Lindsey Roden, MPH

August 3, 2010, eight people killed in Manchester, CT. June 17, 2015, nine people killed in Charleston, SC. December 2, 2015, 14 people killed in San Bernardino, CA. June 12, 2016, 49 people killed in Orlando, FL. October 1, 2017, 58 people killed in Las Vegas, NV. February 14, 2018, 17 people killed in Parkland, FL.  These shootings combined resulted in the deaths of 531 people including two unborn children. Since 1949, there have been 34 mass casualty shootings within the United States, 12 of which occurred within the past decade and still climbing. The magnitude of these unfortunate occurrences has terrorized communities, families, and health care providers.

Firearm-related injuries can be lethal and account for 7.1% of premature deaths and loss of life before the age of 65. Ownership of a firearm has been identified as a risk factor for firearm violence, and there are more than 50 million firearm owners in the U.S., approximately 35% whom are men and 11% whom are women (Wintemute, 2015). Furthermore, Fowler et al, indicates that on average 645 people lose their lives to firearm violence, while 1,565 other people are treated for a firearm related injury per week. Annually, these numbers account for a little over 36,000 deaths per year (Fowler et al., 2015; Gani et al., 2017).

Death by firearm is the second-ranking injury related cause of death in the U.S. following poisoning and preceding motor vehicle accidents. In comparison to other high-income countries, the U.S. is reported to have the highest rates of deaths associated with firearms. This in part, may be due to guns being easily accessible in the U.S. Several studies suggest that men in particular are disproportionately affected by firearm violence for both fatal and nonfatal injuries incurred. While few studies have accounted for mortalities due to firearm violence, there is little to no acknowledgement of the impact that it has on nonfatal injuries to victims or why men are disproportionately impacted by this problem. Gun violence has caused significant physical, psychological, and financial costs to individuals, families, and society. Moreover, this epidemic has the potential to perpetuate a vicious cycle of terror among both bystanders and victims. Long-term effects of firearm violence can include retaliation, risk of disability, or the development of a mental illness.

Given the grave scenario we are facing, what can be done to change the narrative? In 1996, the Centers for Disease Control and Prevention (CDC) barred funding for research on firearm injuries. Since that time, the sparse research available indicates that the U.S. has experienced an increase in mass casualty shootings, accidental shootings, and fatal and nonfatal injuries due to firearm and gun violence. In order to begin to see a change in this cycle, the U.S. must avoid turning a blind eye to this public health crisis, as well as implement micro and macro levels of change in our communities and systems.

Some of these changes may include gun reform, peaceful protests, or boycotts to change gun laws and regulations. Furthermore, evaluation of the problem at stake as well as intervening with preventive measures to alleviate the burden and enforcing protocols to adequately address victims’ needs is critical, as well as resourcefully utilizing supplies and medical equipment.

In January of 2013, President Obama ushered in 23 executive actions to federal agencies, such as the CDC and other scientific organizations, to improve our law enforcement, schools, and health services systems’ knowledge about firearm violence. These orders sought to implement courses of interventions to prevent these incidents, and to continue to put efforts toward finding resolutions to minimize the suffering we face. Although this was intended to bring about change, very little has been done to follow through on these orders. This may be in part due to the politically polarizing nature of the firearm violence debate. Although there are approximately 20,000 laws governing firearms, clear guidelines have not been established to understand the issue at hand.

Former Director of the CDC, David Satcher once said, “if it’s not a public health problem, then why are so many people dying from it?” The few studies that examine gun violence are heterogenous and biased. To have a more comprehensive understanding of this epidemic collaboration from various health professionals, such as public health practitioners and emergency department doctors, we must have input from government agencies, and communities. Aside from establishing a standard and concise definition of the problem, the next step would be to follow through with the initial executive actions drafted by former Vice President Biden on behalf of former President Obama.

While many plans have been proposed to prevent mass casualty shootings, few funds exist to expedite implementation. Therefore, it is imperative to call upon our government to secure a budget dedicated to the prevention of mass casualty shootings. A budget specifically for this issue will give institutions and emergency departments the resources to create interventions, sufficiently supply our EDs, provide adequate treatment and follow up, outsource nonfatal patients to other healthcare services such as physical therapy and mental health services, as well as mandate a protocol to prepare ED staff for mass casualty or any other type of firearm related violence. A specific budget would also allow for data on firearm related violence to be stored and accounted for, and not merely have fatalities tell the tale. The differentiation of information will help to derive data that can then be utilized for interventions.

Across the country, people are calling for action to combat this epidemic. We have experienced the triumph of these tragedies, the rallies that follow, and the court cases. We need to put a higher value on life and understand that firearm violence has no boundaries in regards to geographic region, ethnicity, gender, race, socioeconomic status, or age. Firearm violence is preventable, and until we begin to push Congress to vote on legislation that impacts this cause, will not see the violence decrease. Former President Barack Obama explained, “we don’t benefit from ignorance. We don’t benefit from not knowing the science of this epidemic of violence. (The White House, 2013, p.5)”. Gun violence prevention is a critical task to protect the American people.

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