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When you enter Temple University Hospital’s ER, trauma advocates will help you with more than your injuries

Every year, thousands of Philadelphians are victims of violence, often at the terrifying end of a gun. At their most vulnerable and afraid, these men, women and children often find themselves at Temple University Hospital, one of the busiest trauma centers in the state. There, in an emergency department that sees more than 150,000 patients in any given year, staff routinely bring even the most critically wounded back from the brink.

But surviving doesn’t always keep victims from falling through the cracks in the aftermath. In 2019, the hospital put four crisis responders — some might call them “fixers” — on the front lines to support the battered and the broken as soon as they come through its North Philadelphia doors.

While the hospital’s doctors and nurses furiously work to save lives, the advocates — parents and grandparents; some, survivors themselves — race against the clock. In crucial, often tense moments, they collect as much information as they can — names, ages, mother’s phone number — so that when friends and families inevitably rush in at all hours of the day and night, they can reassure them that their loved ones are in the best hands, and they can immediately connect them to victim services. In the agonizing instances where even the best hands aren’t enough, they at least bear witness to their loss and grief.

We talked to Scott Charles, 53, the Germantown resident who created the Trauma Victims Support Advocates Program, and to the program’s advocates, some of whom have seen upward of 20 victims of violent crime in one shift. These interviews have been edited for brevity and clarity.

Scott Charles, 53, of Germantown, created the Trauma Victims Support Advocates Program.

You’re best known as the longtime trauma coordinator for Temple University Hospital who co-created Cradle to Grave, the gun violence intervention and prevention program, with trauma surgeon Amy Goldberg. Also, as the guy who gives out free gun locks, no questions asked. Now you’re leading this effort. Tell us about it.

One of the things that I recognize from being here so many years is that when it comes to law enforcement officers, when they’re injured in the line of duty, we pull out all stops, and it doesn’t matter if you’re treated at this hospital or any hospital throughout the city. There is an understandable outpouring of support, a sense of urgency.

And what I wanted was to have a similar response for the person who gets shot in North Philly, who might’ve been born in this hospital, who grew up down the street from here, whose grandma gets her heart medicine here, and think about the needs of their families, and their needs as individuals.

You know, the act of being victimized happens every day, several times a day in Philadelphia, and it inflicts so much trauma, not only on the individuals, and not only on their families, but on society.

Leslie Ramirez, 48, of North Philadelphia, mother of three, lost a stepbrother and multiple friends to violence.

I try not to go into crisis mode because I feel like once people go into crisis mode they don’t think. So, I go in calmly and try to gather as much information as I can. I call it ear hustling — listening for any clues or cues that will help me in the situation. You learn to be extremely sympathetic, non-judgmental, and you just don’t take anything personal. You’re approaching families, you’re approaching someone who is extremely afraid. I’ve cried in front of loved ones sometimes, and I apologize and explain that in that moment I was moved or touched. And I welcome it. I’ve been doing social work for a little bit and I always said if I get cold, then I shouldn’t be doing it, if I feel nothing at all then I shouldn’t be doing this. There’s way too many victims of violence. My max has been eight in one shift, and all this violence, it doesn’t just affect the victim. It affects an entire community.
Walk me through an advocate’s typical day.

During an eight-hour shift, the advocates will be here when a police car wheels up with a shooting victim. They’re going to support [victims] in the trauma bay, they’re going to make a phone call to that victim’s family. They are going to try to provide law enforcement the information that they need and they’re going to provide continued up-to-date information to the family. They’re also going to see patients who have already been admitted to the hospital, maybe the day before.

Yesterday, we had something like 12 or 13 shooting victims that came in during the day. Not only are we talking about shooting victims coming in every couple of hours, we had a situation where five shooting victims came in at the same time, which means that you have one advocate trying to sort through completely stressed out and fearful families.

That sounds incredibly traumatic for everyone.

I just went through this last night: a mom hearing that her son was shot, and that’s all she knows.

Sometimes information is what they need, and sometimes what they need is just a hug. But what we think everybody deserves is to feel like there’s somebody on the inside of this situation who is fighting for them.

We pride ourselves on being a community hospital, but what I feel like we’re doing with this program is demonstrating it. None of these advocates that we have are that separated from this issue. We see those neighbors as an extension of us.

Sadiqa Lucas, 44, of South Philadelphia, mother to 10-year-old son, lost friends and family to gun violence.

