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Commentary: The gun violence lane leads directly to the emergency department

https://www.modernhealthcare.com/article/20181129/NEWS/181129925/commentary-the-gun-violence-lane-leads-directly-to-the-emergency-department 

Firearms violence is a serious public health issue in America, and emergency physicians are on the front lines. My colleagues and I see and treat the victims of this senseless and tragic violence every day in our emergency departments. Just a little more than a week ago an emergency physician was gunned down in a fit of rage, along with a police officer and pharmacy resident at a Chicago hospital.

We hear the screams of parents when we tell them their child has died. We do everything we can to heal the victims and save lives. But never has the adage been more true: an ounce of prevention is worth a pound of cure. Recently, an anonymous tweeter at the National Rifle Association created a social media storm by saying that physicians should "stay in their lane" when it comes to gun violence. Many physicians, including me, believe that firearm injuries are very much "in our lane."

Research—both public and private—is essential to reduce firearms injuries and help protect our communities. The treatment we provide to our patients is informed by research and evidence, and the way we approach the public health issue of firearms violence should be no different.

The American College of Emergency Physicians supports the efforts of the American Foundation for Firearm Injury Reduction in Medicine, a not-for-profit organization known as Affirm founded and led by emergency physicians. Affirm and others are working to end the epidemic of gun violence through research, innovation and evidence-based practice. As physicians it is our duty and obligation to speak out regarding all public health issues. It is part of our role in caring for our communities.

In medicine, the approach to public health issues has been both clear and effective. Take motor vehicle accidents for example: we, with the auto industry working alongside us, sought to identify the problem, research possible solutions, then implement evidence-based solutions (speed limit changes, driver education, seat belt laws, etc.) that led to marked decreases in injuries and death.

The duty of physicians to discuss firearms safety with patients must be protected by our legislators. To help address this critical public health issue, the ACEP believes that Congress must do more to ensure that federal agencies conduct necessary scientific research on firearms injuries, and further, that such efforts are appropriately funded. The current approach does not suffice—Congress must actively support a public mission to improve the health and safety of all Americans.

To bolster research efforts, the nation should establish a confidential, national clinical registry for firearm injury research. To be clear, this would not be a registry of firearms or firearms owners. States would be encouraged to have uniform approaches to tracking and recording firearm-related injuries.

While not the sole answer, increasing mental health services in America is also an important consideration in reducing firearms injuries. Some 60% of deaths by firearms are suicides. Millions of people come to EDs across the country with psychiatric emergencies because there are severe shortages of mental health resources in the U.S.

The vast majority of patients with mental illness do not commit firearms violence, nor are they somehow primed to do so. We must be careful not to perpetuate the myth that mental illness leads to violence and further stigmatize patients who suffer from mental illnesses.

Each year in America, more than 36,000 people are killed, and twice that many are injured by firearms. Some suggest that if a specific change does not significantly reduce the number of tragic shootings, we should not pursue it. But doing nothing because a solution does not address every facet of the problem is irresponsible and unacceptable. Emergency physicians do not exist simply to treat the wounds caused by firearms—it is also our role to ensure the health and well-being of our patients, and the discussion on how to help prevent these injuries through public health research and evidence-based practice is our lane.

We call on the National Rifle Association and all firearms advocates to work with the medical community to find, and fund, workable solutions to this problem. No one wants to see increased death and destroyed lives due to firearms, including the NRA.

We are all in this lane together.