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Abstract
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Emergency departments (EDs) play a critical role in the public health infrastructure of the United States. Annually, emergency physicians treat 130 million patients and have the highest daily volumes in the health care system.1 Unlike physicians in other specialties, emergency physicians do not get to choose their patient pathology and instead must be able to deal quickly and equitably with all types of patients and pathologies that present to their EDs. This charge is a badge of pride for most in emergency medicine, but it can be difficult, particularly when one lacks an understanding of the community and sociocultural circumstances of the patients being served.
The incongruence between this aforementioned charge and physician training is one factor that can contribute to health disparities.2, 3 Since the National Academy of Medicine’s landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,4 much has been done to try to improve cultural competency, confront implicit bias, and address many of the structural and social determinants that drive these health disparities.5, 6 Despite these efforts, much work still needs to be done, particularly with respect to violent injury, an issue commonly encountered by emergency physicians practicing in urban centers.7, 8, 9
Violence continues to be a leading cause of death for minority youths aged between 15 and 34 years.9 Although often viewed as a criminal justice issue, emphasis is increasingly being placed on applying more public-health-centered frameworks.10 These frameworks focus on root causes of violence and on mobilizing multimodal strategies, which involve stakeholders from multiple societal sectors to address violence.11, 12, 13 Such root causes include, but are not limited to, substance use, trauma, poverty, and poor mental health.14, 15, 16, 17 Although some of these risk factors, such as substance use, are easy for emergency physicians to identify, and it is easy for them to connect individuals to care, others—such as chronic trauma exposure—are much more insidious and rarely addressed or even considered in the evaluation of the injured patient.
Although people generally associate trauma with physical injury, the concept of trauma is complex and can include physical, structural, or psychological stressors that adversely affect people. Individuals living in urban areas are often subjected to serial personal, community-wide, and historical traumas.18 These experiences include factors such as witnessing or being a victim of violent assaults or shootings, neighborhood blight, real and perceived racism, police brutality, and historically oppressive policies such as red lining, which continue to disenfranchise people today. One measurement of trauma widely accepted in the literature is the Adverse Childhood Experience score, a measure of childhood adversity in several different family-level domains, which ...
Language: en |