1. Bystander Intervention to Reduce Mortality in Gun-related Trauma
Georgia Wiard, MS, Larry Maturin, MSN, APN
DePaul University
1. Crandall, M., Sharp, D., Unger, E., Straus, D., Brasel, K., Hsia, R., & Esposito, T. (2013). Trauma deserts: Distance from a trauma center, transport times, and mortality from gunshot wounds in Chicago. American Journal of Public Health, 103(6), doi: /AJPH
2. Bakke, H. K., Steinvik, T., Eidissen, S. -., Gilbert, M., & Wisborg, T. (2015). Bystander first aid in trauma - prevalence and quality: A prospective observational study. Acta Anaesthesiologica Scandinavica, 59(9), doi: /aas.12561
3. Oliver, G. J., Walter, D. P., & Redmond, A. D. (2017). Prehospital deaths from trauma: Are injuries survivable and do bystanders help? Injury, 48(5), doi: /j.injury
BACKGROUND
RESULTS
NURSING IMPLICATIONS
Gun violence in urban areas is not evenly distributed and usually the burden falls onto socioeconomically distressed neighborhoods.
Effects of bystander intervention
Overall beneficial and associated with a decreased in morbidity and mortality.
Efficacy of an intervention is increased when the bystander has first aid training.2
Wounds to an extremity and resulting hemorrhage are a major cause of death in gun-related violence, yet may be controlled via pre-hospital and pre-EMS intervention.
Factors influencing intervention
Rates of bystander intervention range from 11% to 81%3
Bystander calculus- weighing the potential cost of helping (risk, time, injury, infection) and the potential cost of not helping (negative emotions and negative outcomes for the victim).
Factors increasing intervention:
Prior training
Sense of responsibility to help
Feeling of competence to provide care
Type of injury
Factors decreasing intervention:
Fear of infection, injury, or being sued
Nurses provide direct care to gunshot victims, their families, and the communities affected by gun violence.
Nurses are in a position to advocate for increased public awareness regarding the need for basic hemorrhage control classes, directly teach these courses, and begin them at their place of work.
Nursing organizations can effectively advocate for stricter gun control laws and an increase in research the health implication of gun violence.
Sustaining a gun shot wound on the Southeast side of Chicago in a “trauma desert” results in an increase in mortality.1
There has been a recent call for hemorrhage control to become the trauma equivalent of CPR training.
Multiple studies state that aggressive prehospital intervention will decrease mortality and that bystanders are in a position to provide lifesaving measures.
DISCUSSION
Completing a hemorrhage control class will empower a bystander to intervene and alter the bystander calculus towards intervention.
Free hemorrhage control classes are offered nation wide and two organizations in Chicago are offering free classes targeted at communities with higher rates of gun violence.
Increasing awareness of these classes and the need for hemorrhage control is needed and nurses can take the lead in continuing the conversation.
The Health Belief Model adapted to gun-related trauma and the preventative action of a hemorrhage control class
RESEARCH QUESTIONS
Would bystander first aid decrease mortality in instance of gun-related trauma?
Does the availably of first aid training influence a bystander’s decision to act?
How could first aid courses be marketed for increased community access?
Perceived susceptibility of encountering gun related trauma
Perceived seriousness of gun related trauma
Perceived threat of morbidity and mortality from gun related trauma
Demographic Variables
Age, sex, race, ethnicity, etc
Sociopsychological variables
Personality, social class, peer and reference group pressure
Structural variables
Knowledge about and prior contact with gun related trauma
Cues to action
Mass media campaign
Information on classes in hospitals, community centers, WIC clinics
Religious leaders
County jail intake
Perceived benefits of taking a hemorrhage control class
minus
Perceived barriers to taking a class
Likelihood of taking a hemorrhage control class and then intervening in gun related trauma
trauma
RESEARCH METHOD .
An integrative literature review was used to explore the outcomes associated with bystander, the availability of first aid courses, and how this could be utilized by a community.
The databases Academic Search Complete and Cumulative Index to Nursing and Health Literature (CINHAL) were searched and inclusion and exclusion criteria was applied.
Key words: bystander, trauma, trauma care, gunshot, Chicago.
REFERENCES
Please see attached document