 I'm pleased to introduce Dr. Selwyn Rogers. He earned his medical degree from Harvard Medical School and completed both his surgery residency and an NIH research fellowship in surgical oncology at Brigham and Women's Hospital in Boston. He also completed a surgical critical care fellowship at Mass General and Brigham and Women's and holds a master's degree in public health from Vanderbilt University. After an extensive national search, Dr. Rogers was chosen as the new section chief for the Trauma and Acute Care Surgery Center at the University of Chicago Medical Center. The trauma program just started in May of 2018. Dr. Rogers previously had served as vice president and chief medical officer for the University of Texas Medical Branch at Galveston and the chairman of surgery at the Temple University in Philadelphia and the division chief of trauma burn and critical care at Harvard Medical School. While at Brigham and Women's, he had helped launch the Center for Surgery and Public Health to better understand the nature, quality, and utilization of surgical care nationally and internationally. He's published research that focuses on the impact of race and ethnicity on surgical outcomes. He's committed to reducing disparities in surgical care to close the quality chasm for underserved populations and to provide the most patient-centered care possible. Today, he's going to speak to us about violence and trauma and update for the University of Chicago Medicine Trauma Center. Please join me in welcoming Dr. Rogers. I want to thank Dr. Langehand for starting us off with a bit of a controversial topic about transparency in the operating room. And I think my remarks are not going to be any less controversial. So just for those who don't know, many in the room probably know that there was a long history related to the evolution of trauma care for adults in the South Side of Chicago and the University of Chicago two years ago made a commitment to open an 11-1 trauma center for adults in the South Side and partly in response to community activism, but also partly in response to a pivot towards our community to make that access to adult trauma services a reality. That actually partly was driven by a relative geographic disparity in access to adult trauma services as evidenced by this map in terms of geographic distance for those on the South Side of Chicago. With the advent of the University of Chicago Medicine Adult Trauma Center, we opened in May of this year to address that geographic disparity. And these are the three goals of the trauma center at the University of Chicago to be the needs of patients and families on the South Side of Chicago and beyond, provide compassionate care that extends from prevention to recovery and with our community partners to advance in discovery, education, and advocacy. And I'm just going to show you some very, very quick statistics before I make my remarks. In our first five, now six months of operation, we've seen over 1,500 patients with the primary blunt mechanism of injury being motor vehicle crashes. But I want to focus on this very uncontroversial topic in this day and age, the issue of gun violence. As you can see, the number one reason to come to the University of Chicago Medicine is having been the victim of a gunshot wound. And that's a startling reality that over 25% of our patients are injured or injured by the mechanism of a gunshot. So with that reality, I've often talked about intentional violence as a public health issue. And I look forward to our discussion questions. First, to define violence. Violence is the potential use of physical force of power, threatened or actual against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, gas, psychological harm, maldevelopment, or deprivation. And it would make the argument that the presence of violence makes health or wellness impossible. But violence is complex and intersectional. There's so many different parts. This is a schema from one of my trauma faculty that Gary on. If you look at the focus on the individual event, we often frame it as a rational event. But there are so many interlocking parts looking at the environmental factors, the balance of social structures, social networks, and the relative availability of guns in our society. We often focus on trauma in this middle box with respect to pre-hospital care, the work of Chicago Fire Department, Immersion Medical Services, inpatient care, and post-acute care. But we hardly ever discuss the built environment or lived experiences. Although we do focus a bit on rehabilitation and somewhat on recovery. When we talk about the built environment, that reflects where people live, work, pray, and play every day and the infrastructure of the environment. If you look at the city of Chicago and a host of factors, if you look at housing and elevated blood levels, for example, the west and south sides of Chicago have higher levels than the loop. Similarly, economic hardship index is worse in parts of the south and west sides of Chicago as well as the issue of unemployment in certain communities over others. This also correlates with high school graduation rates. And all of these are social factors that are antecedent to the incident of trauma or violence. With respect to shootings in the city of Chicago, there have been over 2,600 shootings thus far in the city of Chicago. And you can see that they're predominantly on the south and west sides of our city. The symptoms of community trauma are wide and varied. They include equitable opportunity, people, and place. If you look at the issue of equitable opportunity, there's often intergenerational poverty, long-term unemployment, relocation of businesses and jobs, limited employment, and disinvestment over time. With respect to people, we often see disconnected social networks and social relations and elevation of destructive social norms that lead to violence. And also a low sense of political and social efficacy. And then finally, with respect to place, there's often deteriorated environments and unhealthy unsafe environments. So that brings us to the subject of structural violence, which refers to ways that our social arrangements, governments, economies, religions put individuals and populations in harm's way. And with respect to that, if we talk about the issue of intentional gun violence, this is actually the picture that we should look at as a reality of gun violence in America. If we look at over the 36,000 deaths related to firearms in the United States, we overwhelmingly talk about the 2% or so related to mass casualties. The events that happened recently in Pittsburgh or most recently, unfortunately, in California. But over two thirds of gun violence is among people of color in the United States. Gun fatalities by race with respect to homicide, 82% of black Americans are the ones who suffer gun fatalities compared to homicide, compared to suicides. 