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Fracasso JL, Ahmed N. Trauma centers: an underfunded but essential asset to the community. Trauma Surg Acute Care Open 2024; 9:e001436. [PMID: 38974218 PMCID: PMC11227843 DOI: 10.1136/tsaco-2024-001436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/14/2024] [Indexed: 07/09/2024] Open
Abstract
Research indicates that specialized trauma centers, especially those of level I and II designation, can generate revenue if financial support is provided, and most importantly provide better outcomes for an injured patient by reducing length of stay and mortality when compared with treatment at hospitals without trauma center designation. Costs associated with trauma center operation have risen over the past few years in association with growing patient volumes and inflation. Documentation regarding costs for trauma center operations is sparse, and there exists a large variance between reported numbers based on their region. In most cases, the greatest proportion of funds are spent on clinical personnel while the smallest fraction is dedicated to educational and prevention programs. Studies confirm that as a product of these rising costs and a lack of state and federal funding that trauma centers remain uniquely financially vulnerable. Multiple strategies have been implemented to mitigate these costs but have proven insufficient. Legislations providing patients with expanded access to healthcare such as the Affordable Healthcare Act have failed to deliver on their intended purposes, and managed care organizations have moved to protect their own interest at the expense of trauma patient mortality. In lieu of concerted federal support, states and municipalities have explored solutions to support trauma centers such as small fees added to fines or encouraging charitable donations, although these programs have not seen ubiquitous implementation. Most trauma centers have begun incorporating activation costs to recoup losses from their low reimbursement rate, but these have continued to inflate, and pose a growing burden on vulnerable patients. Lack of funding from external sources such as state or federal appropriations poses a tangible threat to trauma centers for closure, and with multiple trauma centers acting as critical pillars of healthcare infrastructure for disadvantaged communities as well as the impact of this lack of funding being so broad and systemic, multiple 'trauma deserts' may emerge, leaving communities-especially disadvantaged communities which rely on the safety-net function of many high designation trauma centers-deprived of an essential treatment resource and increasing annual mortalities that could have otherwise been averted.
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Affiliation(s)
- Joseph L Fracasso
- Surgery, Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Nasim Ahmed
- Surgery, Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Neptune, New Jersey, USA
- Department of Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
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Yoshihara A, Olson MB, Filep EM, Kim D, Eason CM, Casa DJ, Huggins RA. Geographic Disparity in Distance to Trauma Care in Secondary Schools Across the United States. J Athl Train 2024; 59:458-464. [PMID: 37734731 PMCID: PMC11127676 DOI: 10.4085/1062-6050-0149.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
CONTEXT Geographic disparities exist in trauma care (ie, "trauma center desert") within the United States. An athletic trainer (AT) on site at secondary schools (SSs) may help enhance collaboration with emergency medical systems and potentially lead to better outcomes after catastrophic injuries. However, access to AT services relative to the location of level I or II (ie, tertiary) trauma centers remains unknown. OBJECTIVES To visualize and describe the distance between SSs and trauma centers and compare access to AT services across the United States. DESIGN Cross-sectional study. SETTING Public and private SSs with interscholastic athletics programs in the United States. PATIENTS OR OTHER PARTICIPANTS Survey data obtained through the Athletic Training Locations and Services (ATLAS) project database between September 2019 and April 2023. MAIN OUTCOME MEASURE(S) The minimum distance from each SS to a tertiary trauma center was calculated on Tableau Desktop by geocoding with longitude and latitude. The status and level of AT employment were obtained from the ATLAS project database. The odds and percentages of access to AT services were examined by distance ranges. RESULTS A total of 18 244 SSs were included in the analyses. Of these, 75% (n = 13 613) were located within 50 miles (81 km) of a tertiary trauma center. The odds of access to AT services were 2.74 (95% CI = 2.56, 2.93) times greater in SSs situated within 50 miles of a tertiary trauma center (P < .001). Additionally, SSs located more than 60 miles (97 km) from a tertiary trauma center had decreased access to AT services (R2 = 0.9192). CONCLUSION This study highlighted the geographic disparities in distance to trauma care for SSs in the United States. Those SSs located more than 60 miles from trauma centers had reduced odds of access to AT services. Identification of geographic trends of AT services relative to the location of tertiary trauma centers is a critical first step in preventing fatal consequences of catastrophic injuries.