“I’ve been there. I’ve been in their shoes. In 2004, I lost a cousin to gun violence. He was 15. I was that family member that got that call. I was that family member in the waiting area to see if my cousin was gonna make it. Unfortunately, he didn’t. I know what that feeling is like. So I know what level of service that family needs, that mom needs. I lost both my parents at a very young age. I’ve lost several friends and relatives to violence in the city of Philadelphia, not just gunshots, stabbings and domestic violence and car accidents. You know, this program wasn’t around when I went through my trauma, but if it was, knowing what I went through at that particular moment, it would have helped. I want to help.”
Is there a particular case that impacted you more than others?

Oh my God, there’s so many. The ones that stick out for me, because I’m a father, involve children. There was a night when we had a shooting, and the child died. We did the death notification, and then the father predictably lost it. He was yelling, he’s punching walls, at one point he threatened the police officers who were guards in the emergency department because he was so understandably angry, not at us, but at the circumstances.

The hardest part was when he kept asking: ‘What am I supposed to do now?’ and I didn’t have an answer. I stayed with him, to recognize how devastating this was, so that he wouldn’t be alone. When we walked out to leave, he hugged me and just said, ‘Thank you.’ And then, he turned to the police officers that he had threatened earlier, and sobbing, he said, ‘I just want to tell you how sorry I am for the way I behaved when I came here.’ And then the officers hugged him and just held him. I don’t know that the advocates are the only reason that this played out, but I think we provide the space for these moments to occur. There is nothing lonelier than being in a sterile family waiting room and having doctors in scrubs come tell you that the most valuable thing that you have in your life is gone.

Rose King, 60, of Fairmount, mother of two children, five grandchildren.

“I have a strong faith. I believe in God. So I pray a lot. The death notifications are hard because there are so many. And just seeing a family member say goodbye to their loved one, it breaks your heart. Some you can get through, but then you have some that are harder than others — especially if it’s a child, a 16-or 17-year-old who may have been scooped off the streets by police, and you can’t contact the family, because there’s no ID. They’ll eventually come through those doors, but sometimes it’s too late. It takes a lot of compassion, and it takes a lot of understanding and sometimes, a lot of prayer.”
Much of what you’re describing really boils down to basic empathy, sympathy, and respect, and so it’s kind of shocking that this kind of program and support hasn’t long existed in every hospital treating victims of violence.

This is a city where eight out of 10 times when somebody gets shot, they survive, and this is a city that has found some really innovative ways to address gun violence, like scoop and run, for example, or the tourniquet training that we go out to the neighborhoods to teach, and that now other hospitals are starting to do. Now we’re moving beyond doing the clinical stuff well, and we’re thinking about, ‘Well, how do we do the human stuff better?’

Ian Hirst-Hermans, 31, of Fishtown, shot in North Philadelphia after leaving a Halloween party in 2010.

“When I got shot, the dean of students, because I was a Temple student at the time, came up to the hospital. She sat in the room with my mom and dad for hours while I was in surgery, and my mom couldn’t emphasize enough how much she appreciated that, and how much of a difference that made to her, just someone to be there and to bear witness to what they’re going through. I always keep that with me. Sometimes I’ll be in a room with a family that’s going through something similar, and I’ll be like: ‘I should think of something to say’ or ‘I need to make them feel better,’ and then I remember those words where she said sometimes being there with people is really effective and really appreciated, so sometimes, that’s just what I do.”
What’s the future of the program?

We create these really strong relationships with patients who continue to reach out to us. The program [funded by the Pennsylvania Commission on Crime and Delinquency] has referred more than 900 violently injured patients to the crime victim agencies that are part of our collaborative [Central Division Victim Services, Congreso, Concilio, and Northwest Victim Services].

I want to think about the other needs that they have in their lives.

One of the things that we recognize about young men who are the vast majority of shooting victims is that many of them are unemployed. There is such a direct link between poverty and gun violence. I want to include workforce development as part of a more comprehensive service. I also want to have a more rapid response to their mental-health needs, so five years from now we are not just looking at the bullet as the primary issue, but about all the other things that have brought this patient in front of us.

More than 2,000 people got shot last year. There’s the potential for 3,000 people to be shot this year, and there’s no sign that this is going to abate anytime soon. We can’t continue to think that people who experienced this kind of trauma can get the worst possible news, and then just go back out into society as though nothing happened.