THE RECENT DEATHS of two much-loved university students and a father-of-three, apparently stabbed at random in Nottingham, shocked the whole of the UK, but sadly they reminded me of similarly awful killings involving knives closer to home. We’ve all heard of the many tragic cases in recent week and in the past few years in Ireland where innocent people’s lives were snatched away in mere minutes after the frantic pulling of a knife.
And that is how it must be, I suppose. All ‘right-thinking’ people – on both sides of the Irish Sea – should be dismayed by such stories, and deeply disturbed by the relentless rise in serious knife crime in London, and other parts of the UK.
However, despite the valid concerns recently expressed in the Irish media, I’m not sure that our knife crime levels can yet be described as a public health crisis (which is how many medics do describe the situation in Britain).
Nonetheless, throughout a long career in emergency medicine, I’ve observed that most public health challenges in the UK (from drug use to teenage pregnancy, obesity to violence) are sooner or later replicated on this island, so I’d argue that now is the time to resist any complacency and to think long and hard about how we might tackle what is likely to be a growing issue here in the foreseeable future.
That means we need to examine the prevailing pattern of knife crime in Ireland, its likely trajectory, and what can be done to mitigate the effects and address the root causes.
First things first: the basic nature of knife crime here is similar to that in the UK, only writ smaller. Seizures of knives (and other weapons like screwdrivers) are running at about six a day, and rising, but – and this is important – there is little correlation between the number of knives confiscated by the Gardaí and the scale of knife-related crime.
So, while the pile of decommissioned weapons is growing (due to more proactive policing, and better information technology), the ‘medical impact’ may actually be less than it was some years ago. For instance, between 2006 and 2011, the number of “knife attack” victims treated as inpatients in Irish hospitals ranged from 230-270 cases annually, but between 2012 and 2019 the average number of admissions had dropped to between 165-195 cases annually. However, many attacks go unreported, so there will always be gaps in our knowledge.
Of course, the vast majority of knife attacks are not lethal: in the UK, it’s been estimated that the mortality following such an assault is about 0.6%. We know that most stabbing deaths result from chest, abdominal, head and neck trauma, but most knife crime victims have penetrating limb injuries. The reasons for this blessedly low death rate include a non-homicidal intent on the part of most assailants, recent improvements in trauma care in these islands, and the fact that the slashing or stabbing involved usually ‘misses’ vital organs.
To illustrate the risk: chest injury accounts for over 50% of stabbing deaths in the UK, but only 12% of stabbing admissions to emergency departments (EDs); conversely, limb injury accounts for 64% of such attendances but little mortality.
It would be wrong, though, to assume that ‘non-lethal’ is trivial, for either the victim or the healthcare system. Patients can sustain devastating facial wounds or they may lose digits, hands or the use of their limbs in particularly savage attacks, and plastic surgery is required for nearly 80% of arm or leg injuries.
Overall, respectively, plastic surgery is required for 35%, general surgery for 23%, and chest surgery for 22% of knife crime cases.
And some trends are horrifying: ‘bagging’ is a grotesque type of attack increasingly seen in the UK. This involves a stabbing in the buttock, designed to disable and/or terrorise victims, but because a penetrating wound in this anatomical area can affect the rectum, bladder and associated blood vessels, victims may die because the severity of the injury is not initially appreciated, while those who survive often need a colostomy bag and urinary catheter for a long time afterwards. In short, knife crime can be truly nightmarish for all involved.
Medics involved in the prevention of crime (as I was myself in Liverpool as a young consultant) sometimes argue that those on the receiving end of their ‘awareness’ courses should have been targeted 15 years previously, and they have a point.
The fact is that the conditions that nurture violent behaviour include severe material and emotional deprivation, a chaotic childhood home (with intoxicated or brutal parenting), and a neighbourhood where crime, violence and fear are endemic.
Exaggerated ‘masculinity’ or ‘machismo’ may feature too, especially when gang culture is entrenched. Add in poor impulse control, excessive drink and drug consumption (e.g., alcohol, amphetamines, benzodiazepines, cannabis or cocaine), and you generate the disinhibition, impulsivity and paranoia that often feature in the worst knife crime cases.
In trying to prevent knife crime, as well as mitigating its impact, what matters most is to cultivate a facts-based perspective, to maintain a positive attitude (as with all public health challenges) and to learn from models of practice that work.
Tackling deprivation in early childhood, offering genuine alternatives to gang culture, like local opportunities to work and play, teaching schoolchildren about the risk of carrying a knife (which increases the likelihood of it being used by or against the user), reducing drug-taking, and developing emergency medical systems that get victims to the suitable urgent care facility (like a major trauma centre, if there is a risk to life or limb) are all crucial, complicated and costly interventions. Mind you, the alternative, a laissez-faire or defeatist approach, is simply too painful – and ultimately too unbearable – to contemplate.
Dr Chris Luke is a columnist and author, and retired consultant in emergency medicine.
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