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Affiliation(s)
- Ayami Yoshihara
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs
| | - Marcus B. Olson
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs
| | - Erica M. Filep
- Department of Kinesiology and Military Science, Texas A&M University–Corpus Christi
| | - Donghyeon Kim
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs
| | - Christianne M. Eason
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs
| | - Douglas J. Casa
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs
| | - Robert A. Huggins
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs
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Tatebe LC, Ho VP, Santry HP, Tatebe K. Redefining trauma deserts: novel technique to accurately map prehospital transport time. Trauma Surg Acute Care Open 2023; 8:e001013. [PMID: 36704643 PMCID: PMC9872504 DOI: 10.1136/tsaco-2022-001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/07/2023] [Indexed: 01/25/2023] Open
Abstract
Background Prehospital transport time has been directly related to mortality for hemorrhaging trauma patients. 'Trauma deserts' were previously defined as being outside of a 5-mile radial distance of an urban trauma center. We postulated that the true 'desert' should be based on transport time rather than transport distance. Methods Using the Chicagoland area that was used to describe 'trauma deserts,' a sequential process to query a commercial travel optimization product to map transport times over coordinates that covered the entire urban area at a particular time of day. This produces a heat map representing prehospital transport times. Travel times were then limited to 15 minutes to represent a temporally based map of transport capabilities. This was repeated during high and low traffic times and for centers across the city. Results We demonstrated that the temporally based map for transport to a trauma center in an urban center differs significantly from the radial distance to the trauma center. Primary effects were proximity to highways and the downtown area. Transportation to centers were significantly different when time was considered instead of distance (p<0.001). We were further able to map variations in traffic patterns and thus transport times by time of day. The truly 'closest' trauma center by time changed based on time of day and was not always the closest hospital by distance. Discussion As the crow flies is not how the ambulance drives. This novel technique of dynamically mapping transport times can be used to create accurate trauma deserts in an urban setting with multiple trauma centers. Further, this technique can be used to quantify the potential benefit or detriment of adding or removing firehouses or trauma centers.
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Affiliation(s)
- Leah C Tatebe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vanessa P Ho
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Heena P Santry
- Department of Surgery, Kettering Hospital, Columbus, Ohio, USA
| | - Ken Tatebe
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois, USA
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Disparities Among Trauma Patients and Interventions to Address Equitable Health Outcomes. CURRENT TRAUMA REPORTS 2022. [DOI: 10.1007/s40719-022-00224-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Cavalea AC, Tedesco A, Leonard J, Hunt JP, Schoen J, Smith AA, Greiffenstein P, Marr AB, Stuke LE. Mass shootings in the United States: Results from a five-year demographic analysis. Injury 2022; 53:925-931. [PMID: 35031108 DOI: 10.1016/j.injury.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/08/2021] [Accepted: 01/02/2022] [Indexed: 02/02/2023]
Affiliation(s)
| | | | - Jacob Leonard
- Louisiana State University Health Sciences Center - New Orleans, LA USA.
| | - John P Hunt
- Louisiana State University Health Sciences Center - New Orleans, LA USA; University Medical Center New Orleans - New Orleans, LA USA.
| | - Jonathan Schoen
- Louisiana State University Health Sciences Center - New Orleans, LA USA.
| | - Alison A Smith
- Louisiana State University Health Sciences Center - New Orleans, LA USA.
| | | | - Alan B Marr
- Louisiana State University Health Sciences Center - New Orleans, LA USA.
| | - Lance E Stuke
- Louisiana State University Health Sciences Center - New Orleans, LA USA.
