A Milwaukee Syndemic? Penetrative Injury and COVID-19.

INTRODUCTION: This study sought to evaluate injury frequency of penetrative trauma before and after stay-at-home orders were implemented due to COVID-19 in Wisconsin. METHODS: Patients who presented to a level I trauma center from January 2018 through December 2021 with a mechanism of injury of firearm or stab wound were included. The study was split into pre-COVID (January 2018-February 2020) and COVID (March 2020-December 2021) periods. Statistical analysis included chi-square tests and interrupted time series analysis. RESULTS: A total of 1702 patients met inclusion criteria. The COVID group had a statistically significantly higher proportion of firearm injuries (83.2%) and a significantly lower proportion of stab injuries (16.8%) compared to the pre-COVID period group (70% and 30%, respectively, P < 0.001). There was no change from pre-COVID to COVID periods in in-hospital mortality or length of hospital stays. There was an increase in firearm incidents in the COVID period in 72% of Milwaukee County ZIP codes and a decrease in stab incidents in 48% of ZIP codes. Interrupted time series analysis indicated a significant increase from the pre-COVID to COVID periods in monthly firearm and stab injuries. Firearm injury significantly increased from pre-COVID to COVID for Black or African American patients but no other racial group. CONCLUSIONS: These findings are consistent with other state and national trends suggesting increasing penetrative injury during the COVID-19 pandemic. The intersection of the COVID-19 pandemic and violence pandemic may yield a "syndemic," imposing a significant burden on trauma systems. Evidenced-based public health interventions are needed to mitigate the surge of firearm injuries.

Professional Outcomes and Satisfaction Among Graduate Medical Education Wilderness Medicine Fellowship Alumni in the United States.

INTRODUCTION: Wilderness medicine (WM) graduate medical education (GME) fellowships were established in 2003. Outcomes and satisfaction of US WM GME fellowship alumni can inform prospective applicants and program directors of the strengths of fellowships and professional gaps in them. METHODS: A 34-question Qualtrics survey was emailed to 111 alumni from 17 institutions listed in the Wilderness Medical Society's GME database in May 2019. Professional service, scholarship, and satisfaction were queried. Results are represented as percent response (n=answered affirmative) based on the number of respondents per question. RESULTS: The survey response rate was 41% (n=46); 67% reported (n=31) Fellowship of the Academy of Wilderness Medicine recognition. Within the last 5 y, 71% (n=32) reported publications in WM. Free text entry questions had 78% (n=28) describe improved clinical skills, and 68% (n=26) were exposed to new career choices in fellowship. Those who rated exposure to a variety of WM knowledge and skills highly rated the overall fellowship experience higher (P<0.001), as did those reporting a higher number of WM publications (P=0.023). Nearly half, 48% (n=21), felt they could hold their current position without fellowship training. In hindsight, 76% (n=34) would follow the same professional path. CONCLUSIONS: WM GME fellowship alumni reported high rates of professional engagement and scholarly productivity in the subspecialty. Responding alumni overwhelmingly rated the fellowship experience positively. Fellowships that ensure a wide exposure to experiences and foster scholarly productivity are more likely to yield professionally satisfied graduates.