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Speaker 1: Pushkin This season on Revisionist History, We're going to the

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Speaker 1: heart of America's gun violence crisis. Six episodes, some weird,

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Speaker 1: some whimsical, some heartbreaking, some angry, because so much of

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Speaker 1: what Americans tend to believe about guns and assault rifles

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Speaker 1: and mass shootings is actually wrong. We talk about TV westerns,

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Speaker 1: about a crime in a little town in rural Alabama,

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Speaker 1: About the nuttiness of the Supreme Court, about the assassination

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Speaker 1: of Robert Kennedy. The series will air weekly starting Thursday,

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Speaker 1: August thirty first, but you can binge listen to all

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Speaker 1: six episodes early and add free by subscribing to Pushkin

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Speaker 1: Plus on Apple Podcasts, or by visiting our website pushkin

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Speaker 1: dot fm, slash plus. Today we're sharing a short clip

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Speaker 1: from the series. It takes us to the world of

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Speaker 1: trauma surgery, which is actually why I started on this

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Speaker 1: deep dive in the first place. We hear a lot

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Speaker 1: about the gun crisis from law enforcement activists and politicians,

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Speaker 1: but not so much from the people who are quite

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Speaker 1: literally treating its victims. That's who I wanted to talk to. Doctors,

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Speaker 1: specifically trauma surgeons, to try and get a sense of

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Speaker 1: their view of the violence. In this clip, I'm talking

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Speaker 1: to a surgeon named doctor Babak Serrani on the subject

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Speaker 1: of time. The number of homicides in any community is

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Speaker 1: a combination of two completely unrelated variables, the number of

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Speaker 1: people victimized by acts of violence minus how good a

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Speaker 1: job the medical system does at saving the lives of

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Speaker 1: those victims. And a lot of times, what a murder

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Speaker 1: rate really tells you is how good your doctors are,

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Speaker 1: and not how safe your streets are. But there's a

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Speaker 1: twist on the observation, a really important twist which the

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Speaker 1: people who treat gunshots for a living have known about

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Speaker 1: for a long time. So I'm assuming over the course

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Speaker 1: of your career you have treated innumerable gunshot wounds.

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Speaker 2: Unfortunately true.

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Speaker 1: This is doctor Babach Serrani. He's a trauma surgeon at

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Speaker 1: George Washington University Hospital in Washington, d C. If you

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Speaker 1: get seriously injured by a bullet, you get taken to

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Speaker 1: a trauma center, more specifically a Level one trauma center,

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Speaker 1: which is a self contained, twenty four hour facility equipped

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Speaker 1: with everything necessary to treat traumatic injury. General surgeons, orthopedic surgeons, neurosurgeons,

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Speaker 1: plastic surgeons, an the caesiologists, er docs, radiologists, nurses with

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Speaker 1: the right qualifications on and on Level one. Trauma centers

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Speaker 1: cost hundreds of millions of dollars to build and operate.

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Speaker 1: They're relatively rare. DC has thirteen hospitals, but only four

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Speaker 1: Level once. One of those is at George Washington. Serrani

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Speaker 1: is the chief trauma sursion there. Do you know how many, roughly.

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Speaker 2: Speaking, Oh, my goodness, I would think probably by now,

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Speaker 2: the number of gunshot victims I've seen personally. I've been

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Speaker 2: in practice since two thousand and five. I would venture

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Speaker 2: miss Bladewell five hundred plus.

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Speaker 3: Wow.

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Speaker 1: Yeah, and you weren't even there during DC's darkest years.

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Speaker 2: Correct, Yeah, correct.

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Speaker 1: I wanted to talk to Serrani about time, because trauma

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Speaker 1: sursions are obsessed with time. There's a phrase common in

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Speaker 1: their world, the golden hour. If you get shot, they

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Speaker 1: really want to have you on the operating table as

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Speaker 1: soon as possible. That's why we pull over for ambulances.

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Speaker 1: Talk a little to me about time. You said, ems

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Speaker 1: tends to get there within ten minutes, and you tend

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Speaker 1: to get to the trauma centner between twenty and forty five.

