Inside Eastern Wisconsin's Only Adult Level I Trauma Center

Marc de Moya, MD, trauma surgeon, and Terri deRoon-Cassini, MS, PhD, trauma psychologist, provide a unique look inside the Trauma Center at Froedtert Hospital in this two-part series from Wisconsin Public Radio.

Froedtert Hospital doctors are often first point of contact for gunshot victims

Froedtert Hospital one of few in nation to screen trauma patients for PTSD

The adult Level I Trauma Center at Froedtert Hospital is launching Milwaukee’s first hospital-based violence interruption program, which will provide medical support for 414LIFE — a City of Milwaukee Health Department Office of Violence Prevention initative. The Trauma Center, along with experts from the Emergency Department and Froedtert Hospital, will lead efforts for other health systems to develop hospital-based violence interruption programs, creating a network of medical support. 

414LIFE focuses on reducing the burden that gun violence places on individuals and families in Milwaukee County by treating gun violence as a disease. A key element to the success of the 414LIFE program is engaging community members as “violence interrupters” in neighborhoods across Milwaukee County and in the hospital setting.

The first objective of the Froedtert & MCW hospital-based violence interruption program is to save lives by taking steps to interrupt the cycle of violence. Interventions that start in the hospital setting have the potential to change behavior patterns such as using gun violence to settle disputes. The hospital-based effort is also designed to reduce pressures on the health care system that arise from repeated trauma care due to firearm violence: Gunshot injury survivors ages 15-35 are at a 20 to 40 percent increased risk of suffering repeat firearm injuries compared to their same-aged peers who have not been shot. Twenty percent of people who die from gun violence were treated for a gunshot injury within the five years prior to their death.

Combining public health, Trauma Center, Emergency Department and community efforts in a coordinated partnership can lead to safer, healthier communities. This critical partnership provides immediate violence intervention, help addressing issues that contribute to negative actions (such as post-traumatic stress disorder, mental health, substance abuse), and appropriate follow-up health care.

Our hospital is one of just 20 U.S. medical centers participating in similar violence prevention programs. Our Trauma team treats about 3,500 trauma patients each year, 450 of whom receive care for gun-related injuries. The majority of gunshot survivors we treat are in the high-incidence demographic of 15 to 35-year-old men.

The City of Milwaukee’s 414LIFE Initiative

The City of Milwaukee Health Department Office of Violence Prevention’s 414LIFE uses a disease control/public health approach to reducing violence. Modeled after Chicago’s Cure Violence initiative, it treats violence as a disease that is transmitted to others who are exposed to it and uses effective techniques to halt its progression. United Garden Homes, Inc., in collaboration with Milwaukee’s 414LIFE initiative, carefully selects credible outreach workers from the community and trains them to engage in prevention-based outreach, targeted intervention and conflict mediation in neighborhoods and in the hospital setting.

Reducing Violence by Treating it as a Disease

Disease outbreaks and violence patterns have parallels, and methods that work to control diseases (such as water-born cryptosporidium, HIV/AIDS and cholera) are also effective in interrupting violence and keeping it from spreading. 

A public health approach to violence focuses on identifying individuals, families and communities most affected by violence and reducing the severity of modifiable root causes. This approach has resulted in significant success across the country:

  • Since late 2018 in Milwaukee, the 414LIFE program’s violence interrupters have completed more than 25 violent incident mediations in the community, including at two schools. 
  • In Chicago, the Cure Violence initiative has resulted in a 41 percent reduction in gunshot wounds and a 73 percent reduction in homicides
  • In Baltimore, Maryland, the city’s violence interrupter program (in partnership with the R. Adams Cowley Shock Trauma Center) has seen a 56 percent reduction in gun-related homicides.  

Cure Violence Strategies

Learn more about the Cure Violence initiative’s successful, evidence-based violence reduction strategies and listen to a TED Talk. Visit cureviolence.org.

How the Hospital-Based Violence Interruption Program Works

Our Trauma team focuses violence interruption efforts on 15 to 35-year-old patients who have sustained gunshot injuries. Patients who can benefit from interventions are connected with appropriate resources, which may include community resources as well as resources from Froedtert Hospital, to help patients recover and avoid future violent events.

Depending on the patient, the care team may also call in 414LIFE violence interrupters to begin immediate intervention. Starting at the patient’s bedside, these violence interrupters use conflict resolution tactics, mentoring and consistent follow-up to help shift patients, their families and friends toward positive ways of thinking about and coping with conflict.

The 414LIFE violence interrupters are residents of Milwaukee communities that experience a high incidence of gun violence. They know their neighbors, understand day-to-day routines in their neighborhoods and have experiences similar to those of their neighbors. Having an insider’s perspective, they can be the most effective in mediating volatile situations.

414LIFE violence interrupters undergo more than 50 hours of training in communication and conflict resolution, as well as prevention of human trafficking and domestic violence. They also participate in a 16-hour Froedtert Hospital orientation module to familiarize them with Trauma Center, Emergency Department and hospital processes and policies so they are set up for success in the hospital setting.

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