The ambulance-homicide theory
New York Times
By Ryan Lizza
December 15, 2002
For all the theoretical talk of ''broken windows'' and ''zero tolerance'' policing that has dominated the public discourse on crime during the past decade, research published this year suggests that the most significant factor in keeping the homicide rate down is something much more practical: faster ambulances and better care in the emergency room. That, in any case, is the intellectual hand grenade that Anthony Harris, director of the Criminal Justice Program at the University of Massachusetts, Amherst, has thrown into the polarized debate over crime prevention.
Harris stumbled upon this simple idea after years of trying to figure out why the aggravated-assault rate skyrocketed by several hundred percent over the past four decades, while the murder rate has remained flat, never increasing or decreasing by more than 50 percent. He had his breakthrough a couple of years ago, while watching an emergency-room reality TV show that featured the story of a man stabbed in the head with a huge knife. Despite horrendous injuries, E.R. doctors saved the man's life. Instead of a homicide, the patient became an aggravated-assault victim, and Harris realized he had the explanation he had been looking for. ''It was an epiphany,'' he says.
In ''Murder and Medicine,'' a paper published in May in the journal Homicide Studies, Harris and three other researchers determined that the murder rate is being artificially suppressed because thousands of potential homicide victims each year are now receiving swift medical attention and surviving. Americans, in other words, aren't any less murderous -- it's just getting harder for us to kill one another. Our modern 911 dispatchers, E.M.S. technicians, trauma-care units and emergency-room surgeons have been saving patients who were on the cusp of becoming murder statistics and moving them into the aggravated-assault column.
Between 1960 and 1999, the proportion of criminal assaults ending in death -- what Harris calls ''the lethality rate'' -- dropped by 70 percent. (The steepest decline came in the aftermath of the Vietnam War, when advances in battlefield surgery led to innovations in civilian emergency care.) In fact, Harris estimates that there would be 30,000 to 50,000 additional murders in the U.S. each year -- doubling or tripling the current rate -- without our current levels of emergency-care technology.
If he's right, the focus by criminologists on the stable or declining murder rate is actually masking a radical increase of violence in America, a fact that has unexpected consequences. For example, communities without access to the most advanced emergency medical services may have higher homicide rates. ''How much is the black-offender rate inflated?'' Harris asks. And there are strange implications for the criminal-justice system. An attempted murderer carrying out his crime in an area with poor emergency services is more likely to succeed than one operating near a high-tech trauma center. The former may be executed, while the latter spends just a few years in prison, their punishments determined not by any disparity in lethal intent, but by the unequal levels of local medical care.