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Sierra-Arévalo M, Nix J, O’Guinn B. A national analysis of trauma care proximity and firearm assault survival among U.S. police. POLICE PRACTICE & RESEARCH : AN INTERNATIONAL JOURNAL 2022; 23:388-396. [PMID: 38239930 PMCID: PMC10795852 DOI: 10.1080/15614263.2022.2036611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/05/2022] [Indexed: 01/22/2024]
Abstract
Past research on factors influencing firearm assault (FA) mortality have not focused on police officers who, compared to other U.S. workers and the general public, experience especially high rates of firearm victimization. This study focuses on this unique population of FA victims and examines the relationship between travel time to the nearest trauma care facility and the probability of survival among officers shot on duty. Combining data on trauma care center location and 7 years of data on U.S. police officers fatally or non-fatally assaulted with a firearm, we use logistic regression to model the probability of FA fatality among police by proximity of the FA to the nearest trauma care facility. We find that travel time to trauma care was not associated with reduced FA mortality among police from 2014 to 2020. FA mortality was significantly lower in 2020 than the six years prior.
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Affiliation(s)
| | - Justin Nix
- School of Criminology and Criminal Justice, Univesity of Nebraska—Omaha, Omaha, NE, USA
| | - Bradley O’Guinn
- School of Criminal Justice, University of Cincinnati, Cincinnati, OH, USA
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Nix J, Shjarback JA. Factors associated with police shooting mortality: A focus on race and a plea for more comprehensive data. PLoS One 2021; 16:e0259024. [PMID: 34758026 PMCID: PMC8580236 DOI: 10.1371/journal.pone.0259024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To quantify nonfatal injurious police shootings of people and examine the factors associated with victim mortality. METHODS We gathered victim-level data on fatal and nonfatal injurious police shootings from four states that have such information publicly available: Florida (2009-14), Colorado (2010-19), Texas (2015-19), and California (2016-19). For each state, we examined bivariate associations between mortality and race/ethnicity, gender, age, weapon, and access to trauma care. We also estimated logistic regression models predicting victim mortality in each state. RESULTS Forty-five percent of these police shooting victims (N = 1,322) did not die. Black-white disparities were more pronounced in nonfatal injurious police shootings than in fatal police shootings. Overall, Black victims were less likely than white victims to die from their wound(s). Younger victims were less likely to die from their wound(s), as well as those who were unarmed. CONCLUSIONS Racial and age disparities in police shootings are likely more pronounced than previous estimates suggest. POLICY IMPLICATIONS Other states should strongly consider compiling data like that which is currently being gathered in California. Absent data on nonfatal injurious police shootings-which account for a large share of deadly force incidents-researchers and analysts must be cautious about comparing and/or ranking jurisdictions in terms of their police-involved fatality rates.
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Affiliation(s)
- Justin Nix
- School of Criminology and Criminal Justice, University of Nebraska Omaha, Omaha, NE, United States of America
| | - John A. Shjarback
- Department of Law and Justice Studies, Rowan University, Glassboro, NJ, United States of America
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Scantling D, Orji W, Hatchimonji J, Kaufman E, Holena D. Firearm Violence, Access to Care, and Gentrification: A Moving Target for American Trauma Systems. Ann Surg 2021; 274:209-217. [PMID: 33605588 DOI: 10.1097/sla.0000000000004771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to determine whether gentrification predicts the movement of shooting victims over time and if this process has decreased access to care. BACKGROUND Trauma centers remain fixed in space, but the populations they serve do not. Nationally, gentrification has displaced disadvantaged communities most at risk for violent injury, potentially decreasing access to care. This process has not been studied, but an increase of only 1 mile from a trauma center increases shooting mortality