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April 28, 2011

EMS advances help lower Dayton murder rate

By Doug Page Staff
Dayton Daily News

DAYTON — The homicide rate in Dayton has dropped by almost 50 percent since the 1970s.

One of the reasons: more of those shot, stabbed or beaten survive because of advances in medical technology and trauma care.

"It would be fair to say gunshot wound victims, if they suffered the same injury 25 years earlier, their chances of survival would be much less," Dayton police Maj. Pat Welsh said. "It's a credit to the advances in medical technology and procedures, particularly 'The Valley.'"

"The Valley" is the common police reference to Miami Valley Hospital, the region's sole Level I Trauma Center, providing the highest level of surgical care to trauma patients for 17 counties in Ohio and Indiana.

National studies seem to back up the veteran cop's take on the city's homicide rate.

"(T)he principal explanation of the downward trend ... involves parallel developments in medical technology and medical support services that have suppressed the homicide rate compared to what it would be had such progress not been made," according to the findings of "Murder and Medicine," a 2002 study led by University of Massachusetts Amherst sociologist Anthony R. Harris.

In 1973, the city had 105 homicides or 4.3 per 10,000 population. In 2000, there were 2.4 per 10,000. Since 2000, the rate has remained almost constant, reaching 2.47 per 10,000 last year.

By comparison, the city still has the highest murder rate of the six major cities in Ohio: Akron 0.97, Cincinnati 1.65, Cleveland 1.84, Columbus 0.96 and Toledo 1.13, a 2009 Dayton Daily News analysis shows.

The Valley
If you get shot and it's serious you are going to The Valley.

The hospital has six trauma surgeons and is adding a seventh.

In critical situations, a gunshot wound can be taken directly from the medic unit to the surgery theater, bypassing the emergency room, said Dr. Peter Ekah, one of the trauma surgeons.

He said there has been a dramatic change in trauma treatment over the past three decades. "We have learned a lot in our recent conflicts - Iraq, Afghanistan - especially in the area of gunshot wounds," he said.

Which is a good thing because that is much of what Ekah and his colleagues see, particularly from handguns. Gunshot wounds to the head, the majority self-inflicted, often do not have a good outcome.

"The next most severe are to the chest or abdomen," he said. "It's open season there with so many organs and major blood vessels."

Gunshot wounds from rifles - military or sporting - also are troubling because of the high velocity of the round.

"Typically, there is a lot of injury in the soft tissue. And there's a lot of multiple injuries to internal organs. Typically, a lot of blast effect. Typically, devastating," Ekah said.

Blast effect is the transfer of the high-velocity round's energy through the body, causing injuries far from the wound site, he explained.

Mindful of gunshot wounds, the hospital and Wright-Patterson Air Force Base have an agreement where one of the Air Force surgeons spends extended periods in the hospital's emergency room. Ekah said the Air Force surgeons keep their hand in trauma care and can share with the staff surgeons their experiences with combat wounds.

The medic
Getting a trauma victim from the crime scene to the ER as soon as possible is critical.

"They really stress to us how important it is to reduce our on-scene time and get the patient to surgery," said fire Lt. Chris Kinzeler, an EMS supervisor.

"We do what we have to to get the patient stabilized. We're lucky we're only five minutes away from any of the city's hospital," he said.

The biggest change Kinzeler has seen is in the research-driven protocols for EMTs and paramedics. "The studies bring the newest information to the forefront. Sometimes it's a new drug or a new dosage."

The latest techniques save lives.

"You see somebody shot in the head and you say to yourself, 'They're not going to make it.' Six months later, you may see that person on the street," he said.

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