On a happy day in February 2014, 13-year-old DeAndre Knox was attending a birthday party at a friend’s house in Indianapolis.
At the hospital, he was bleeding so much internally that “the left side of his skull had to be removed to prevent his brain from erupting,” recalls his mother, Deandra Dycus. “A few months later, he had surgery to replace part of his skull and put a tube in his head to drain the fluid in his skull.”
DeAndre was alive, but eight years later he was unable to walk or speak. His ongoing struggles include multiple hospitalizations and surgeries, physical and psychotherapy, and bouts of pneumonia resulting from progressive lung damage.
“Life will never be the same again,” said Dycus, who was recently treated for a particularly devastating pneumonia after visiting her son at a hospital near her home. The total cost of treatment is said to be in the millions. The mental toll is immeasurable.
DeAndre is one of more than 80,000 people who survive firearm-related injuries each year. 2020 report Led by researchers at the University of Pennsylvania Perelman School of Medicine (PSOM).
“Most of what we hear about the spread of gun violence in this country centers around death. Relatively little attention is being paid to survivors of gun injuries. ‘ said Zirui Song, MD, PhD, an associate professor of health policy and medicine at Harvard Medical School who studies the costs of gun injuries. “People who didn’t die have the implication that they’re generally okay. We tend to forget about them.”
Many are not okay. While some are treated quickly in the emergency department (ED), possibly stitching up flesh wounds, others face significant, costly, and sometimes painful medical procedures that last months, years, or a lifetime. to face Some have to deal with organ damage, limb disability or removal, chronic pain, or trauma forever.
“Injuries and long-term morbidity affect patients, their families, and society,” says Chad Krause, DO, DrPH, FACEP, emergency physician and researcher at Geisinger Health System in Pennsylvania. say. Care after a mass shooting.
cost calculation
Obtaining and analyzing detailed data on gun injuries in the United States is particularly difficult. First of all, there is no government database of firearms incidents nationwide. plane crash and all deadly car accidentFor nearly 25 years, no Congressional appropriations bill provided dedicated federal funding for gun injury research until 2019. some new projects limited in scope.
In addition, it is difficult to fully track individual patient costs. This is difficult to track not only within the hospital system, but also among different providers outside the hospital, especially primary care physicians, specialists, home care adjuncts, and therapists.
“We are operating in a data-limited zone,” says Thomas Weiser, MD, MPH, a trauma surgeon and clinical associate professor of surgery at Stanford Health Surgery in California.
Existing data indicate that while self-harm is the leading cause of firearm deaths in the United States, most gun injuries (fatal and non-fatal combined) are caused by: I’m here. assault and accidentResearchers have used a variety of records, including insurance payouts and emergency department databases, to delve deeper into the economic impact of these injuries. Among their findings:
High initial cost. Immediately after a shooting, most victims are treated only for their ED, according to the U.S. Office of General Accounting Accountability (GAO). About 50,000 people a year. In addition, he has 30,000 hospitalized for inpatient care.
According to one agency, ED treatment for firearm-related injuries averages $1,500 per patient, and initial care for patients admitted as inpatients averages $31,000, totaling $1 billion in primary care costs annually. 2021 GAO Report“This may be a significant underestimate,” as some costs not tracked in patient discharge data were not included in the calculation, the report said.
One study that specifically looked at over 704,000 people who arrived in the ED with firearm-related injuries found much higher costs. the study A study by Johns Hopkins Medicine in Maryland, covering the period 2006-2014, found that emergency care costs per patient were $5,254 and inpatient costs $95,887 annually, totaling $2.8 billion annually. Become.
Costs continue to increase after initial care. a Survivor Care Research A study published in June, conducted by Song and fellow researchers at Harvard Medical School and Massachusetts General Hospital, found that medical costs for gunshot victims increased by an average of $30,000 in the first year after injury. understood. This is four times the concurrent medical costs of the control group. A group of patients without firearm injuries. With about 85,000 firearm injury survivors each year, the study found that he would have $2.5 billion in extra spending for survivors in his first year.
Coping with ongoing physical and psychological distress creates ongoing expenses. According to the study, one year after gunshot wounds, survivors (compared to controls) had “a 40% increase in pain diagnoses, a 51% increase in psychiatric disorders, and an 85% increase in substance use disorders. …more pain and more psychiatric medications.”
The pain extends to family members. Dycus says she and one of her sons regularly receive mental health care related to DeAndre’s condition. “When your loved one survives, you’re on a rollercoaster of emotions,” she says. It will be removed.”