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Speaker 1: What's the difference between twenty and forty five. What happened

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Speaker 1: in that extra period of time that would diminish someone's

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Speaker 1: chances of survival?

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Speaker 2: Yeah, I think it depends on where the injury is.

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Speaker 2: You know, if you've been injured in the abdomen and

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Speaker 2: it hits your intestine, honestly, nothing will happen between twenty

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Speaker 2: and forty five minutes. That's plenty of time. But if

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Speaker 2: you're bleeding, specifically speaking, if you're bleeding, then every minute

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Speaker 2: that goes by is you know the value of that

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Speaker 2: is plutonium.

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Speaker 1: Like for example, if you take a bullet to your liver,

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Speaker 1: the liver is a maze of blood vessels.

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Speaker 2: Making the liver, of all things, stop bleeding is exceedingly difficult.

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Speaker 2: You know, kidney, I can take it out, you have

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Speaker 2: two kidneys, spleen, I can take it out. You don't

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Speaker 2: need a spleen. I cannot take out your liver that

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Speaker 2: you need a liver to live, and so I'm obligated

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Speaker 2: to try to repair it while it just continues to bleed.

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Speaker 1: When we spoke, Serrouni had just treated someone who had

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Speaker 1: taken a rifle shot to the liver.

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Speaker 2: The reason he's alive. And I will take some credit

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Speaker 2: at George Washington, but honestly, one of the bigger reasons

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Speaker 2: he's alive is the paramedics. They completely scooped and and

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Speaker 2: with this guy. I think their entire scene time was

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Speaker 2: like ten or twelve minutes, and they just high tailed

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Speaker 2: it to the trauma center when he showed up on

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Speaker 2: our doorstep. You figure by now it's been twenty twenty

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Speaker 2: five minutes of the most from the moment of wounding

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Speaker 2: to arrival to the trauma center. He was probably five

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Speaker 2: to ten minutes away from dying. He was the extreme

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Speaker 2: end stages of shock.

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Speaker 1: Or what about a bullet to the lungs?

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Speaker 2: A paramedic can actually treat a gunshot win to the lung.

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Speaker 2: They can temporize that person very nicely. So do that.

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Speaker 1: How do you temporize someone who's had a gunshot win

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Speaker 1: to the lung?

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Speaker 2: So, when you have a gunshot to the lung, assuming

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Speaker 2: it has not hit a blood vessel, assuming you're not bleeding,

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Speaker 2: all you have is a gunshot to the lung, which

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Speaker 2: is I believe or not really really common. The problem

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Speaker 2: is you have air leaking from your lung, and that

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Speaker 2: air is accumulating inside the chest. As that air collects

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Speaker 2: more and more inside the chest because it's leaking out

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Speaker 2: of lung, it'll create a lot of pressure in the

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Speaker 2: chest and it'll cause it'll alter the blood flow to

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Speaker 2: your body. So the paramedic can simply put a needle

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Speaker 2: inside your chest, believe it or not, just like literally

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Speaker 2: in sort of needle through your skin into your chest

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Speaker 2: and it's like popping a balloon. It'll allow that air

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Speaker 2: that's accumulating to decompress, and that's all you have to do.

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Speaker 2: That will buy the person then tens of minutes if

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Speaker 2: not more, to get to the trauma center to allow

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Speaker 2: us to then fix the issue at hand. But that's

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Speaker 2: a paramedic.

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Speaker 1: Skill absince that intervention that would be a fatal event. Correct,

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Speaker 1: Just to deling on this time question for a moment.

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Speaker 1: So if I have a gunshot wound to the chest

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Speaker 1: and I have exactly happening to me what you just described,

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Speaker 1: how much time do I have without an AMS's intervention?

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Speaker 1: Half an hour?

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Speaker 2: Yeah, probably about half an hour or so, I mean

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Speaker 2: plus minus, But yes, I would think so.

