Why Does This Exist?

The Problem That Trauma Surgery Cannot Solve Alone

Dr. Ashley Williams Hogue, a trauma surgeon at USA Health University Hospital in Mobile, Alabama, described the experience that drives support for intervention programs: she has “operated on the same victims who’ve been shot in separate incidents.”¹ Dr. Michel Aboutanos at VCU Medical Center in Richmond put national numbers on it: gunshot wound recidivism runs at “almost up to 50%, if not a little bit higher.”² Minneapolis Next Step’s baseline data showed 41% of victims were shot again within five years.³

The Window That Traditional Medicine Has Not Used

Trauma surgeons have long understood that the hours after injury create an unusual psychological moment. Dr. Lindsey Dunkelberger, the Prisma Health trauma surgeon in Columbia, South Carolina, describes what her team observes: as they treat “physical wounds, survivors become open to interventions to break the cycle of violence.”⁴

Former Mayor Sandy Stimpson of Mobile, Alabama, who championed the launch of his city’s HVIP before leaving office in November 2025, described the cycle: “When individuals show up as victims of crime at the hospital, typically they go back out into the streets, back into the neighborhoods and they become a victim again or they themselves commit a crime.”⁵ The program at Grady Hospital in Atlanta describes the same dynamic: “The trauma surgeon saves a life at 2am. By 2pm, that same patient is getting calls about who shot them, where to find a gun, and when to strike back.”⁶

The six-month window after initial injury is the period of highest risk. Dr. Kirsten Bechtel, physician and professor of pediatrics at Yale School of Medicine, explains: assault victims “are much more likely to be involved in a homicide or an assault with a firearm in the next six months.”⁷

The Root Causes That Sit Beneath the Wound

The physical injury is often the smallest part of what a trauma patient needs. Data from Dr. Randi Smith’s program at Grady Hospital found that two-thirds of 14- to 24-year-old gunshot victims face “issues like food insecurity, housing issues and financial instability.”⁸ These conditions are not incidental to their violence exposure — they are part of it. A patient who has no housing, no income, and no path to employment cannot simply choose to leave the environment that produced their injury. They have nowhere to go.

Dr. Amy Makley, trauma medical director at UC Health in Cincinnati, points to a related gap: violence survivors “experience high rates of mental health disease and post-traumatic stress disorder that extend beyond the initial injuries.”⁹ Untreated PTSD, trauma-related hypervigilance, and grief over lost community members all increase the risk of future violent encounters — either as a victim or as a perpetrator. Traditional trauma care discharges the patient with treated physical wounds and untreated psychological ones.

Daniel Blum, chief executive of Sinai Hospital and Grace Medical Center in Baltimore, articulates what this means for hospital responsibility: “A patient often needs more than a splint or a suture. They may need a counselor, a referral, or help to secure housing, education, food or even a job.”¹⁰ The hospital that discharges a patient with none of those things has treated the event but not the person.

The Retaliation Cycle That Injury Activates

Dr. Smith describes the compressed timeline at Grady: the trauma surgeon saves a life at 2am; by 2pm, the same patient is fielding calls about who shot them, where to find a gun, and when to shoot back.¹¹

Two randomized controlled trials document the criminal justice effects of hospital-based violence intervention. Cooper, Eslinger, and Stolley (2006), publishing in the Journal of Trauma, found that the control group in a hospital-based violence intervention study was three times more likely to be arrested for a violent crime than the intervention group.¹² A Johns Hopkins University School of Medicine trial led by Tina L. Cheng, published in Pediatrics in 2008, examined youth aged 10-15 presenting with peer assault injury at two large urban hospital emergency departments; the study found trends toward reduced misdemeanor activity and aggression scores, and increased self-efficacy, though most results did not reach conventional statistical significance.¹³

What “Violence as a Public Health Crisis” Means in Practice

The U.S. Surgeon General issued an advisory formally designating gun violence a public health crisis.¹⁴ The American Medical Association, the American College of Surgeons, and the American Public Health Association have all adopted positions framing community violence as a public health issue requiring public health responses.¹⁵

Dr. Simbo Ige, Chicago’s Public Health Commissioner, described this explicitly when announcing the city’s hospital-based violence intervention investment: “Just as we treat the physical manifestations of violence, we must also treat the psychological and emotional aspects for both victims and their families. It is critical that victims of violence are transitioned into community-based programs to promote ongoing physical and psychosocial recovery and increased safety.”¹⁶

The Economic and Systemic Case

Virginia’s 12 hospital-based violence intervention programs, which have served more than 8,000 violence victims since 2019, are estimated to have generated “over $82.5 million in health care costs avoided due to preventing and reducing re-injury rates,” with nearly half representing direct savings to the state.¹⁷ A 2024 report from the American Hospital Association estimated the total cost of violence to U.S. hospitals at roughly $18 billion annually.¹⁸

A separate analysis found estimated cost savings per HVIP participant ranging from $82,765 to $4 million across a five-year model, with savings driven by reduced injury recidivism, avoided trauma surgeries, reduced criminal justice costs, and maintained economic productivity.¹⁹

The Health Alliance for Violence Intervention (HAVI) and Everytown for Gun Safety Support Fund developed a cost calculator to help cities and health systems model these returns, built because “cities and funders need to understand the key costs of implementing Hospital-Based Violence Intervention Programs” before making investment decisions.²⁰

Daniel Blum of Baltimore’s Sinai Hospital and Grace Medical Center captures the institutional shift: “Hospitals are no longer in the business of patch and release. They want to treat victims of violence in ways that will keep them from being victimized again or even becoming perpetrators.”²¹