Beyond the Finochietto: The Role of Education in Injury Prevention

We’ve drilled this in the simulation lab, and we’ve seen our teams enter the chest with speed and grace. “Grab the Finochietto!” Learning the steps of a resuscitative thoracotomy ensures we’re prepared for this traumatic cardiac arrest and will undoubtedly save lives. But how else can we train surgeons to prevent violent injuries and save lives?

Social drivers of health such as socioeconomic status, education, housing, and access to healthcare play a significant role in health outcomes, especially with violent injury. While this concept is not new, the recent COVID-19 pandemic highlighted just how deeply these factors influence health. However, when it comes to trauma, particularly in cases of violence, physicians are often underprepared to address the root causes that contribute to their injury.

While it’s no surprise that a patient’s health is influenced by their social environment, surgeons have been slow to incorporate social drivers of health into their training. And yet, it is this very understanding that could help prevent future trauma cases and potentially save lives before patients ever step foot into the trauma bay. However, several ongoing efforts highlight a shifting mindset in the field.

Socially Responsible Surgery is a national group that focuses on social drivers of health in surgery through four pillars: education, service, advocacy, and research (https://www.sociallyresponsiblesurgery.org/ )
Trauma surgeons are helping to lead hospital-based violence intervention programs, which are multidisciplinary programs of medical staff, credible messengers, and community-based partners that address unmet social drivers of health of people who are violently injured ( https://www.thehavi.org/what-is-an-hvip )
Surgeons are developing curricula to teach trainees about how to counsel patients on firearm safety. While physicians often cite feeling unknowledgeable, uncomfortable, overly intrusive, these curricula can provide the knowledge and skills necessary to lead a conversation focused solely on safety
The American College of Surgeons formed the Improving Social Determinants to Attenuate Violence (ISAVE) workgroup have outlined four strategies to improve health and health care for people impacted by violence. Included is the concept of trauma-informed care, which is an approach to patient care that involves recognizing individuals’ traumatic history appropriately responding to the impact trauma has on survivors ( https://www.facs.org/media-center/press-releases/2021/isave-073021/ )

With such a complex, interrelated web of social drivers of health, one single approach is insufficient to solve this problem. However, continuing to incorporate social drivers of health into the minds of surgeons has the potential to develop life-saving solutions. Let us learn to place the Finochietto while also working to never place it again.