Blog note: Jesus indicated that one (of many) signs of the end times or the end of the age grace would be that love for one another would grow cold. Matthew 24:12, “And because iniquity shall abound, the love of many shall wax cold.” This can also be interpreted that lawlessness will abound. This includes violence, murder, terrorism, shootings, knife attacks, car/van attacks, chemical attacks and other similar acts of destructive and evil behavior. Yes, these things have occurred in time past. But consider the frequency, intensity and devastation of these types of attacks and mass school shootings. They are like birth pangs in frequency and intensity. This is just one part of the CONVERGENCE or CONVERGING of signs. End of note

Surgeon’s view: ‘Stabbing victims are getting younger, and their wounds worse’

Dr Martin Griffiths, a consultant trauma surgeon, talks about his experiences of knife crime

Denis Campbell. Tue 6 Nov 2018 18.30 EST. The Guardian.

Stabbing victims are getting younger, the time of day when they’re typically stabbed is changing and more of them are sustaining more injuries. That’s what we have found from data on the 1,824 patients under the age of 25 who have been stabbed and who have been treated in our major trauma centre between 2004 and 2014.

In the 1980s in the same part of the city we cover, east London, a stabbing victim was, on average, in his late 20s and had sustained a solitary stab wound. Our average is now 18, and 25% of knife victims we see are of school age. It’s now not unusual to treat victims with multiple stab wounds.

Five, seven, nine or more wounds are commonplace in our practice. We routinely see increasingly severe injuries. The injury patterns – bladed weapons, blunt trauma from beatings or being run over, caustic agents – and structures injured represent a much greater threat to life than injuries I saw in my surgical training. I suspect that these young people are the victims of multiple assailants.

No injury is minor. Every one takes a mental and physical toll. This year we will admit 800 stabbing and 60 gunshot victims with life- or limb-threatening injuries. Knife/gun injuries are about 30% of our workload. This year we’ve seen double the number of stab wounds we saw in 2012. For the first time, knife injury is the most common reason London air ambulance helicopters with doctors on board are dispatched.

Stabbing victims look scared. There are no heroes in a resuscitation room. Most of those who are conscious fear for their lives. They’ve never seen their own blood spilt and don’t want to die. Patients present in all states, from awake and talking to ventilated and actively bleeding, with every possible permutation in between.

Young people over 16 tend to be injured in the late evening; that hasn’t changed. But we’ve identified a previously undocumented and disturbing pattern relating to injuries to children on weekdays. Under-16s tend to be injured between the hours of 4pm to 6pm and close to their home. I suspect this relates to large numbers of children travelling from school and congregating in places such as bus stations, shopping centres and food outlets.

What triggers these assaults? Young people are often injured in robberies, old beefs or incidents related to the drug trade. But we also commonly encounter individuals who are injured for seemingly little or no reason. Respect and ratings are hugely commonly cited as reasons. I recall a young girl being shot in the head for making a joke about another girl at a party. The girl’s partner felt bound to respond with violence.

The rules of the game dictate why people get hurt. If you don’t show the appropriate respect to a local “face”, or you step on the wrong person’s trainers, it’s obvious what happens next. History is littered with fighting rituals and duelling. Challenge and counter-challenge have been part of youth culture for as long as history has recorded youth violence.

About half the people we come across are stabbed by their own weapon. Often there’s been hand-to-hand combat, with lots of shouting and swearing, and during that knives get taken away from people and used on them.

Why are victims getting younger? Every older generation thinks younger ones grow up much faster than they did. I suspect that the world is a much smaller place: information travels near instantaneously and, more importantly, technology gives children access to unfiltered, fully formed opinions and belief systems without the opportunity to challenge or even understand what male and female roles are. We have all been empowered to voice our opinion remotely, for example via social media, without the need or willingness to explain our position or compromise.

For those who have no experience of living the lives our patients live, these facts must seem unsettling. I don’t condone any of the acts that I see, but if you understand the rules of the game, you understand the actions. The lack of empathy or even the willingness to want to understand the drivers and logic behind the violence we see is as much a problem as the violence itself. I suspect society feels more comfortable demonising a portion of society – the police, educators, social services, housing or parents – than taking a considered view. Why are you scared of 14-year-olds standing on a corner?

I go into schools to talk about the realities of knife violence. I show pupils some pretty graphic photographs of stabbing victims, sometimes with a surgeon’s hand inside their chest, to help them realise the impact of a knife wound. The most common question I get asked by pupils is: is there a safe place to stab someone? I say: in your dreams – no, there’s not. I’ve seen people die after being stabbed in the calf, shoulder, face or arm. Some people think it’s safe to stab someone in the buttocks, but there are a lot of big blood vessels there, and the bowel is near there, too. There is no safe place to stab someone.

Some kids think: if I can inflict an injury that’s not life-threatening then I can get some respect for doing that. But the truth is, that’s a myth. If you hurt someone with a knife and they survive, they will be out for revenge – on you, your brother or your mum. Plus, the police may catch you and you may go to prison. So it’s madness to think like that. People need to connect action and consequence. They have another choice, of course, which is not to stab someone.

The news about knife crime is relentlessly grim. But behind the headlines there are some good things going on. For example, we have reduced the proportion of stabbing victims who come back to us after being knifed a second time from 45% to just 1%. We’ve had tremendous success in reducing rates of retaliation violence readmission in young people. We work in partnership with the St Giles Trust, a charity that works to reduce youth violence, and it has played a key role in that. It helps victims from the moment they arrive all the way through their treatment, rehabilitation and return to their community, and works with their families, too.

Youth knife violence can be reduced. I’ve also seen tremendous benefit from well thought-out and delivered secondary prevention – or “gangs call-in” – programmes in which at-risk youths receive focused support. There is amazingly strong data documenting the benefit of supporting children and parents in early life, promoting strong parental relationships, education and engagement with empowering non-academic activity, but they are long-term, decades-long interventions.

The key is forming consistent, supportive and nurturing relationships between youths and people they trust and respect, who are culturally competent and appropriate. We need to have services that are fit for purpose and are allowed to deliver, such as policing, education and housing. But each individual needs a solution that’s unique to them. It’s like making a pizza: what’s perfect for a 16-year-old-girl in Basingstoke isn’t right for a 14-year-old boy in south-east London.

• Dr Martin Griffiths is a consultant vascular and trauma surgeon at the Royal London hospital, lead for trauma surgery for Barts Health NHS trust and a co-author of a new research study which found that a large proportion of stabbing victims treated at a London trauma centre were children.
• This article was amended on 7 November 2018. An earlier version referred to 1,824 stabbing victims under 25 who were treated at the hospital’s major trauma centre since 2012. That figure is the number of such patients treated there between 2004 and 2014.