Doctors Recommend PTSD Screening for Civilians

Medical association to release new guidelines recommending PTSD screening in trauma centers

Post-traumatic stress disorder is often associated with troops coming back from Iraq and Afghanistan, but victims of violent crime are often developing PTSD at rates comparable to veterans of war, the Investigative Unit has learned. 

Trauma patients may not be getting the help they need, however, and that may be costing entire communities in healthcare and public safety. A growing body of research shows that people who are shot, stabbed and beaten with untreated symptoms of PTSD can be more likely to carry weapons, have a harder time holding onto their jobs and end up back in the hospital. 

NBC Bay Area News, in connection with the nonprofit journalism organization ProPublica, found that trauma centers in the Bay Area and around the nation can be doing more to address the disorder that disproportionally affects victims of neighborhood violence. 

“Somewhere between 10 percent and 40 percent of those crime victims suffer high PTSD symptom levels in the days and weeks after their trauma,” Dr. Douglas Zatzick said. 

Zatzick is an attending psychiatrist at Harborview Medical Center, a level one trauma center in Seattle. His research indicates that more than 25 percent of trauma patients still exhibit signs of PTSD and depression up to a year after an emergency room visit. He also found that the odds of not returning to work jump from 40 to 60 percent in violently injured patients who do not receive treatment for post-traumatic stress.

Like many doctors who work in the nation’s trauma centers, Zatzick sees patients living in civilian combat zones. 

“It’s sort of the intersection between public health and gun violence,” Zatzick said. “Our studies all say don’t throw away the underclass. We can help these folks.”

The Oakland organization Youth Alive! found that hospital-based violence intervention programs do, indeed work. For two decades the group’s “Caught in the Crossfire” program has served 1,200 victims of violence at Highland Hospital and Children’s Hospital and Research Center—both in in Oakland—and Eden Medical Center in Castro Valley. In a study undertaken by the organization in 2000, Youth Alive! found that people who received intervention were 70 percent less likely to be arrested and 60 percent less likely to engage in violent crime. 

“There are hundreds of thousands of people, mostly young men, who have undiagnosed symptoms of trauma. They are not sleeping well, they’re depressed and disconnected from love ones,” said Youth Alive! director Anne Marks. “The understanding and sympathy we have shown to soldiers who have come back from war we have to show to the young people who don’t come back from the battlefield.”

Jean Eason and his daughter.

Oakland resident Jean Eason is recovering from a traumatic injury he sustained more than two years ago when a bullet passed through his right leg. Eason, 23, was hanging out in a friend’s car near the intersection of Golf Links Road and 82nd Avenue in Oakland New Year’s Eve morning in 2011. 

“Next thing I know I just started hearing shots,” he said. “I am hanging there with my foot caught and I saw the blood splatter. I laid down on the street; paramedics came and I ended up in the hospital.”

Eason says that when he was released from Highland Hospital, almost immediately he was hit with a wave of depression.  He felt isolated and lost, and was plagued by nightmares. 

“The dreams kept going and I kept hearing gunshots go off,” Eason said. 

Soon after the shooting he got a call from an intervention specialist from Caught in the Crossfire, who drove him to medical appointments, took him out to eat and to baseball games and connected him with a therapist, whom he still sees today. 

“I don't hear the gunshots anymore but I still have the nightmares," Eason said. "I just try to find a goal every day and do something for it and stay out of trouble."

But systematic treatment of PTSD is lacking in many places and even non-existent in some emergency rooms. ProPublica surveyed 21 trauma centers in cities with high rates of violence including Oakland, Detroit and Baltimore and found that only one hospital in New Orleans—Spirit of Charity Trauma Center—consistently screens patients for PTSD. 

The Investigative Unit also surveyed local trauma centers and found that some such as John Muir Medical Center in Walnut Creek and Stanford Hospital in Palo Alto do assess patients in the hospital for acute signs of stress. John Muir also reports that it participates in a program called Beyond Violence, that like Caught in the Crossfire, links trauma patients to violence intervention specialists. 

North Bay Medical Center in Fairfield—which sees the second-highest number of penetrating trauma victims in the Bay Area behind Highland Hospital—reports that it plans to develop a program to screen patients for emotional and psychological stability. The hospital currently provides post-incident follow up sessions with social workers for patients who want the help. 

The Wraparound Project based out of San Francisco General Hospital also provides trauma patients with case managers who aim to stop the cycle of violent injury. 

“I think a number of sites and teams are doing outstanding PTSD care,” Zatzick said. “The guidelines that will be imposed by the end of the year will extend this kind of care nationally.”

The American College of Surgeons (ACS)—the accrediting entity for the country’s trauma centers—says that hospitals can be doing more to assess patients for stress and depression. 

By the end of March the ACS will update its best practices manual to recommend that hospitals develop a plan to evaluate, support and treat PTSD. The new guidelines in the Resources for Optimal Care of the Injured Patient manual state that “because the relationship between PTSD and depression is clear, routine screening for depression following an injury is prudent.”

Experts say they expect the recommendations to eventually become mandates and believe that an investment in PTSD screening will pay off in the prevention of future violence so that civilians caught in the trauma won’t repeat it. 

Hospitals Have a Long Way to Go

Pro Publica surveyed trauma hospitals in states with the highest murder rates in the country. Most did not have a system to screen for PTSD. (Note that two hospital, Highland Hospital in Oakland and Truman Medical Center in Kansas City, Mo. declined to comment on PTSD screening).

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Hospitals Some or More Screening Does not Screen Developing Plans for Screening
Hurley Medical Center  
Detroit Receiving
Spirit of Charity Trauma Center, Interim Hospital
University of Mississippi Medical Center  
Saint Louis University Hospital    
R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center  
The New Jersey Trauma Center at University Hospital  
Highland Hospital      
University of Alabama at Birmingham Hospital    
Our Lady of the Lake Regional Medical Center  
San Joaquin General Hospital  
University of Arkansas Medical Science  
Truman Medical Center Hospital Hill      
Loma Linda University Medical Center  
Temple University Hospital    
MetroHealth Medical Center
Baptist Medical Center South    
Elvis Presley Memorial Trauma Center at the Regional Medical Center  
Virginia Commonwealth University Medical Center
Grady Hospital
Cook County Trauma Unit, John H. Stroger, Jr. Hospital of Cook County

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