up to 22%. METHODS We performed a cross-sectional study utilizing Philadelphia Police Department (PPD) and Pennsylvania trauma systems outcome (PTOS) data 2006-2018. Shootings were mapped and grouped into census tracts. They were then cross-mapped with gentrification data and hospital location. PPD and PTOS shooting data were compared to ensure patients requiring trauma care were captured. Census tracts with ≥500 residents with income and median home values in the bottom 40th percentile of the metropolitan area were eligible to gentrify. Tracts were gentrified if residents ≥25 with a bachelor's degree increased and home price increased to the top third in the metropolitan area. Change in distribution of shootings and its relation to gentrification was our primary outcome while proximity of shootings to a trauma center was our secondary outcome. RESULTS Thirty-two percent (123/379) of eligible tracts gentrified and 31,165 shootings were captured in the PPD database. 9090 (29.2%) patients meeting trauma criteria were captured in PTOS with an increasing proportion over time. The proportion of shootings within gentrifying tracts significantly dropped 2006-2018 (40%-35%, P < 0.001) and increased in non-gentrifying tracts (52%-57%, P < 0.001). In evaluation of shooting densities, a predictable redistribution occurred 2006-2018 with incident density decreasing in gentrified areas and increasing in non-gentrified areas. Shootings within 1 mile of a trauma center increased overall, but proportional access decreased in gentrified areas. CONCLUSIONS Shootings in Philadelphia predictably moved out of gentrified areas and concentrated in non-gentrified ones. In this case study of a national crisis, the pattern of change paradoxically resulted in an increased clustering of shootings around trauma centers in non-gentrified areas. Repetition of this work in other cities can guide future resource allocation and be used to improve access to trauma care.
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Affiliation(s)
- Dane Scantling
- The University of Pennsylvania Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania
| | - Whitney Orji
- The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin Hatchimonji
- The University of Pennsylvania Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania
| | - Elinore Kaufman
- The University of Pennsylvania Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania
| | - Daniel Holena
- The University of Pennsylvania Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania
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Farhat A, Grigorian A, Farhat A, Chin TL, Donnelly M, Dolich M, Kuza CM, Lekawa M, Nahmias J. Injury and Mortality Profiles in Level II and III Trauma Centers. Am Surg 2021; 88:58-64. [PMID: 33775161 DOI: 10.1177/0003134820966290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND While the benefit of admission to trauma centers compared to non-trauma centers is well-documented and differences in outcomes between Level-I and Level-II trauma centers are well-studied, data on the differences in outcomes between Level-II trauma centers (L2TCs) and Level-III trauma centers (L3TCs) are scarce. OBJECTIVES We sought to compare mortality risk between patients admitted to L2TCs and L3TCs, hypothesizing no difference in mortality risk for patients treated at L3TCs compared to L2TCs. METHODS A retrospective analysis of the 2016 Trauma Quality Improvement Program (TQIP) database was performed. Patients aged 18+ years were divided into 2 groups, those treated at American College of Surgeons (ACS) verified L2TCs and L3TCs. RESULTS From 74,486 patients included in this study, 74,187 (99.6%) were treated at L2TCs and 299 (.4%) at L3TCs. Both groups had similar median injury severity scores (ISSs) (10 vs 10, P < .001); however, L2TCs had a higher mean ISS (14.6 vs 11.9). There was a higher mortality rate for L2TC patients (6.0% vs 1.7%, P = .002) but no difference in associated risk of mortality between the 2 groups (OR .46, CI .14-1.50, P = .199) after adjusting predictors of mortality. L2TC patients had a longer median length of stay (5.0 vs 3.5 days, P < .001). There was no difference in other outcomes including myocardial infarction (MI) and cerebrovascular accident (CVA) (P > .05). DISCUSSION Patients treated at L2TCs had a longer LOS compared to L3TCs. However, after controlling for covariates, there was no difference in associated mortality risk between L2TC and L3TC patients.
