Doctors and nurses work tirelessly to save the lives of thousands of gunshot victims annually, but treating so many horrific injuries can take a toll on hospital staff, Modern Healthcare reports.

According to the Agency for Healthcare Research and Quality, tens of thousands of Americans seek emergency care and are hospitalized for firearm injuries every year.

Many of them arrive at Jackson Memorial Hospital's Ryder Trauma Center in Miami, which has treated an average of 550 gunshot victims annually—more than one victim a day.

Army veteran and surgeon George Garcia trained at Ryder before being deployed to Afghanistan. "In my own personal experience, Miami was busier than Afghanistan," he tells Modern Healthcare.

One nurse recalled a recent shift in which Garcia treated four gunshot victims as being "like a war zone." That's a common enough occurrence at Ryder Trauma, Tristram Korten writes for Modern Healthcare, that the U.S. Army trains all teams that will perform surgery on soldiers in battle zones at the hospital.

Says trauma nurse Victoria Franco, "You know you’re coming to work to see the worst. There is no happy day at work."

At John H. Stroger Jr. Hospital in Chicago, clinicians saw an even worse toll from gun violence last year. Staff treated about 900 gunshot victims, about one-third of all people shot in the city.

Hospitals have to act fast to save lives when the call comes. Staff quickly prep the observation bay, ready IVs for fluids, prep the blood infusion machine, bring out the thoracotomy tray, and charge the defibrillator—and that's all before the patient arrives.

"If you're a medical professional in trauma," Korten writes, "there is no greater sense of fulfillment than using the available minutes, even seconds, to save someone's life."

The costs for providers

But such work can also take a great toll on providers, Korten notes.

Several providers tell Modern Healthcare that compartmentalizing or taking steps to unwind such as yoga helps them get by—but often, it's not enough.

How you can be proactive at managing behavioral health

One 2012 survey of 133 trauma surgeons found that two-thirds of respondents had signs of post-traumatic stress disorder (PTSD), while studies in Belgium and Denmark, which have lower rates of gun violence than the United States, have found that only 10 to 20 percent of ED doctors have PTSD symptoms.

If PTSD symptoms go untreated, they can result in suicide or substance misuse, Maria Castellucci reports for Modern Healthcare. Some researchers estimate that about 400 physicians in the United States die by suicide annually, and studies have found that nurses are four times as likely to die by suicide as other professionals.

Modern Healthcare reports that few hospitals do enough to "address the emotional toll and exposure their employees face dealing with everyday gun violence."

Some hospitals offer counseling, but some providers feel pressure to hide any mental health issues. However, Leslie Zun, president of the American Association for Emergency Psychiatry and chair of emergency medicine at Mount Sinai Hospital in Chicago, says the culture is beginning to change.

For instance, some state medical board certifications no longer ask doctors whether they are being treated for PTSD, out of concern the question could be stigmatizing. In addition, Zun says physician leaders are making an effort to be more available to discuss issues with staff and that clinicians are becoming more willing to speak up.

Some hospitals are also broadening their efforts to try to prevent gun violence from happening in the first place. The stakes are especially high because, in addition to its physical and emotional tolls, gun violence can create financial difficulties for health care organizations because many victims are uninsured.

One example of the new approach: John H. Stroger Jr. Hospital uses a violence intervention model, partnering with Cure Violence, Project BrotherHood, and other not-for-profit groups to provide support to victims and reduce the chances of retaliatory actions, Bob Herman reports for Modern Healthcare.

But American Medical Association President Andrew Gurman says hospitals can't do that work alone—they need more support from the federal government to combat gun violence and assess its effects on physicians.

"Most physicians have a high degree of frustration over the ongoing gun violence in our culture," he says (Korten, Modern Healthcare, 6/27).