UT Health San Antonio is an integral partner in the trauma network of San Antonio and South Texas – a national model that involves the military, the Level 1 Trauma Center at University Hospital, trauma faculty of the Joe R. and Teresa Lozano Long School of Medicine, regional hospitals and many other collaborators. Because Long School of Medicine trauma surgeons are leaders within this unique trauma network, known as the Southwest Texas Regional Advisory Council (STRAC), the perspectives of its trauma faculty are sought at the local, state and national levels. Guided by distinguished military experience, UT Health San Antonio trauma surgeons were instrumental in the development of a novel whole blood trauma response effort that saved lives at Uvalde. STRAC, with the contributions of faculty in multiple departments and schools of UT Health San Antonio, brings coordination and efforts during disaster responses that save lives.
Ronald Stewart, MD, FACS, professor and chairman of the Department of Surgery in the Joe R. and Teresa Lozano Long School of Medicine, discussed the national crisis of firearm violence at an American College of Surgeons (ACS) briefing June 2 in Washington. Dr. Stewart, who treated victims of the Uvalde school shootings, advocated for firearm injury and death prevention and spoke in support of recommendations of the ACS Firearm Strategy Team (FAST) and Improving Social Determinants to Attenuate Violence (ISAVE) workgroups. A transcript of Dr. Stewart’s remarks follows.
ACS press conference, June 2, 2022, Washington
Good morning. I’m Ronny Stewart. Sadly, I’m here today as a trauma surgeon who has cared for two of the largest mass shootings in modern U.S. history: Sutherland Springs First Baptist Church and the Uvalde school shootings. The injuries inflicted by high-velocity weapons used at both attacks are horrific. A high-capacity, magazine-fed, semiautomatic rifle such as the AR-15 causes extremely destructive tissue wounds. These wounds are horribly lethal at close range, and, sadly, most victims do not survive long enough to make it to a trauma center.
Our team at University Health received four patients from the Uvalde shooting, and all of our current patients are improving, which really brings us joy in this dark time. But all of them have a long road to recovery from both the physical and emotional impact of their injuries. And unfortunately, this moment of crisis will have a lifetime of impact on these innocent souls. Our teams are working together to facilitate healing in a way that minimizes long-term impact and effect.
Model trauma system
I’m very proud and honored to work with the American College of Surgeons, and the ACS has worked tirelessly to establish regional, organized trauma systems of care that make a real-life difference in our patients and in our communities all across the U.S. In many ways, South Texas has a model trauma system; it is modeled on the ACS system, and this system worked extremely well both in Sutherland Springs and Uvalde to coordinate and communicate the situation from the scene and improve the care of those patients.
Using our trauma system, we were able to get whole blood directly to the scene in Uvalde, which appears to have made a real difference in at least one of our patients. As an action item from the Sutherland Springs mass shooting, we increased Stop the Bleed education and training, and advocated for state Stop the Bleed educational training. We partnered with Rep. Barbara Gervin- Hawkins on Texas House Bill 496, which implemented that training and equipment in Texas schools.
So, having a great trauma care system, implementing the ACS Stop the Bleed educational program, and regional whole blood are all critically important programs that do make a real difference in our patients’ lives, but they are not enough. Those are all mainly treatment things, and treatment is not enough. We have to effectively prevent these tragedies. They are preventable.
A key facet of the ACS trauma system approach is working together to serve the best interests of our patients and our communities. A trauma system encourages and enhances — it hard wires — cooperation and communication, because cooperation and communication save lives. And it hard wires cooperation and communication and partnerships even among competitors, which is necessary.
And the ACS approach centers around a common narrative with respect to firearm injury prevention that really facilitates working together. It is an inclusive narrative that goes something like this: Firearm ownership is a constitutionally protected liberty, and we also, though, have an epidemic of violence and firearm-related injury, death and disability in the United States. 2020 was the year that firearm-related injury became the No. 1 cause of death of U.S. children and adolescents. I’m not talking the No. 1 trauma-related cause. The No. 1 cause of death of U.S. children and adolescents was firearm-related injury in 2020. And the deaths are just the tip of the iceberg.
So, what can we do? Well, using the common narrative, we can address this epidemic of violence by continuing to work together to do two things: One, work to understand and address the root causes of violence while simultaneously working together to make firearm ownership as safe as reasonably possible for those who own a firearm and those who do not.
We can address these atrocities by working together. The American College of Surgeons Committee on Trauma has proven that people who hold very different views on firearms can and will harmoniously work together, hand in hand, to develop programs and strategies that reduce unnecessary death and suffering of our patients, our families and our communities. We have proven that it is possible to do that.
‘We can save lives’
So, our FAST [Firearm Strategy Team] and ISAVE [Improving Social Determinants to Attenuate Violence] workgroup recommendations provide a pathway to do just that, and it is our fervent hope that legislation that incorporates our FAST and ISAVE groups can pass at the federal and state levels. We can save lives. We know we can do it, and we must act. If we increase cooperation and communication, work together and talk together, I know we can find a way forward. The public wants and expects us to do that. The medical community has the expertise in caring for the patients, and we know that if we bring a health and medical approach to this, to the legislative table, we can really make a difference. Thank you very much.