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Affiliation(s)
- Ali Farhat
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine, CA, USA
| | - Ahmed Farhat
- Department of Surgery, University of California, Irvine, CA, USA
| | - Theresa L Chin
- Department of Surgery, University of California, Irvine, CA, USA
| | - Megan Donnelly
- Department of Surgery, University of California, Irvine, CA, USA
| | - Matthew Dolich
- Department of Surgery, University of California, Irvine, CA, USA
| | - Catherine M Kuza
- Department of Anesthesiology, 5116University of Southern California, Los Angeles, CA, USA
| | - Michael Lekawa
- Department of Surgery, University of California, Irvine, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine, CA, USA
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Dalve K, Gause E, Mills B, Floyd AS, Rivara FP, Rowhani-Rahbar A. Neighborhood disadvantage and firearm injury: does shooting location matter? Inj Epidemiol 2021; 8:10. [PMID: 33678193 PMCID: PMC7938602 DOI: 10.1186/s40621-021-00304-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Firearm violence is a public health problem that disparately impacts areas of economic and social deprivation. Despite a growing literature on neighborhood characteristics and injury, few studies have examined the association between neighborhood disadvantage and fatal and nonfatal firearm assault using data on injury location. We conducted an ecological Bayesian spatial analysis examining neighborhood disadvantage as a social determinant of firearm injury in Seattle, Washington. Methods Neighborhood disadvantage was measured using the National Neighborhood Data Archive disadvantage index. The index includes proportion of female-headed households with children, proportion of households with public assistance income, proportion of people with income below poverty in the past 12 months, and proportion of the civilian labor force aged 16 and older that are unemployed at the census tract level. Firearm injury counts included individuals with a documented assault-related gunshot wound identified from medical records and supplemented with the Gun Violence Archive between March 20, 2016 and December 31, 2018. Available addresses were geocoded to identify their point locations and then aggregated to the census tract level. Besag-York-Mollie (BYM2) Bayesian Poisson models were fit to the data to estimate the association between the index of neighborhood disadvantage and firearm injury count with a population offset within each census tract. Results Neighborhood disadvantage was significantly associated with the count of firearm injury in both non-spatial and spatial models. For two census tracts that differed by 1 decile of neighborhood disadvantage, the number of firearm injuries was higher by 21.0% (95% credible interval: 10.5, 32.8%) in the group with higher neighborhood disadvantage. After accounting for spatial structure, there was still considerable residual spatial dependence with 53.3% (95% credible interval: 17.0, 87.3%) of the model variance being spatial. Additionally, we observed census tracts with higher disadvantage and lower count of firearm injury in communities with proximity to employment opportunities and targeted redevelopment, suggesting other contextual protective factors. Conclusions Even after adjusting for socioeconomic factors, firearm injury research should investigate spatial clustering as independence cannot be able to be assumed. Future research should continue to examine potential contextual and environmental neighborhood determinants that could impact firearm injuries in urban communities.
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Affiliation(s)
- Kimberly Dalve
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA. .,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA.
| | - Emma Gause
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA
| | - Brianna Mills
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA
| | - Anthony S Floyd
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Box 354805, Seattle, WA, 98105-4631, USA
| | - Frederick P Rivara
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351619, Seattle, WA, 98195-7230, USA.,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA
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Shjarback JA, White MD, Bishopp SA. Can police shootings be reduced by requiring officers to document when they point firearms at citizens? Inj Prev 2021; 27:508-513. [PMID: 33397795 DOI: 10.1136/injuryprev-2020-043932] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/21/2020] [Accepted: 11/27/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the impact of a novel firearm 'pointing' policy that requires officers to document when they directly point their guns at citizens. METHODS Sixteen years (2003-2018) of narrative officer-involved shooting (OIS) reports from the Dallas Police Department were qualitatively coded to explore both the total frequency and specific characteristics of OIS before and after the policy change in 2013. RESULTS χ2 tests found that the firearm pointing policy was associated with a reduction in the proportion of 'threat perception failure' shootings (ie, those where an officer mistakes an item for a gun). Auto Regressive Integrated Moving Average analysis found that the policy change was associated with a gradual, permanent reduction in total OIS; however, that impact was not immediate. CONCLUSIONS Firearm pointing policies have the potential to alter organisational behaviour, particularly in highly discretionary shootings. It is unclear whether the specific mechanisms for the changes include more accountability through constrained discretion, reduced options to handle situations once officers' guns are drawn and pointed, or an effect on officers' timing and vision during ambiguous scenarios. POLICY IMPLICATIONS Although organisational change may be a long and complex process, reductions in OIS can prevent serious injuries and death. The policy change did not lead to an increase in the proportion of officers injured during OIS incidents.
