’s Community Leadership Award for his work to prevent shooting.

He sat down with Adam Chodak to talk about those programs and his experience during this violent past year.

Adam Chodak: When we talk about being director of the trauma center, what does that mean?

Dr. Mark Gestring: As the director I’m responsible for kind of the general organization, general day-to-day activities for the trauma center so working with the nurses and physicians and other providers to make sure we can do what we do 24 hours a day and every is up to speed on policies and procedures and what’s compatible with what’s accepted around the country. We’re a verified trauma center and there’s a lot of administrative work involved in that, you have to re-up if you will so that all falls to me.

AC: So if there’s a shooting in our area nd the patient is coming to Strong Memorial Hospital what happens with you?

MG: I represent a team so whether it’s me or a member of my team, there’s 8 of us who do this work 24-7, we’ll usually get some advance notice that somebody is coming and we’ll report down to the emergency room where there’s a team in place to receive the patient, whatever the emergency is. In the event of a shooting and it looks like that patient is going to need an operating room, it’s part of our designation as a trauma center, we have to be able to do all of those things at once. You have to be able to do a resuscitation in the emergency room, but we also have to be able to follow up surgery if it’s needed 24-7 so having that infrastructure in place is really important. So we would to respond to your question directly we would see the patient when they first arrived, make an assessment, see what the issue is and then deal with it. If we have to surgically deal with it we have the capability to deal with it right away.

AC: So you see the impact of gun violence up close…

MG: Every day. Every day. It’s what we do, so it’s a big part of what we do. The University of Rochester covers a very large area so we gun violence predominantly from the city, but then we see trauma from 17 counties so it could be agricultural, motor vehicle, motorcycle, industrial any of those kinds of things, but gun violence takes its toll.

AC: How so?

MG: I’ve been in this community for 20 years and I think it’s worse now than I think it’s ever been as far as what I see. When I moved into this community the homicide rates were 60 a year or something like that, it came down precipitously over the next decade or so and now things are really creeping back up and I think we’re at 25, 26 something like that and we’re only in the beginning of June. We have a ways to go before we’re done with the year and people can easily look at mortality, people who died, but you don’t see the toll of 2 or 3 people being shot every night which is a lot of what I consider to be pretty senseless injuries because these things didn’t have to happen.

AC: And I’ve often thought about that. These folks who don’t know die are probably going to have live with that pain or repercussions of that for the rest of their life, I would think.

MG: That’s definitely true. If you’re lucky enough to be shot through something that doesn’t matter then you’re healed and a couple months later you’re back to normal, but many times spinal chord injury, you end up needing a colostomy, you might need a couple surgeries. So you’re not dead and I think that’s a testament to modern medicine and EMS care and all of those kinds of things, but at the same time you’re going to remember that this happened and it’s going to affect your life, it’s going to affect your family, it’s going to affect your ability to work, it’s going to affect pretty much all aspects of your life going forward and we focus on homicide rates, but we don’t pay attention to what happens to the shootings and when we looked at it the numbers for shootings were way above what the homicide rates are.

AC: This impacted you as well. It prompted you to try to address the larger problem, how did you go about doing that?

MG: The thing that I’ve been involved with for the longest is called the Rochester Youth Violence Partnership and that was something that was developed by three of us at the university so the three of us started to realize independently we’re taking care of a lot of young people who are coming back to the hospital over and over and over again so there were two specific kids if you will, young people, that triggered our program. The was a 13- or 14-year-old kid who was shot in the butt and he came into the trauma center shot in the butt and he was absolutely furious, not that he was shot but the fact that the bullet proof vest that he had didn’t cover the area where he was shot so we started to think, why is this kid getting up every morning and putting on a bullet-proof vest, there’s something wrong with that.

So that was the first kid. Then there was a second kid who was shot while he was 16 in the leg or something like that. We treated, released him. He was shot while he was 17, came back a second time, this time shot in the arm or something like that. Now he’s 17 or 18 shot in the head and he’s dead. And it caused us to wonder, was there something we could have done differently. Could we have done something to change this path. Out of that this program grew and there’s multiple people involved, it’s not just me, but the idea is to identify kids, young people, at the time it was focused on under 18, identify kids who are at risk and see if we can do something to help what the situation is. So many times their parents didn’t know where they were.

You get shot at 2 or 3 in the morning, you’re a 13-year-old kid, why are you out at that hour? And does somebody know that and how do we prevent that sort of thing? You might not be doing something wrong, but you just might be in a place where you’re at risk of increased exposure. All of those things. Sometimes there’s psycho-social needs, somethings they’re financial needs, sometimes they’re safety type things, but it turns out Rochester is a pretty resource rich community and what we did is put this group together led by the hospital but still with multiple partners to say look at each individual episode if you will and ask why is this happening. This is happening because the kids are involved in a retaliation situation so maybe we have to offer the opportunity to move this kid somewhere else and working with the school district and the police department and a number of social agencies around town we were able to really do that.

