Some were simply sleeping in bed or playing in the neighborhood when the bullets began to fly. But projectiles fired in drive-by shootings don’t discriminate; and sadly, children end up being the smallest and youngest victims of gun violence in the United States.
Most people learn of the tragedies through the news, but surgeons working in trauma units see the carnage up close.
“I’ve had to operate on children with gunshot wounds to every abdominal organ you can imagine, and what I can’t impress upon people enough is just how devastating those injuries can be,” said Chad Thorson, a pediatric surgeon at the University of Miami Miller School of Medicine. “Having to tell a parent that their child didn’t survive is something you never forget. Obviously, as physicians, we have to go home and take care of our own families. But those injuries stick with us, and we don’t ever forget the face and the reaction of a parent to that news,” added Thorson, a father of three.
He didn’t need the horrific mass shootings in Buffalo, New York, and Uvalde, Texas, to remind him that gun violence is a public health crisis.
In 2020, the most recent year for which complete data is available, 45,222 firearm-related deaths occurred in the U.S., according to the Centers for Disease Control and Prevention. That figure includes firearm murders and gun suicides as well as gun-related deaths that were unintentional, involved law enforcement, or had circumstances that could not be determined.
What’s more, in 2020, firearm-related injuries became the leading cause of death among children and adolescents 1 to 19 years of age, overtaking motor vehicle crashes, CDC data shows.
“That’s something none of us should be living with,” Thorson said. “We treated automobile deaths like a public health epidemic in the ’70s by getting car seats and seat belts and enacting other protective measures to make vehicles safer. We should be treating this epidemic the same.”
Outreach and education programs are one way to help curb the epidemic of gun violence, states Marilyn “Mimi” Sutherland, a former nurse at Jackson Memorial Hospital’s Ryder Trauma Center. In 1998, she started a diversionary program for juvenile weapons offenders called GATE, which is not an acronym. It symbolizes “closing the gate on your past and opening a new gate to the future,’’ the nurse said.
As part of the program, teenagers visited the Ryder Trauma Center, the Miami-Dade County Medical Examiner’s Department, a funeral home, and a nursing care facility, getting a firsthand look at the consequences of gun violence.
At the county morgue, they filled out their own toe tags. “You get to rip it up at your GATE graduation,” Sutherland, who was also a neurological nurse coordinator at the Miller School of Medicine, would tell them. “You don’t want to be famous for filling out your own toe tag.”
Though she is no longer involved with GATE, the program is still in existence today.
“If you don’t make an impression on the kid, you’re not going to change anything,” said the now-retired Sutherland. “You can’t make them change. They must want to change. You have to invest in these kids,” she explained.
When Sutherland came to Miami in 1975 from Canada to work at Jackson Memorial, she was alarmed to see the increasing number of victims who arrived at the emergency room with serious gunshot wounds. A disproportionate number of those victims, she said, were young people. “[They had] traumas to the brain and spinal cord, which were often very devastating,” Sutherland recalled. “And the victims kept getting younger and younger and younger. I didn’t want to see 13-, 14- and 15-year-old kids die.”
And that’s why she created GATE, collaborating with Miami-Dade State Attorney and University of Miami alumna Katherine Fernandez Rundle to get the program off the ground and running.
Sutherland estimates that as many as 800 children participated in the program during the time she operated it, turning around their lives and helping them to become productive citizens. Some of those teens returned as adults to speak to other children in the program.
GATE, Sutherland pointed out, can serve as a model for other diversionary programs around the nation.
“And we’ve proved it works,” said Enrique Ginzburg, a professor of surgery at the Miller School of Medicine, who has participated in the program.
In a 2020 study, Ginzburg, Sutherland, and others followed a cohort of 215 teenagers who were enrolled in a six-month cycle of GATE, showing that the recidivism rate for any criminal charge was 20.1 percent for those who completed the program and 32.9 percent for those who did not.
For Ginzburg, who is the trauma medical director and chief of surgery at Ryder Trauma Center at Jackson South Medical Center, treating child and teenage gunshot victims compelled him to reach out to Sutherland seven years ago to volunteer for the program.
“I wanted to help sensitize those kids to the impact guns can have on people,” Ginzburg said. “As trauma surgeons, we deal with it daily. Gunshot wounds are among the most horrific injuries we see. And without a doubt, the cases that really affect us all are the innocent victims—the children who not only get shot in drive-by shootings but are killed or maimed so severely that they’re never the same. Those are the hardest to deal with emotionally.”
Thorson is also doing his part to help put an end to gun violence. In a 2021 study, he and a group of other researchers examined demographic, clinical, and injury information on pediatric gunshot wound cases that came into the Ryder Trauma Center from September 2013 to January 2019. In the 393 cases they identified, 92 percent were violence-related and 4 percent accidental, with 63 percent of the total number occurring outside school hours. The mortality rate was 12 percent, double the national rate, Thorson noted.
The research team also identified zip code hot spots of gun violence in neighborhoods in Miami-Dade County.
“Based on what we’ve found and knowing where these injuries are happening, we’ve increased our outreach in the community,” Thorson said. “We’re going to schools, we’re going to neighborhoods, talking about how to prevent these injuries and how to keep children safe.”
He noted the Stop the Bleed national awareness campaign that encourages bystanders to become trained, equipped, and empowered to help in a bleeding emergency before medical help arrives.
Trauma surgeon Anjali Sarver and her colleagues in the emergency room sometimes lean on each other to deal with the emotional strain that comes with treating the “really bad gunshot wound cases,” she said.
When Sarver, who graduated from the Miller School’s M.D./M.P.H. dual-degree program two years ago, arrived in Chicago to begin a residency in emergency medicine at the University of Chicago Medical Center, the city’s high rate of gun violence continued to rise even amid COVID-19 shutdowns.
She recently completed a monthlong rotation in the surgical intensive care unit, treating many patients who were young males recovering from gunshot wounds. Sarver, who observed some of the GATE sessions when she was a Miller School student and was a co-author on Sutherland and Ginzburg’s study, said some of the victims never recover.
“Hearing the cries of mothers who have lost children to gun violence is terribly sad,” she lamented, “and something I’ll never be able to forget.”
