Recently, I was asked if the YWCA was a place where women go to exercise without sweaty men. A few hours after, Hillary Clinton received the democratic nomination, the first woman in the history of America to do so. Women still have a long way to go, not just in employment or politics, but in our communities and our lives.
As hatred and violence towards others spread around the world, I am reminded of the patients we strive to care for and protect. In surgery, we see a multitude of trauma, including domestic violence every day. But what are we doing to prevent its recurrence?
I am reminded of a young woman I met as a Level 1 trauma. Upon arrival in our ED, she saw us all donned in our blue protective gear. Despite a very large stab wound to her upper abdomen she was alert and stable. As I was taking her to the operating room I asked, “What happened?” Ignorant of the statistics at the time, I was shocked when she told me, “My boyfriend stabbed me with a box cutter.” This 16-year old healthy girl, barely able to drive, was lucky to be alive with large lung, diaphragm, and liver injuries secondary to intimate partner violence.
One in 3 women will be affected by domestic violence in their lifetime.1 Intimate partner violence, a form of domestic violence, is known to be an underappreciated cause of morbidity and mortality among female trauma patients.2 When medical records of homicide victims are examined, 44% of women murdered by an intimate partner had visited an ED within the previous 2 years and 93% had sought medical care at least once for their injuries.3 More than 12 million adults experience intimate partner violence annually and more than 10 million children younger than 18 years experience some form of maltreatment from a caregiver.4 These are people we know and care for.
Each day, a breadth of trauma enters our EDs and trauma units. There is a multitude of research and processes built around how to prevent its recurrence in our patients. Children with concern for non-accidental trauma are referred to the Department of Children’s Services. Individuals with motor vehicle or bicycle injuries associated with the lack of seatbelt or helmet use are taught prior to discharge on the importance of seatbelt or helmet use. Gun violence and firearm safety are priorities in our discharge teaching to those affected. All patients routinely receive universal alcohol and drug screening and intervention strategies, as research has shown it significantly decreases trauma recidivism. For domestic violence, however, there are less standard screening initiatives and poorly defined pathways for counseling. Studies have shown that specific interventions still may not be enough, with up to 3 in 4 cases of domestic violence cases being missed by providers.2 As a surgery resident who likely witnesses and treats patients suffering from domestic violence on the trauma service every day, I have very little knowledge or formal training on how to screen and identify cases of domestic violence. We are all grateful for our social workers who are the resource for clinicians and patients in these circumstances; however, if we cannot appropriately screen and refer our patients to get help, they will likely return with more significant injuries, or even death.
I encourage all to become more active in domestic violence prevention within your own communities, simply by being aware for our patients. What can we do as providers? Keep it in the back of our minds and prevent it from being considered a taboo subject. Some groups have advocated universal screening of all trauma patients for domestic violence and safety at home, as almost half of individuals who disclose domestic violence arrive with seemingly non-violent injuries such as motor vehicle crashes or falls. While this may not be immediately attainable at all institutions, certainly if we suspect one of our patients may be at risk and don’t feel comfortable having the discussion, it is our responsibility to ask a colleague or social worker for advice and expertise. We must remember that 1/3 of the women we know, including patients, family, or friends, will one day be affected by domestic violence, and our intervention could be life-saving.
The YWCA is a nonprofit organization dedicated to eliminating racism, empowering women, and promoting peace, justice, freedom, and dignity for all. Nope – it’s not the YMCA for girls. And I am grateful to the organization for opening my eyes to the need for increased focus in this area of trauma prevention.
CDC. National Intimate Partner and Sexual Violence Survey. http://www.cdc.gov/violenceprevention/pdf/nisvs_report2010-a.pdf. Accessed Jul 18, 2016
Sims C, Sabra D, Bergey MR, Grill E, Sarani B, Pascual J, et al. Detecting intimate partner violence: more than trauma team education is needed. Journal of the American College of Surgeons. 2011;212(5):867-872
Wadman MC, Muelleman RL. Domestic violence homicides: ED use before victimization. The American journal of emergency medicine. 1999;17(7):689-691
Sumner SA, Mercy JA, Dahlberg LL, Hillis SD, Klevens J, Houry D. Violence in the United States: Status, Challenges, and Opportunities. Jama. 2015;314(5):478-488