After policing changes in Camden, NJ, fewer gunshot patients at major trauma center

 
Camden, NJ. (Smallbones / Wikimedia Commons)
By

November 8, 2019

A wholesale change in policing tactics earlier this decade in Camden, New Jersey — a city that historically has struggled with violent crime — is associated with the city’s major trauma center treating lower rates of gunshot patients in recent years, finds new research in Preventive Medicine Reports.

Camden disbanded its police force in 2013 after one of the city’s most violent years on record. Camden County took over and in May 2013 formed a new department, the Camden County Police Department, to patrol the city. There were 175 officers in Camden in 2011 but by 2014 the force was up to 411, according to an analysis in Governing. CCPD also instituted community-based policing tactics along with new technology.

In the paper, analysts from Cooper University Hospital — a Level 1 trauma center near the Camden waterfront — compare 940 cases of patients with gunshot wounds treated at the hospital from 2010 to 2017. The data include 444 people shot within 1,215 days before CCPD was established and 496 shot within 1,705 days afterward.

The authors observe that on average there were 34 gunshot patients treated every three months before the policing changes, and 26 quarterly gunshot patients after. To account for population fluctuations during the study period, they standardize those numbers and report a final decline from 44 to 35 gunshot patients per quarter, per 100,000 people — a 22% drop following the policing changes. The authors acknowledge the percent drop they report in the paper, 24%, is inaccurate and appears due to an oversight during editing.

The quarterly average number of days that patients with gunshot wounds spent at the hospital dropped 31%. Health care costs for treating gunshot patients fell $254,000 per quarter.

The authors write that policing changes like those Camden pursued “could alleviate the burden of firearm-related injuries in similar communities and save millions in taxpayer dollars. This money could be reallocated towards programs that can continue to decrease firearm-related injuries.”

While the rate of gunshot patients at Cooper declined substantially, the firearm injury fatality rate per 100,000 people increased from 13.5% to 17.3% among patients the hospital treated. The authors put forward several theories to explain the increase, but they’re most confident it’s connected to a policing tactic CCPD mandated called “scoop and run.” Sometimes called “scoop and go,” this tactic emphasizes getting victims to doctors as soon as possible. Police take critically wounded victims to the hospital, instead of waiting for an ambulance.

“Delay in trauma treatment is very important and it’s minimized with ‘scoop and go,’” says Justin Frisby, one of the paper’s authors. “You give hope for people to get into the trauma center with less interventions.”

Rather than gunshot victims dying at the scene, “scoop and go” gives victims the chance to receive potentially life-saving medical treatment. But it also means the most critically wounded patients, who have a lower chance of survival, may still die even if they make it to the trauma center.

A history of violence

Camden is a city of about 77,000 across the Delaware River from Philadelphia. Violence peaked there in 2012.

In the city police department’s last year of existence, it reported 86 criminal homicides per 100,000 people to the FBI’s Uniform Crime Reporting Statistics program — the highest recorded rate in nearly two decades. The overall violent crime rate, including crimes like assault, rape, robbery and murder, was 2,566 per 100,000 people in 2012. At the time, just a dozen officers might have been patrolling the city in any given night, according to Governing.

The criminal homicide rate in Camden in 2012 was outpacing rates in much larger historically violent cities. Detroit, for example, had a criminal homicide rate of about 55 per 100,000 people, while Baltimore and St. Louis were each at about 35 criminal homicides per 100,000 in 2012, according to FBI UCR data.

In the years that followed, Camden became a city with one of the most progressive police departments in the country. CCPD rewrote its use-of-force guidelines “to ensure officers respect the sanctity of life” by exercising “the utmost restraint” in situations when they might need to use force. Patrol officers started wearing body cameras. The department also put more eyes on Camden in the form of hundreds of street cameras, a video observation platform covering a six-block radius, and monitoring technology that alerts police when and where shots are fired.

All that new technology came with a $4.5 million price tag. Cooper analysts show some return on that investment is coming in the form of health care savings — about $1 million per year. Most medical costs for gunshot patients during the study period were paid through public insurance like Medicaid and Medicare, according to the authors. The actual savings could be much higher.

“Costs are only for the initial encounter and do not capture readmissions, long term care, rehabilitative services, and other post-treatment costs,” the authors write. “As we expect these costs to be high, we believe our study is a conservative estimate compared to the overall total cost these patients have on the healthcare system and society.”

The new paper reflects overall trends in Camden’s violent crime reduction since 2012. The criminal homicide rate had fallen by roughly three-quarters by 2018, according to CCPD data, while the number of criminal homicides caused by shootings decreased 68% since 2012. Overall crime is now at a 50-year low in Camden, and some residents credit improved relations with police.

The drop in violent crime means Camden might be catching up to most of the rest of the country. Violent crime rates in U.S. cities have fallen dramatically since the 1990s, according to Americanviolence.org, a project led by Princeton University sociology professor Patrick Sharkey that supplements FBI UCR crime statistics with data from the non-partisan Gun Violence Archive.

Despite the statistical improvements, violence remains a part of everyday life for many Camden residents and police. Last summer, two detectives were ambushed and shot at while at a traffic light during National Night Out, a campaign with roots in the Philadelphia suburbs meant to strengthen bonds between police officers and the communities they serve.

Yet in the year she has worked at Cooper, Emily Schultz — another author on the new paper — has seen signs of growth in parts of Camden.

“There is a new health science building along the waterfront,” Schultz says. “There are new businesses, restaurants and stores, so it’s growing and developing pretty quickly.”

Study limitations

The authors note several limitations in their paper. There is the possibility that some gunshot cases were misclassified in Cooper’s trauma database.

“However, as our institution is required to have a dedicated database manager for all traumas presenting to the trauma bay, we believe the database information is accurate,” the authors write.

Because Cooper is a Level 1 trauma center, it can handle comprehensive care for any injury. As the only such trauma center in the county, the authors cannot be sure that every gunshot patient at Cooper during the study period came from Camden city. There also might be factors at play that contributed to the violent crime reduction, beyond the changes in policing.

“There’s no such thing as a perfect study, especially looking retrospectively,” Frisby says. “We couldn’t rule out every other variable. But there’s definitely a relationship between the policing tactics and reduced incidence of gunshot wounds in Camden.”

The authors also don’t compare gunshot wound patients who ended up at Cooper against police reports. In addition to scoop-and-go, the authors speculate that new types of firearms might have contributed to the increase in mortality from shootings. They also offer that because there were more police on Camden’s streets, gun violence might have moved indoors where shots may be fired at a closer, more lethal range. But without specifics from police reports, the authors do not draw conclusions.

Still, they write that Camden’s policing changes could serve as a broad template for reducing firearm injuries in similar cities — but the devil is in the details.

“Every city is different,” Frisby says. “It’s difficult to apply one set policy to every city.”

Certain surveillance technology, for example, may run afoul of civil liberties watchers. Last year, Seattle dismantled a $3.6 million wireless police surveillance network that a representative from the American Civil Liberties Union of Washington said was wrapped up in “a brave new world where data and algorithms can be used against you without transparency,” according to The Seattle Times.

 

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Citation: Frisby, Justin C.; Kim, Tae Won B.; Schultz, Emily M.; Adeyemo, Adeshina; Lo, Karina W.; Hazelton, Joshua P.; Miller, Lawrence S. “Novel Policing Techniques Decrease Gun Violence and the Cost to the Healthcare System,” Preventive Medicine Reports, October 2019, doi:10.1016/j.pmedr.2019.100995.