Guns and Medicine

As of June 2016, the most powerful medical organization in the U.S., the American Medical Association (AMA), has declared gun violence a public health crisis. This is a fact, not a political statement. Public health measures address disease and illness protection; but by definition public health includes the health, safety, and security threats of a society (http://npalliance.org/wp-content/uploads/NPA-Myths-Facts-Gun-Violence-Research-June-2014.pdf). After all, who cares for all the victims of gun violence?

Doctors, nurses and all our healthcare providers deal with the aftermath of the violent attacks. Emergency rooms and trauma centers are flooded with patients, and the healthcare industry must tackle the management and prevention of injury, death and other harms resulting from firearms.
            The numbers have simply grown so large in America that gun violence is considered an epidemic (AMA and American College of Physicians). The Centers for Disease Control and Prevention (CDC) defines Epidemiology as “the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems.” So, bottom line, managing gun violence falls into the arena of medicine despite the protests of some in our country, claiming that it is not a health issue.
            Dr. Steven Stack, AMA President, notes that America is unrivaled compared to any other developed country in the world. On average, 30,000 Americans die annually at the face of a gun and twice as many are injured. In comparing these stats with other countries, America’s gun murder rate is 25 times the average of other developed countries (https://everytownresearch.org/gun-violence-by-the-numbers/).  In the U.S. non-fatal firearm-related crimes (rape, robbery, assault), encompass over 460,000 per year (http://nij.gov/topics/crime/gun-violence/Pages/welcome.aspx). These victims not only become patients in our hospitals, but too often the violence follows into our emergency departments and healthcare facilities. Healthcare providers are at risk of violence in emergency rooms and other healthcare settings.
            Gun violence is clearly a public health issue. In addition to the sheer number of people dying with healthcare providers trying to save them, society has to consider the healthcare cost of the dying process. Whether a patient dies or survives, Faran Bokhari, MD, chairman of the Cook County Trauma & Burn Unit at John H. Stroger Jr., Hospital, emphasizes that trauma care is extremely expensive. A four to five day hospital stay can cost upwards of $250,000 and transportation cost via helicopter is close to $20,000.
            For every death from a gun, there are 10 times as many people disabled as a result of shootings and this once again brings the victims into the healthcare field, along with the burden of cost to our society (http://www.beckershospitalreview.com/hospital-management-administration/how-hospitals-need-to-help-fight-gun-violence-3-experts-weigh-in-on-chicago-s-nagging-public-health-problem.html). Violence intervention is yet another healthcare concern since there is a 45% chance of reinjury within five years for gunshot victims. Finally, there is the factor of the mental health of patients and staff to consider. In addition to the stress and emotional issues that victims and their families experience, staff members in emergency departments and trauma centers are exposed to more and more stress in what is called “vicarious trauma.”
            So, how will the health field begin to tackle this challenge? Gun violence as a public health crisis has many layers to unravel, and the solution begins with research. Our approach to traditional healthcare in this country starts with evidence-based medicine. This means our healthcare industry looks for methods that have been researched and proven effective. But when it comes to researching gun violence, there has been a 20-year ban blocking the CDC from funding any research related to gun violence (http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-gun-violence-lobby-congress.page). According to Sandro Galea, an epidemiologist and the Dean of Boston University's School of Public Health: "It's time for us to collect better data so we can understand the consequences of gun violence, and understand what we can do to mitigate the consequences."
(http://www.usnews.com/news/articles/2016-06-14/ama-calls-gun-violence-a-public-health-crisis). The AMA’s first step is approaching Congress to lift this ban to allow research to begin. The original funding block, known as the Dickey Amendment, was established by Representative Jay Dickey in 1996, and now he has openly expressed his regret for helping promote the ban.
            Shannon Cosgrove, MHA, is director of health policy for Cure Violence, which is an organization that applies disease prevention models to violence. Ms. Cosgrove states: “One of the key pieces is really having trusted community members involved with violence prevention.” (http://www.beckershospitalreview.com/hospital-management-administration/how-hospitals-need-to-help-fight-gun-violence-3-experts-weigh-in-on-chicago-s-nagging-public-health-problem.html). One aspect of Ms. Cosgrove’s study on violence has resulted in finding a health-system approach for reducing retaliation-related shootings. As noted above, in addition to the physical and emotional trauma of gun violence, the cost of caring for victims is astronomical. If nothing else, the amount of money each conflict mediation saves is substantial and a worthy investment for many reasons. Let’s hope the AMA’s adoption of gun violence as a public health crisis will result in research that leads to the understanding of the consequences of gun violence and how to alleviate the crisis.