Project RISE

Mass Disaster Treatment Methods Being Adjusted For Gunshot Wound Survivors

Identifying GSW Patients At Risk Of Developing
 Long-Term Trauma Symptoms Begins ASAP


THURSDAY, NOVEMBER 21, 2019

9/11... Katrina...Those two mass disasters—the terrorist attack that brought down the World Trade Center's twin towers, the storm that devasted New Orleans—left thousands dead and the survivors traumatized. 

Today, psychologists and other doctors are treating gunshot wound victims for PTSD using what Dr. Joah Williams calls “adapted versions of these disaster-response protocols for providing responsive support.”

we understand the need for more immediate intervention to treat people beyond the gunshot wound, its

Dr. Williams is leading up a new initiative Truman Medical Center (TMC) has implemented—and COMBAT is funding—to begin accessing the psychological well-being of gunshot wound (GSW) patients, once they are physically stablized. Through Project RISE, TMC begins applying “psychological first aid” as soon as possible, with an initial screening for Post Trauma Stress symptoms.

“Identifying these patients will start right in the Emergency Department,” emphasized Rosemary Friend, Performance Improvement Coordinator For TMC Trauma Services, when she and Dr. Williams testified before the COMBAT Commission in July. “Whether a patient is admitted or treated and released, they will receive some sort of intervention and information for ongoing trauma treatment.”

TMC was, Friend said, working to remove any barriers patients might have to receiving ongoing care: from eliminating financial charges for the treatment, to providing transportation for outpatient services or offering a “tele-health” communication option. She stressed, “Some people just plain don’t want to leave their homes after this type of trauma.”

At-Risk Signs

Wanting to shut out the world—find a safe place and just stay there—is not an uncommon reaction after suffering trauma. “After a shooting, we expect there to be significant trauma symptoms,” Dr. Williams said. “These symptoms will resolve in most people over time, but for some folks those symptoms don’t go away.

“What we look for are just the intensity of the emotional response in the immediate aftermath,” he continued. “Some people feel really helpless or horrified or have some other strong emotional reaction. That can be a big risk factor for more long-term problems. We also look for any sign of cognitive impairments like difficulty remembering what happened or trouble paying attention to other things going on around you.”

Avoidance (actively avoiding situations, people and places that might remind the victim what happened to them) and isolation (not wanting to leave their homes) are also significant warning signs.

“There may be some places you want to avoid going back to after being wounded,” Dr. Williams said. “When we are working with people, we want them to avoid those places where they might be harmed again. But we don't want them to avoid the things and places that are ultimately going to be helpful to their recovery in the long run.

“We want to help you get back out there, have new experiences that show you people can be trusted—that it is OK to go out and do things again, without always worrying about being attacked again.”

PTSD Symptoms

Collecting Data & Expanding

Project RISE will collect data on the GSW patients Truman Medical sees and attempt to track what happens to them long-term. Dr. Williams and Jackson County Prosecutor Jean Peters Baker hope the program will expand beyond TMC to other medical facilities in the metropolitan area that have Level 1 Trauma Centers.

“We need to have a better sense of what is happening to our shooting victims long-term” Peters Baker said. “How can we intervene to make a difference, so we do not have victims being revictimized?”

Dr. Williams finds the findings of a Washington State study, which concluded GSW survivors are at significant risk of being shot—again—and killed within five years, “incredibly sobering.”

“Even in the absence of us having that kind of data gathered about victims in Kansas City and Jackson County,” he said, “we understand the need for more immediate intervention to treat people beyond the gunshot wound, itself. We only have a small sample size, so far, but six weeks into Project RISE, at least 80% of people we’ve identified as needing it have opted to get the Level 2 or 3 care.

“That’s really encouraging. The people most distressed, screening as high risk, are receptive to getting the care they need.”


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    Trauma surgeons can describe in graphic detail the bloody horror bullets inflict when they pierce the skin and violate the body. But for individuals fortunate enough to survive a gunshot wound (GSW), recovering physically might be only half the struggle. “To not address the psychological trauma done to survivors puts them at grave risk,” stresses Jackson County Prosecutor Jean Peters Baker. Project RISE, a COMBAT-funded program at Truman Medical Center/University Health, focuses on helping GSW survivors make a full recovery. Since Project RISE was introduced in September of 2019, nearly 300 survivors of gun violence have been screened for Post-Trauma Stress Disorder and received Psychological First Aid.
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    During the Civil War, amputations were routinely performed to “treat” arm and leg wounds. In both World Wars doctors observed the psychological toll combat wounds had on “shell-shocked” soldiers. Then Vietnam veterans—and women displaying similar symptoms after suffering domestic violence or sexual assault—pushed for more research to be done. In 1980 Post Traumatic Stress Disorder was finally recognized as an official diagnosis. Early intervention to treat PTSD is being widely viewed as the latest progression in the overall treatment of gunshot wound survivors, whether they sustained their wounds in a war zone or a crime committed in our community. 
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