I recently spent a month rotating on the trauma service at my hospital. One day early in my rotation, my team and I got called down to manage a pedestrian who was struck by a car. As soon as the paramedics arrived at the emergency department, I knew that this case would be more complicated than I initially anticipated. As the senior resident, I was charged with managing her initial resuscitation. I went through her primary survey as expeditiously as possible, and amid the chaos of the crowded trauma bay, I distinctly remember locking eyes with her. I struggled with finding the right words to say to console her as tears rolled down her face. Behind that gaze, I could see a deep fear and anguish that seemed different from other trauma victims I have taken care of. She had been run over by a car multiple times and was severely injured, with road rash covering half of her body, flesh hanging off of her extremities, and two broken legs that potentially needed amputation. She soon was intubated and started on a massive transfusion protocol. She was rushed to the operating room for further exploration.

I bewilderedly stepped out of the trauma bay. How? Why?

I then overheard officers nearby saying that “her boyfriend is still at large, another typical DV case.”

Another typical domestic violence (DV) case? I could not help but feel a sense of disgust and anger that this was considered typical. Nothing about almost losing your life at the hands of a loved one should be typical. This patient would ultimately survive her injuries, but the physical, mental, and emotional disabilities would be permanent.

An Urgent Problem with No Easy Solution

In the Untied States, roughly 7 million women and 6 million men are victims of rape, physical abuse, or stalking by an intimate partner. Since the Violence Against Women Act was passed in 1994, DV rates have steadily declined. Yet, despite declining rates, the United States still has the highest rate of DV homicide of any industrialized country. On average, three women are murdered daily by intimate partners.^1,2 Literature shows that 79.2 percent of DV-related homicides were perpetrated by current intimate partners and 14.3 percent by former intimate partners. Approximately one in 10 victims experienced some form of violence in the month preceding their death.³

Emergency departments are often the first point of care for victims of DV. It is estimated that 14 percent of women treated in the emergency department are there for DV-related conditions, and DV accounts for at least 1.4 million ED visits annually.⁴ Data suggest that simply treating the patient’s acute symptomatology has no effect on future occurrences of domestic violence.⁵ It has also been shown that when treatment for acute injuries is paired with direct handoffs to a victim advocacy agency, DV victims are more likely to use and follow up with interventions, resulting in reduced repeat victimization rates.⁶

One of the reasons I chose emergency medicine is that within this field we have an incredible opportunity to enact change and alter people’s lives during times of calamity. These are not the patients who we can simply treat and street. These are high-risk patients who, in many cases, may not even make it back to the hospital. As providers, we should arm ourselves with the knowledge and resources to empower our patients to no longer endure the torment of being victims of domestic violence.

Dr. Thomas is an emergency medicine resident at Highland Hospital in Oakland, California.

References

1. Black MC, Basile KC, Breiding MJ, et al. The national intimate partner and sexual violence survey (NISVS): 2010 summary report. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2011.
2. Serious intimate partner violence against females declined 72 percent from 1994 to 2011. Bureau of Justice Statistics website. Accessed Sept. 19, 2017.
3. Petrosky E, Blair JM, Betz CJ, et al. Racial and ethnic differences in homicides of adult women and the role of intimate partner violence—United States, 2003–2014. MMWR Morb Mortal Wkly Rep. 2017;66(28):741-746.
4. Davidov DM, Larrabee H, Davis SM. United States emergency department visits coded for intimate partner violence. J Emerg Med. 2015;48(1):94-100.
5. Taft A, O’Doherty L, Hegarty K, et al. Screening women for intimate partner violence in healthcare settings. Cochrane Database Syst Rev. 2013;(4):CD007007.
6. Miller E, McCaw B, Humphreys BL, et al. Integrating intimate partner violence assessment and intervention into healthcare in the United States: a systems approach. J Womens Health (Larchmt). 2015;24(1):92-99.