GANG WARFARE - THE MEDICAL REPERCUSSIONS

Gang related violence in Los Angeles County has increased, with homici des increasing from 205 in 1982 to 803 in 1992. This study examines th e medical and financial consequences of such violence on a level I tra uma center. Of 856 gunshot injuries over a 29-month period, 272 were g ang related. There were 55 pediatric and 217 adult patients. Eighty-ni ne percent were male and 11% were female. Trauma Score averaged 14.7 /- 3.1, Glasgow Coma Scale average score was 13.7 +/- 3.4, and the mea n Injury Severity Score was 10.8 +/- 14. Twenty-two percent of the gun shots were to the head and neck, 20% to the chest, 20% to the abdomen, 6% had a peripheral vascular injury, and 33% sustained an extremity m usculoskeletal injury. Emergency surgery was performed on 43%, includi ng laparotomy 58 (49%), craniotomy 16 (13%), laparoscopy 14 (12%), vas cular procedures 10 (8%), orthopedic procedures 6 (5%), head and neck endoscopies 4 (3%), thoracotomies 2 (2%), and 10 (8%) unspecified. The re were 25 deaths (9%), primarily caused by head injuries and exsangua nating hemorrhage. Eighty-six percent entered the hospital during the hours of minimal staffing that pre-empted the use of facilities for ot her emergent patients. Charges totaled $4,828,828 (emergency room, sur gical procedures, intensive care, and surgical ward stay) which equate d to $5,550 per patient per day. Fifty-eight percent had no third part y reimbursement, 22% had Medi-Cal, and 20% had medical insurance. Beca use of dismal reimbursement rates, the costs of gang violence are pass ed on to the tax payer. The cost of gang related violence cannot be de rived from hospital charges only, because death, disability, and pain are not entered into the calculation. Education, increased social prog rams, and strict criminal justice laws and enforcement may decrease ga ng related violence and the drain it has on financial and medical reso urces.