Proceedings from the Medical Summit on Firearm Injury Prevention: A Public Health Approach to Reduce Death and Disability in the US

Abstract

An historic meeting of 44 major medical and injury prevention organizations and the American Bar Association was hosted by the American College of Surgeons (ACS) February 10-11, 2019. Leaders of these professional organizations met with the goal of building consensus around opportunities to work together to address the growing problem of firearm injury and death in the US. A multidisciplinary planning committee invited speakers who are leading experts and researchers in this field to review the epidemiology of firearm injury, discuss structural violence and the social determinants of health, review the public health approach to the problem, and discuss opportunities for injury prevention interventions. The goal was to be maximally inclusive and include organizations that represent physicians, nurses, public health professionals, and emergency medical services providers who are both on the front lines in caring for injured patients and also manage the long-term consequences of violence in the community. All invited organizations were encouraged to submit digital materials related to their organization’s firearm injury prevention initiatives and these were shared before the Medical Summit. A list of the organizations that have agreed to support the consensus statements from this conference can be found in Appendix 1. For the past 30 years, many medical organizations have led efforts to address firearm injury and firearm violence, but most (if not all) of these efforts have become mired in a debate about personal liberty and the Second Amendment to the US Constitution. Some of this controversy has been internal to professional organizations, and some has been external. In general, this debate has not been productive—while death rates from other medical conditions such as traffic injury, heart disease, cancer, and HIV have decreased, firearm death rates in the US are increasing. The ACS Committee on Trauma has worked steadily to move beyond this debate, and to move from published statements to constructive action. The keys to this approach center on addressing firearm injury as a medical and public health problem, not a political problem; developing research agendas to understand and address root causes of violence; and committing to a professional and civil dialogue centered on how best to reduce and prevent firearm injury, death, and disability. This mirrors the public health model that has been so effective in improving outcomes in traffic-related injury. The following were the objectives of this Summit: Identify opportunities for the medical community to reach a consensus-based, non-partisan approach to firearm injury prevention Discuss the key components of a public health approach and define interventions this group will support Develop consensus on actionable items for firearm injury prevention using the public health framework We also sought to learn about the current independent efforts of all participating organizations to identify gaps and collaborative opportunities (Appendix 2). These objectives focus on injury prevention, which is integrated into a healthcare and trauma system framework that also functions to turn bystanders into immediate responders, and ensures the delivery of optimal prehospital, hospital/trauma center, and rehabilitative care. This system also serves as a framework for disaster and mass casualty response. This systematic approach requires engagement, stakeholder partnerships, data collection, research, education, advocacy, communication, and cooperation. The public health approach to firearm injury prevention is identical to other highly successful injury prevention initiatives. The underlying philosophy is grounded in an ethical framework centered on the principles of beneficence, autonomy, and honesty. Although not speaking specifically about injury prevention, Dr Richard Moulton sums up the philosophic approach well about the rationale for professionals leading in this sphere. He states, “We dedicate ourselves to the service of humanity, and most importantly we place the needs of the patient above those of the doctor…” And, “We will base our knowledge and actions on objective scientific truth as best we can determine it.” This ethical framework is the foundation of why professional societies are engaged in injury prevention programs. Firearm injury is a significant health problem for our patients and the communities we serve; therefore, it is important that we develop effective injury prevention strategies. Coming together as a professional community and approaching this epidemic as a disease and a public health problem promises to make our neighborhoods and our country safer, stronger, and more resilient. We believe that this can be done in a manner that preserves (or even enhances) freedom. This professional approach requires freedom with responsibility. The group reviewed survey data from the ACS that, on the surface, are consistent with a philosophic divide concerning the general benefit of firearms and views of firearms and freedom. In previous surveys of surgeons, a majority in the US adheres to 1 of 2 contrasting and conflicting narratives about firearm ownership.1 The visual abstract in Figure 1 graphically depicts this polarized debate and an inclusive alternative.2 This philosophic divide is most evident on the extremes, but these competing philosophies lead to polarized personal narratives and create the perception of a large chasm between 2 groups. One of 2 dominant narratives asserts that firearms are beneficial, necessary, and a protected right. The strongest adherents of this philosophic view very tightly link freedom and firearms; so for them, the term gun control is synonymous with freedom control. The second narrative asserts that firearms are harmful, generally unnecessary in civil life, and decrease personal liberty because of increased risk of harm (in homes and in communities). Strong adherents of this philosophic view very tightly link guns with violence, so for them gun control is synonymous with violence control.Figure 1.: Visual abstract describing the American College of Surgeons Committee on Trauma Consensus–based approach to the dialog related to firearm injury prevention.When faced with a perceived stress or crisis, those who view firearms as critical for personal freedom and protection push for greater availability and tend to purchase more firearms. Those who view firearms as emblematic of violence and harm push for increased restriction on access to firearms, and protest the violence. Both sides appear convinced they are absolutely correct, and both often react to each other by reinforcing their own position, while simultaneously villainizing the other. When searching for constructive solutions that realistically could positively impact hundreds of thousands of American lives annually, this gap can initially appear uncrossable. However, the chasm is not as wide as it might seem. In surveys of both medical professionals and the lay public there are many areas of agreement about firearm injury prevention. In a recent survey of ACS members, most respondents believe that firearms are both beneficial and harmful. When questioned about the role of firearms in protecting or restricting freedom, the most common response was that firearms neither protect nor limit personal freedom (unpublished data, ACS membership survey). The view of 2 conflicting narratives creates a false dichotomy. As Figure 1 depicts, there is a common narrative, inclusive of both philosophic views: firearm ownership is a constitutionally protected right and we also have a major firearm violence problem. The way to address the epidemic of firearm violence is to work together to fully understand and address the underlying causes of violence, while simultaneously working to make firearm ownership as safe as possible (for those who own firearms and for those who do not). The emergency healthcare community has led the implementation of a systematic approach to developing emergency medical services, trauma, disaster, and emergency healthcare systems. Through the development of these important have been that are to addressing health The general approach to implementation of these is on the following key be maximally inclusive with of create a dialogue and develop a consensus centered on is the right to do for the patient or the that and and communication, develop data with support for research and and a for with a focus on and system This approach requires professional freedom with to the patient and the community. 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