During my pediatric surgery rotation, I distinctly remember taking care of a teenage girl who presented with a thoracic cord transsection and paraplegia after a drive-by shooting; she had previously lost both her parents to gun violence as well. It was disheartening to watch someone so young lose so much. In honor of National Safety Month, I have decided to devote this blog to a topic surgeons are unfortunately well familiar with: gun violence.
On average, 96 Americans, including 7 children/teens, are killed with guns each day, and the numbers increase each year in the United States (US). Compared to other high-income countries, the US has 25.2 times more firearm related deaths.
As surgeons, we are ready to respond with medical and surgical resources once gun violence victims enter our ED doors. However, we are limited with medicine/surgery alone to combat the detrimental effects of gun violence, as exemplified by the paraplegic teenager from my night on call. In the US, political and social factors influence gun violence mortality well before the bullet is fired. The modern interpretation of the 2nd Amendment is controversial and varies by state, social/racial disparities increase the risk of mortality from trauma including firearms, and federal funding for the investigation of gun violence is relatively underfunded, as recently mentioned by Dr. Copeland in a recent AWS blog post .2 Given the complex political and social context underlying gun violence, we as surgeons may question our role in preventing gun violence: what is our responsibility and what if anything can we do about it?
Shortly following the Parkland shooting earlier this year, the ACS published an open statement on the surgical community’s responsibility regarding gun violence prevention:. As “everyone’s problem,” the ACS Committee on Trauma (Cot) has created a Firearm Strategy Team (FAST) to implement three main areas of focus: legislation advocacy, research, and education. Legislation supported includes increased regulation of assault weapons as well as mandatory background checks. Education includes patient counseling on safe firearm ownership and the Stop the Bleed campaign designed to train civilians as first-responders to crises. Research goals include building a national firearm injury database in order to guide federal health policy.
Although as surgeons we are inevitably limited by time and energy to address all the challenges we face, we are often the sole primary healthcare providers for survivors of violence and thus we have a responsibility to screen and prevent disease witnessed as specialists in other fields do, such as gastroenterologists who screen for colon cancer or urologists who screen for prostate cancer.2 Hospitals have documented success attempting such interventions called violence intervention programs (VIPs) targeted at victims of violence and aimed at preventing injury recidivism.3,4,5 But, despite their documented success, VIPs are secondary prevention measures, and more needs to be done even further upstream—as outlined by the ACS COT FAST—to prevent inciting trauma.
As surgeons we witness the devastating effects of gun violence every day; we owe it to our patients—past, present and future—to use our knowledge to address the root causes of gun violence in order to both prevent and treat this public health epidemic.
Justine Broecker is a first year surgery resident at Emory originally from Atlanta, GA. She completed medical school at Emory University and her undergraduate degree at UVA. Her twitter handle is @jasb805.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.