It’s hard to say your efforts resulted in a shooting not happening but we can say for a period of time we weren’t seeing these kids coming back so we knew that was a positive sign. On a family level, you could see the positive influence you’d have on this particular kid and his family and to kind of make the point that these things don’t happen by accident, most people go their entire lives without getting shot, here you are 14, 15, 16 and you’ve been shot several times, that’s not really normal so what can we do to make that not happen anymore and I think from the hospital point of view, like I said, we’ve been doing that for over 15 years and I think that’s been very productive.

That’s the first thing we do. What we’ve done recently now is through the program Pathways to Peace which is part of the City of Rochester, through their help we were able to expand it now so we now look at people 25, 26, 27 years old. The only difference is the older you get you have a little bit more ability to say no thank you I don’t want to participate. But we have the program in place and we offer it and we try to encourage people. Sometimes the patient doesn’t want to do it but the family steers them toward it whether it’s a wife or a girlfriend or mother or aunt or something like that. Once they realize these programs are available we work hard to make people see that this is a preventable problem and give them tools to try and prevent it in the future.

So that’s what that’s about. On the opposite end of the equation we’re trying to work with responsible gun ownership. That’s kind of a new program we’re developing once again with community support and that’s aimed at a different problem and it deals with somebody who has a legally registered handgun and how are they safeguarding that weapon. We have a right to own weapons, but we have a responsibility to safeguard those weapons and it’s a significant problem in our area, guns are stolen, they’re stolen from cars, they’re stolen from houses, they’re not properly secured and that’s a failure so if you have a legally registered handgun and it gets stolen, that’s on you if you didn’t have it locked up so how can we educate people about that responsibility.

And, at the same time, it’s maybe a little bit more complicated to talk about, but you have a legally registered handgun in your house how do you protect it from people in your house who maybe shouldn’t have access to it so you might have a child, you might have somebody who has alcohol problems or drug problems or psychiatric problems and that’s an individual equation, everybody should make sure they’re aware and know what to do with that weapon and how to properly safeguard it, giving people options on how to get rid of their weapons if they don’t want them anymore.

A common problem is someone will die, a registered gun owner will die, the gun is in the house, the family doesn’t know how to get rid of it so if you want to keep it, this is how you make it legal, if you want to get rid of it, these are all the options for properly turning in that handgun, selling the handgun, moving the gun along so we’re kind of looking at that problem from several different areas. So one of the things I do on the side is I’m part of the Project Exile community board and one of the things that’s become clear from my participation in Exile is handguns that are stolen end up as crime guns so in our area the number one source of crime guns is stolen guns.

You think your car gets burglarized, you gun gets stolen in the suburbs and you think it’s a nuisance, well it’s not nuisance because that gun is now in circulation and that gun circles back to what we were talking about before and could very well be responsible for some of the shootings that we’re seeing so I think coming at this problem from both sides is the way to go.

AC: Is it disheartening to see this increase in violence with this level of investment?

MG: Well, of course, but I can tell you nationally it’s been a strange, strange couple of years so with COVID, people being inside, the economic impact of COVID, the job losses associated, the business closures and all the craziness associated with that it’s not just a Rochester problem. I mean, penetrating injury, violence, assaults have been significantly elevated in cities around the country. I think part of this is related to the pandemic and I also think New York State laws have changed a little bit and I think we’re seeing flux in terms of how criminal justice should work, pretty much as the system should work.

I’m personally seeing more people who are on parole who either turning up as offenders or as victims, probably shouldn’t be happening and I think somebody needs to look at that. I think that’s an artificial effect that we’re seeing. It’s clear, we haven’t even started the summer, we’re just starting June and our numbers of shooting and homicides is significantly higher and you think the first three months the average temperature is 30 degrees, right? So it’s only just getting warm. I think there’s a lot of factors, but certainly it all ends on our doorstep.

There’s no question, it all ends on our doorstep because as the trauma center the ambulances are bringing these patients to us, the patients are showing up on their own to us and as much as we can impact what’s happening, it’s way more than just the hospitals, there’s a lot of stuff happening but it does end with us.

AC: You end up talking with a lot of the patients. What kind of things do you hear from them?

MG: That completely varied, but when you’re talking about the violence most of it didn’t need to happen. In retrospect, people look back and say this didn’t really need to happen. We have some, I’m sure every community some people who are hardened criminals and they’re going to do this as part of their day-to-day activity, but that’s the minority of cases that we see.

The majority of this is you’re out at the wrong time and wrong place and the bullets start flying and the bullet might not have been intended for you and you got shot and people realize I shouldn’t have been there, I shouldn’t have been with those people, I shouldn’t have been engaged in that opportunity. So many times we can get people to see that, this doesn’t have to happen again, you have to be careful it doesn’t happen again. For the most part we see people who are happy that things have ended well.

We see families who are happy things have ended well and we very much try to deliver the message that this didn’t really need to happen and we’re very happy that you’re doing well but now what can we do to prevent this from happening again. But sometimes it’s just a crime victim, it wasn’t their fault to begin with.

You guys have recently coverage people just sitting in their house, shot through the wall, people sitting in a church, they didn’t do anything to deserve that so that’s a sign of the escalating violence and the brazenness of people in the middle of the day would fire a weapon at a church for instance, that’s not OK. And I think from a public safety aspect politics aside, that’s not OK. And I think we would very much like to see that kind of stuff stop.

