June 2, 2022 – Trauma surgeons are in the tough position of seeing victims just after gun violence across the United States, and they have some advice.
Their strategies can work regardless of where you stand on the Second Amendment of the Constitution, said Patricia Turner, MD. "Our proposals are embraced by both gun owners and non-gun owners alike, and we are unique in that regard."
These “implementable solutions” could prevent the next massacre, Turner, executive director of the American College of Surgeons, said during a news briefing the group sponsored Thursday.
“Our future – indeed all of our futures – depend on our ability to find durable, actionable steps that we can implement tomorrow to save lives," she said.
"Sadly I'm here today as a trauma surgeon who has cared for two of the largest mass shootings in modern U.S. history," said Ronald Stewart, MD, chair of the Department of Surgery at University Hospital in San Antonio, TX.
Stewart treated victims of the 2017 Sutherland Springs First Baptist Church shooting – where 27 people died, including the shooter – and last week’s Uvalde school shooting, both in Texas.
"The injuries inflicted by high-velocity weapons used at both of these attacks are horrific. A high-capacity, magazine-fed automatic rifle such as the AR-15 causes extremely destructive tissue wounds," he said.
One of the group’s proposals is to increase the regulation of high-velocity weapons, including AR-15s.
"These wounds are horribly lethal at close range, and sadly, most victims do not survive long enough to make it to a trauma center," Stewart said.
On a positive note, "all of our current [Uvalde] patients are improving, which really brings us joy in this dark time," he said. "But all of them have a long road to deal with recovery with both the physical and emotional impact of their injuries."
Jeffrey Kerby, MD, agreed.
"Trauma surgeons see the short-term physical effects of these injuries and watch patients struggle with the long-term impact of these wounds,” said Kerby, director of trauma and acute care surgery at the University of Alabama at Birmingham.
Surgeons Feel 'Profound Impact' of Shootings
"Firearm violence has a profound impact on surgeons, and we are the undisputed subject matter experts in treating the tragic results," said Patrick Bailey, MD, medical director for advocacy at the American College of Surgeons.
"This impacts surgeons as well," said Kerby, who is also chair of the Committee on Trauma for the surgeons’ group. "We are human, and we can't help but share in the grief, the pain, and the suffering that our patients endure."
"As a pediatric surgeon … I have too often witnessed the impact of firearm violence, and obviously, the devastation extends beyond the victims to their families," Bailey said. "To put it succinctly, in our culture, parents are not supposed to be put in a position of burying their children."
A Public Health Crisis
"It's important to recognize that we've been talking about a public health approach," said Eileen Bulger, MD, acting chief of the trauma division at the University of Washington in Seattle. That strategy is important for engaging both firearm owners and communities that have a higher risk for firearm violence, she said.
A committee of the American College of Surgeons developed specific recommendations in 2018, which are still valid today. The group brought together surgeons from across the U.S. including "passionate firearm owners and experts in firearm safety," Bulger said.
The committee, for example, agreed on 10 specific recommendations "that we believe are bipartisan and could have an immediate impact in saving lives."
"I'm a lifelong gun owner," Bailey said, emphasizing that the team’s process included participation and perspective from other surgeons "who, like me, are also gun owners, but gun owners who also seek to reduce the impact of firearm violence in our country."
The recommendations address these areas:
- Gun ownership
- Firearm registration
- Education and training
- Ownership responsibilities
- Mandatory reporting and risk reduction
- Safety innovation and technology
- The culture of violence
- Social isolation and mental health
For example, "we currently have certain classes of weapons with significant offensive capability," Bulger said, "that are appropriately restricted and regulated under the National Firearms Act as Class 3 weapons."
This group includes fully automatic machine guns, explosive devices, and short-barrel shotguns.
"We recommend a formal reassessment of the firearms designated within each of these national firearms classifications," Bulger said.
For example, high-capacity, magazine-fed semiautomatic rifles, such as the AR-15, should be considered for reclassification as NFA Class 3 firearms, or they should get a new designation with tighter regulation.
The ACS endorses formal firearm safety training for all new gun owners. Also, owners who do not provide reasonably safe firearm storage should be held responsible for events related to the discharge of their firearms, Bulger said. And people who are deemed an imminent threat to themselves or others through firearm ownership should be temporarily or permanently restricted, with due process.
Research and Reporting Reforms
The ACS is also calling for research on firearm injuries and firearm injury prevention to be federally funded, Bulger said. The research should also be done in a nonpartisan manner, she said.
"We have concerns that the manner and tone in which information is released to the public may lead to copycat mass killers,” she said. “The ACS recommends that law enforcement officials and the press take steps to eliminate the notoriety of the shooter, for example.”
Bulger also addressed the mental health angle. "We encourage recognition of mental health warning signs and social isolation by teachers, counselors, peers, and parents." When identified, immediate referral to professionals is needed.
In addition to these recommendations, another team from the American College of Surgeons has published an overview of ways to address the inequities that contribute to violence. "We advocate for federal funding to support the development of hospital-based and community programs for violence intervention and prevention," Bulger said.
Turner said that based on ACS’ work group recommendations, she believes that many gun owners would support these steps.
Bailey said as a gun owner himself, “I do not believe that the steps recommended … pose undue burden on the rights of individual gun owners.”
The Time Is Now
Most firearm injuries are not from mass shooting events, Kerby said.
"My own trauma center has seen a 40% increase in the number of firearm injuries just in the last 2 years," he added, "and these numbers continue to grow."