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Speaker 1: So let's think through the logic of this. A city

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Speaker 1: or country's homicide rate is heavily dependent on how good

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Speaker 1: its medical system is a treating gunshot once. And what

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Speaker 1: determines how good a medical system is a treating gunshot ones,

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Speaker 1: at least in part, it's how quickly a gunshot victim

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Speaker 1: can get to a Level one trauma center. Okay, second question,

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Speaker 1: and in this case, let's use Chicago as our example,

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Speaker 1: classic big American city. Chicago absolutely confirms the theory that

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Speaker 1: proximity to a trauma center matters. According to a big

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Speaker 1: study done a couple of years ago by the epidemiologist

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Speaker 1: Marie Crandall, if you live more than five miles from

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Speaker 1: a Level one trauma center in Chicago, you had a

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Speaker 1: thirty five percent higher chance of dying from your wounds

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Speaker 1: than if you were shot less than five miles from

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Speaker 1: a Level one. So here's the second question. What determines

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Speaker 1: how quickly you get to a trauma center in Chicago?

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Speaker 1: Is it a random fact like whether there's an ambulance

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Speaker 1: nearby when you get shot, or how bad the traffic

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Speaker 1: is that day on the way to the hot hospital,

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Speaker 1: or is there a pattern to who lives within five

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Speaker 1: miles of a Level one and who doesen't a physician

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Speaker 1: at the University of Chicago named Elizabeth Tongue set out

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Speaker 1: to answer that question a few years ago, what do

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Speaker 1: you find in Chicago?

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Speaker 3: And so we found that black majority census tracks were

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Speaker 3: disproportionately in these trauma deserts.

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Speaker 1: A trauma desert, by the way, is what er docs

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Speaker 1: call places that are a long way from a level one.

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Speaker 3: That racial disparity was essentially very large, approximately a sevenfold

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Speaker 3: increase on the south Side in black communities.

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Speaker 1: Wait to explain the sevenfold the racial disparity between what

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Speaker 1: and what is sevenfold higher.

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Speaker 3: The racial disparity between black majority census tracks and white

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Speaker 3: majority census tracks.

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Speaker 1: Is seven x sevenfold sevenfold. Wow. For a period of

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Speaker 1: thirty years, between nineteen one and twenty eighteen, the south

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Speaker 1: side of Chicago didn't even have a Level one trauma center.

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Speaker 1: So if you got shot on the south Side, and

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Speaker 1: by the way, the south Side is the area of

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Speaker 1: Chicago where you're most likely to get shot, the ambulance

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Speaker 1: had to take you all the way across the city

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Speaker 1: uptown to Northwestern or Cook County or west to advocate

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Speaker 1: Christ Medical Center miles away. Now, why did the south

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Speaker 1: Side go so long without a trauma center? Because it

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Speaker 1: makes no sense for any hospital to open one on

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Speaker 1: the South Side. Treating gunshot wounds serious ones is incredibly expensive,

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Speaker 1: and the typical gunshot victim in Chicago is a young

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Speaker 1: black man from a poor neighborhood, and young black men

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Speaker 1: living in poor neighborhoods in Chicago typically don't have health

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Speaker 1: insurance or they're on Medicaid, which reimburses at a fraction

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Speaker 1: of what private insurance does. The euphemism used in the

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Speaker 1: healthcare world is payer mix, which refers to how many

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Speaker 1: of your patients come to you blessed with private coverage.

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Speaker 1: Opening a trauma center in a bad neighborhood messes with

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Speaker 1: your payer mix deeply, which is a paradox. Right. The

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Speaker 1: point of a trauma center is to be closest to

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Speaker 1: the places where people are getting shot. But if you

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Speaker 1: put your trauma center close to the places where people

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Speaker 1: get shot, your payer mix will go to hell in

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Speaker 1: a handbasket and you won't be able to afford to

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Speaker 1: run your trauma center. So you put your trauma center

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Speaker 1: as far away as possible from the people who most

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Speaker 1: need your trauma center. As I said at the very

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Speaker 1: beginning of this series, the way America deals with gun

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Speaker 1: violence is bonkers. You can hear this series starting August thirty,

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Speaker 1: first six episodes airing weekly with ads or ad free,

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Speaker 1: and all at once for Pushkin plusubscribers. Subscribe on Apple

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Speaker 1: Podcasts or at pushkin dot Fm, slash plus