AC: Earlier in the conversation you said it takes a toll. How do you manage the stress and the emotional impact that can come with this job?

MG: I told you I work with a very talented group surgeons and we’re all lifers in this field, this is what we do so I think most of us have coping mechanisms to deal with that. I think the bigger aspect that we pay attention to is the learners, those who are in medical school or a surgical residency program and part of doctor training, surgeon training is spend time with us.

Those are the folks we have a little bit more careful because they’re on the front lines with us in these situations when these things happen and we definitely do debriefs afterwards, there’s well types of programs at place in the hospital. We also do that with our staff where there’s a significant event there’s always a critical incident debrief similar to what EMS would do and we would bring the multi-disciplinary teams, respiratory therapist, nurses, techs, those kind of folks, we get them all together and kind of talk about what happened, how it went and how people feel about it. I tell you, it’s a pretty professional group and we see an awful lot of this kind of stuff so it’s not like we’re having debriefings every single day but there’s big events that happen in the community.

We have cars that jump up on sidewalks and kill innocent families, those are the kinds of things that hit home because we tell people don’t walk in the street, don’t ride your bike without a helmet, those kinds of things, but here, you have families that minding their own business and get run over by an errant vehicle, those are the kinds of things that everybody immediately starts thinking this could have happened to us, this could have happened to my family, this could have happened in my neighborhood, those kinds of things, but you’re right, it’s stressful work, we do our best to makes sure people have the support that they need, the help that they need and they’re not doing this every night so we have a big enough team where we’re not rotating people round because I think burnout is certainly a concern.

AC: Anything that you’d like to add that I might have missed?

MG: Stop the Bleed is basically a program that’s focused on the concept that the most preventable cause of death after injury is bleeding and just like CPR and the Heimlich maneuver a bystander has a critical role to do something before EMS gets there and all of these programs are focused on what do you do to keep a patient alive before EMS gets there. We’re not making doctors or surgeons, we empowering people to take action before help gets there and in the case of Stop the Bleed it’s focused on bleeding control so being able to apply direct pressure to something that’s bleeding, being able to pack a wound if you need to or being able to use a tourniquet if you have access to it.

So we teach people, the trauma center is actively engaged, we’re one of the leading centers in New York State teaching this, but it’s being taught around the country, close to 2 million people now have been trained, not just by us, but around the country in how to do this. There’s multiple success stories related to this but essentially you know something that developed out of the multiple casualty scenario really morphed into something that’s much more applicable to society.

If you’re kid falls and gets cut on a rusty spike or you’re in a motorcycle or hunting accident or industrial accident, those kinds of things, having the knowledge and feeling empowered to do something, even in the short team saves lives and then the other component of this which we’re working very hard on now is trying to get bleeding control equipment into the public space just like defibrillators, no different.

You learn CPR, CPR is great. CPR with a defibrillator much better. You look around a public place there’s generally an AED hanging somewhere so we’ve done a lot to co-locate bleeding control equipment with those defibrillators so people know where to go. The stuff is cheap, it lasts for a long time. There’s really no harm in having it there. We teach people how to work tourniquets, but acknowledge what’s the point in teaching them how to work a tourniquet if they don’t have a tourniquet, if they don’t have access to it.

So we spend a lot of time with different groups. So we go with hunting groups, motorcycle groups. I mean, if you’re going hunting there’s really no reason you can’t have a $25 tourniquet in your bag and God forbid gun goes off and you shoot your foot off and you’re in the woods you can help yourself out a lot before somebody is able to come and provide first aid. There’s really no reason you shouldn’t have one of those things. And we make people aware of that and many people after they’ve played with it for a little while they realize it’s pretty straightforward and common sense and very simple.

So the other thing I can tell you, we’ve worked extensively with law enforcement and we’ve recently, end of May was national Stop the Bleed Day, and we went to the Rochester Police Department as one example and we recognized 10 or 15 officers who that year had saved a citizen with one of these bleeding control techniques. I remember one case where a woman was shot in the neck and the first police officer who arrived, blood was flowing out of this woman’s neck, she had a carotid artery injury and if you wait, that’s not going to go well and this officer kept pressure on that would and it kept that lady alive until she got to the hospital and that’s a perfect example and we had multiple more that involve tourniquets.

Police officers carry tourniquets, partially to take care of themselves, God forbid they need it, but they’re also first on the scene for many of these situations and we recognize those positive interactions, first officer on the scene saved a life and we’ve done that with the Rochester Police Department, we’ve spent a lot of time with the state police doing that, they’re in rural areas by themselves for a long time, multiple miles between humans in some of those areas, so they’re many times first on the scene.

We’ve worked with EMS, we’ve worked with rural police departments teaching those skills. They’re very simple, we can train them under an hour, it’s usually a half hour. The training is free and we do it all the time. I would refer people stopthebleed.org if they’re interested in learning more and the University of Rochester would be happy to provide that kind of training for anybody so whether it’s a school group or community group or specific group like a hunting group or something like that.

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