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Affiliation(s)
- John A Shjarback
- Department of Law and Justice Studies, Rowan University, Glassboro, New Jersey, USA
| | - Michael D White
- School of Criminology and Criminal Justice, Arizona State University, Phoenix, Arizona, USA
| | - Stephen A Bishopp
- Dallas Police Department, University of Texas School of Public Health - Houston (Dallas campus), Dallas, Texas, USA
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Sierra-Arévalo M, Nix J. Gun victimization in the line of duty: Fatal and nonfatal firearm assaults on police officers in the United States, 2014-2019. CRIMINOLOGY & PUBLIC POLICY 2020; 19:1041-1066. [PMID: 38549863 PMCID: PMC10978003 DOI: 10.1111/1745-9133.12507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/14/2020] [Indexed: 04/01/2024]
Abstract
Research Summary Using open-source data from the Gun Violence Archive (GVA), we analyze national- and state-level trends in fatal and nonfatal firearm assaults of U.S. police officers from 2014 to 2019 (N = 1,467). Results show that (a) most firearm assaults are nonfatal, (b) there is no compelling evidence that the national rate of firearm assault on police has substantially increased during the last 6 years, and (c) there is substantial state-level variation in rates of firearm assault on police officers. Policy Implications GVA has decided strengths relative to existing data sources on police victimization and danger in policing. We consider the promises and pitfalls of this and other open-source data sets in policing research and recommend that recent state-level improvements in use-of-force data collection be replicated and expanded to include data on violence against police.
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Nix J. On the challenges associated with the study of police use of deadly force in the United States: A response to Schwartz & Jahn. PLoS One 2020; 15:e0236158. [PMID: 32722714 PMCID: PMC7386827 DOI: 10.1371/journal.pone.0236158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
In response to Gabriel Schwartz and Jaquelyn Jahn's descriptive study, "Mapping fatal police violence across U.S. metropolitan areas: Overall rates and racial/ethnic inequalities, 2013-2017," I provide three reflections. First, the framing of this issue is vitally important. Second, police-involved fatalities represent a nonrandom sample of all incidents involving police use of deadly force (i.e., physical force that causes or is likely to cause death), and unfortunately, we lack comprehensive data on use of deadly force that does not result in fatalities. Finally, to make sense of who is killed by the police, researchers must also identify who was exposed to the risk of being killed by the police.
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Affiliation(s)
- Justin Nix
- School of Criminology and Criminal Justice, University of Nebraska Omaha, Omaha, Nebraska, United States of America
- * E-mail:
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Abstract
Firearm violence is a leading public health issue that contributes to significant health inequalities within communities. Relatively little is known about the community-level social processes that occur at the street segment level and contributed to the community variation of firearm violence. This study examines the spatial patterns of firearm shooting events on street segments and the associated community-level social processes at both the street segment and neighborhood level. Multilevel mixed-effects Poisson regression was used to assess the relationship between measures of social disorder, physical disorder, and collective efficacy at the street segment-level and neighborhood-level measures of social disorganization theory. The results demonstrate that firearm shooting events occur on a small number of street segments across the city. Street segments with higher levels of social and physical disorder, along with lower levels of collective efficacy, are expected to have higher rates of firearm shooting events when accounting for neighborhood-level measures. Overall, the findings indicate specific street segments are experiencing higher rates of firearm shooting events and that these events are influenced by social processes. Prevention efforts should be focused on street segments experiencing higher rates of shootings.
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Affiliation(s)
- Lauren A Magee
- Indiana University-Purdue University Indianapolis School of Public and Environmental Affairs, Indianapolis, IN, USA.
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