Readmissions are another significant cost. GAO reports that up to 16% of initially hospitalized survivors were readmitted at least once for their injuries, with average costs ranging from $8,000 for him to $11,000 for him.
The type of firearm and the intent of the shooter affect the severity of injuries. a study A study led by the University of Iowa School of Public Health found that the highest average admission cost was “legal intervention,” primarily police shootings ($33,462 per admission) and assault weapon shootings ($32,237). , the lowest cost was for accidental injury ($16,975).
Injuries from mass shootings are particularly serious and costly. Mass shootings account for a small percentage of gun-related injuries, but medical costs for these injuries average $64,976 per person. Investigation It was published in May by Kraus and other researchers at ED and trauma services nationwide. In this study, over seven years he examined his 403 patients from 13 incidents. This included all injuries such as fall injuries while escaping gunshots and use of health care after initial treatment.
There are other costs besides medical expenses. Medical cost estimates do not reveal the full cost of gun injuries, as costs are also borne by other agencies involved in the case, including police, the justice system, social services, and employers. “Firearm injuries cause cost ripples outside the health care system,” says Corinne, lead author of the Iowa study on firearm types and shooter intent, and now vice president of the University of California. says Peek-Asa, MPH, PhD. San Diego (UCSD).
Investigation A report released in July by Everytown for Gun Safety found that gun violence is associated with long-term medical care, criminal justice system resources, lost wages, reduced worker productivity, and reduced quality of life for victims. , is estimated to have an annual “economic impact” of $557 billion. and their families.
Implications for providers and policy makers
Medical expenses for gunshot survivors are spread among people and facilities, and some costs are not paid.
Investigation A 2019 study of six years of patient data published by Stanford Health researchers (including Weiser) found that the government pays nearly half of all hospital costs. Of the $5.47 billion he spent during the study period, Medicaid and Medicare paid him $2.5 billion, while private insurance and out-of-pocket patients accounted for $1.1 billion each.
Dycus said one of the “I’ll Never Forget” charges was a statement from her insurance company showing $75,000, charged by the company that flew DeAndre from the rehabilitation center to the hospital to treat a medical emergency. said to be in the book.
What if the patient is uninsured? In the first Johns Hopkins Medicine study that looked at ED and hospital care, researchers noted that more than half of the 704,000 patients studied were uninsured or self-paying. Hospitals had to bear the cost as uncompensated treatment.
Researchers studying the economic impact of gun injuries hope their findings will help spur the development of strategies and policies to reduce injuries and provide better care.
The findings provide “evidence that supports the business case for reducing gun violence,” said UCSD’s Peek-Asa.
“Your tax dollars, my tax dollars, are going to pay for these patient injuries,” said Weiser, with most of the costs being borne by the federal and state governments that jointly fund Medicaid. I am paying attention to what is being done. “States have a vested interest in understanding the financial implications of firearms policy.”
The researchers stress that their call to reduce gun injuries is not a call to ban guns. In fact, Peek-Asa and Kraus are gun owners.
“I live in rural Pennsylvania, where gun ownership is common, including among doctors,” Krause says. “I see the implications of this research in terms of harm and risk reduction.”
Reducing the risk of gun injuries can include policies that define the manufacture, marketing and storage of weapons, the training of gun owners, and who has access to the weapons that cause the most severe and costly injuries. Researchers say it has potential.
As for providers, the researchers hope that knowing the types of physical and mental health care that firearm injury survivors and their families need will help hospitals and doctors better prepare and coordinate that care. I hope to become
“That could mean putting resources into programs for survivors and families of survivors to avoid the downstream effects of non-lethal firearm injuries,” Song says. “By better aligning primary care and mental health care, for example, physical scars aren’t the only thing that matters when caring for gun injury survivors. It could mean better coordination with experts.”
September issue of jam There is an article of opinion that focuses on firearm injuries and calls for a national data system to track injuries and deaths. Increase efforts in academic medical centers to address gun violence. For the health of our employees and the financial health of our businesses, we want businesses to get more involved in reducing gun violence. more.
Knowing firsthand the impact of gun violence, Dycus became an activist to help victims and educate the public.she is a volunteer mom demands actionfounded and directed Purpose 4 My paina resource hub to help families affected by gun violence, creates and leads advocacy and support programs at the Indianapolis Metropolitan Police Department for survivors of nonfatal shootings and violence. .
Her main message to society is: Don’t forget them just because they were alive. ”