57% of gun homicide victims are black in the United States with black men being 10 times more likely to be shot and killed than white men, while 93% of gun suicide victims are white. White men are three times more likely to shoot and kill themselves than black men. Similarly, white women are four times more likely to shoot and kill themselves than black women. So very interesting different demographics based on race and ethnicity. Income inequality often drives violent crime rates with counties that have higher income inequality having higher rates of violence. So having said all of that as background in terms of the social and demographic factors, what's the duty of trauma centers, hospitals, health systems with respect to addressing this? We often talk about, again, the traumatic event, but once that happens, what can health systems trauma centers do going forward? With respect to that, Hume Chicago Medicine has also concurrently stood up a violence recovery program that's hospital based and that by definition, what violence recovery programs do is try to address this actorial curve. This is data from the University of Maryland Shocked Trauma Center. I basically looked at people who were victims of violent episode once and only once, which is a top line versus more than once. And obviously there's a survival difference having been injured once and only once versus more than once. The dotted lines is obviously the line that you don't want to be on. And the question is what's the intervenable moment or teachable moment for those who are victims of violence once so that they're not repeat victims? Violence intervention program basically is a multidisciplinary approach to offering support, ongoing and assertive case management and advocacy for victims of violence and at close contacts during the hospitalization and beyond. Those recovery efforts focus on immediate safety, psychiatric and mental and behavioral care and social support. And what we found in our short five months thus far is that the needs are varied. They range from food insecurity for meals, emergency shelter, housing expense, relocation assistance and affordable housing to education issues and economic and employment issues as well as legal assistance. These are obviously not all the areas that health systems traditionally venture in, but one question that we all have to ask ourselves is what's the duty and where does our duty as health providers begin and end in this space? Similarly, the needs for healthcare are varied, including counseling services, crisis prevention and mental health and wellness services as well as a host of other services. And what we're doing now as we are doing our early phases of learning about our patients is trying to find out how we can address these needs through connection with community agencies and other social service entities on the south side of Chicago. And this is one of the challenges that we have. How can we define trauma care beyond does someone live or die after the traumatic event? How can we address undiagnosed and poorly managed co-mobilities, especially post-traumatic stress disorder and other mental and wellness issues in addition to the acute trauma services need for ongoing and close management following discharge and then finally focusing on the recovery of patients physiologically, psychologically, emotionally and socially. And so with that, our focus is not just on providing for a class clinical care, but also addressing some of the issues of equity and access. And this work needs to be facilitated across all our institutions, including education, economic development, social services in partnership with our community. And there's a whole host of factors that lead to that, including housing, legal, community, job training, advocacy, addressing substance abuse and balance interruption. So I look forward to some questions from the audience. I hope I've been somewhat provocative in my initial comments and I haven't taken questions. And I was the one to try to get back up time. Dr. Rogers. Thank you. Thank you. I'm Krista Kirschner, rehab physician and a former McLean fellow. I have two things. One is you touch upon violence and eruption and with your background in public health, I would like to know where University of Chicago and your personal beliefs are regarding the use of violence and eruptors through what used to be called ceasefire. How effective is it? Should we be embracing and expanding that particular model? My second question is really about the housing problems. As a rehab doctor, a lot of my patients who have been victims of gunshot wounds don't want to return to their neighborhoods. Finding affordable accessible housing is a huge problem for people who have now significant disabilities. I'm at the University of Illinois at Chicago in the Sinai system now and UIC has an emergency room program looking at housing for patients and I'm wondering what your thoughts are about formalizing a program to move these people out of the neighborhoods where this occurred. So actually I'll tie both questions together. First is our initial attempts developing a violence interruption program that's somewhat internally based, a low wear in partnership with Cure Violence with respect to some of the communities surrounding the University of Chicago Medicine but a violence recovery specialist that meet patients and their families at the outset and introduction into the trauma center tries to tackle some of these issues in terms of what's the antecedent challenges that led to the violent event in the first place and trying to prevent retaliation so I do believe that there's a role for violence interruption in that space. We've also with our violence recovery specialist begun to see that safe housing or safe and stable transition from the hospital into the back of the community is a challenge for some people and at times we've had to help facilitate relocation of individuals from their communities in which they've lived for years into other places for them to feel safe so safe and affordable housing is a key issue for a number of our victims of trauma. Thank you. Time for one more question. Hi, I'm Neil Fine. I'm a plastic surgeon at Northwestern and Dr. Rogers Selwyn. I happen to have the privilege of knowing Selwyn. Thank you so much for coming. I think the things you do are so great but you brought up gun violence which I think is very interesting and that gun violence in particular is lethal violence. This is life-threatening violence. People who are involved in gun violence are involved in fatal life and death and all these things that are associated with it. I wonder if you've looked at or you consider all these things actually to be a proxy for how people value life. The more you value life, the less likely you are to take life perhaps. Everyone who's shooting these guns is saying I don't value that person's life. You wonder how much they value their own life and then when you bring all these other contextual elements into play, is it really again a proxy for asking or being able to measure or understand how do these people value life? If they value life low, then they take life. If they value life high, then they don't and can we get people to value life more? Is it really a value in life issue? That's fine, Neil. I appreciate that question. I think it's a very important one and one that we actually hope that we can learn from our patients and their loved ones in terms of how we can alter the trajectory of their recovery, but also thinking more broadly about how did we get here in the first place? And certainly it's not gonna change in a simple way but need the resources and novel ways of thinking about transitioning people from the path that they've been on to get injured or be victims of recurrent injury but also potentially perpetrators of violence themselves. Hi, I'm Sevelyn Chen, University of Chicago. As I sit here today, I remember four years ago during this session, the community activists came here demonstrating for our trauma center and it is so wonderful to see that four years later we do have that as a result of the fact that our Dean Polanski and the Board of Trustees listened to the community, listened to the needs of the community and have filled that void that's so necessary here on this outside. And I wanna congratulate you on your work here and not only dealing with the acute injury at the time of the presentation but also the far reaching effects socially, economically, et cetera with the victims and their families. I think it's wonderful what you're doing. It's wonderful what the University of Chicago has done for the community. Thank you for that. Thank you.