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ACS takes a public health approach to firearms

OCTOBER 22, 2018
Clinical Congress Daily Highlights, Monday First Edition

There has been much talk about gun violence and gun safety, but little constructive, engaged dialogue between those concerned about gun violence and those concerned about gun rights.

The American College of Surgeons (ACS) is hoping to foster such a conversation by engaging gun owners. Taking a public health approach to firearm injuries based on partnership and engagement, a panel discussion Monday looked not only at the epidemiology of gun violence but also explored several efforts to involve gun owners in tackling what has become a serious public health problem.

The panel was introduced with a very personal story from Joseph Sakran, MD, MPH, MPA, FACS, Assistant Professor of Surgery, Johns Hopkins Hospital, Baltimore, MD. When he was 17 years old, Dr. Sakran was nearly killed by a .38 caliber bullet to the throat. Trauma surgeons at Inova Fairfax Hospital in Falls Church, VA, were able to save his life.

“They gave me a second chance,” he said. “It inspired me to become a trauma surgeon.”

Despite what he acknowledges is an “emotionally charged subject,” Dr. Sakran emphasized the importance of listening to the other side, to “move the conversation forward.” Firearm injuries are clearly a significant public health issue, he said, but unfortunately, research on the issue has been stymied by a lack of federal funding.

The scale of the issue is clear.

Out of 175 violence-related deaths per day, 58 percent are related to firearms and 70 percent of those are suicides, said Deborah Kuhls, MD, FACS, FCCM, University of Nevada, Las Vegas. By far the largest group who are victims of gun related homicides are young black males, she said.

There are 4 million to 6 million incidents per year of physical violence, one in four of which involve intimate partners, said Carrie Sims, MD, PhD, FACS, University of Pennsylvania, Philadelphia. Intimate partner violence is five times more likely to result in death if there is a gun involved.

“For those who say the answer is to have women buy guns, the problem is that women who have guns are twice as likely to die by a gun than those who do not own one,” Dr. Sims said.

Another issue that needs to be addressed is structural violence, in which a social structure or social institution harms people by preventing them from meeting their basic needs, said Selwyn Rogers, MD, PhD, MPH, FACS, from Chicago.

“Black men are 10 times more likely to be shot than white men, and black women are three times more likely to be shot than white women,” Dr. Rogers said.

The issue cuts close to home for surgeons, not just because they witness the carnage but because one in three have friends or family who have been affected by gun violence. Dr. Sherilyn Gordon-Burroughs, a transplant surgeon, died by intimate partner gun violence in 2017, Dr. Sims said. That led to the ACS revising a 2013 statement on intimate partner violence; the new statement came out this month. As part of the effort, ACS developed an intimate partner violence toolkit and survey to help people recognize when they may be in a dangerous situation, she said.

Despite the sobering statistics, several gun violence Initiatives cited by the panel have had an impact. Among them:

Safe storage

Many children are victims of unintentional gun violence because a gun in the home was not stored safely, said Brendan Campbell, MD, PhD, FACS, Connecticut Children’s Medical Center, Hartford, CT. One out of three children in America live in a home with a gun present, and 15 percent of those guns are stored unsafely, he said. An ACS effort to encourage gun safety among gun owners was well-received, Dr. Campbell said, with two-thirds of gun owners who were not storing their guns safely saying they would rectify the situation.  

Temporarily putting the gun away

In her presentation “Beyond Docs versus Glocks,” Catherine W. Barber, MPA, Harvard T.H. Chan School of Public Health, Boston, MA, said that guns are clearly a modifiable risk factor in suicides. When an individual appears suicidal, someone – a doctor, a firearms instructor, a friend – should encourage off-site storage of their guns to protect their family and themselves until the problem is resolved, she said.

“We have seen significant progress in designated drivers over the last five to 10 years,” Barber said. She believes that with support from thoughtful gun owners, health professionals can reduce suicides among gun owners.

FireArm Strategy Team (FAST)

FAST is comprised of ACS members who are gun owners or knowledgeable about guns, such as hunters, sport shooters, those who keep guns for self-defense, or current or former law enforcement or military personnel, said Gary Timmerman, MD, FACS, University of South Dakota Sanford School of Medicine, Sioux Falls, SD. The group is coming out with a report by the end of the year, but some of its main recommendations include:

  • Robust and thorough background checks
  • A database of registered firearms
  • Licensure of high-capacity firearms
  • Gun owner responsibility, including requiring reporting stolen weapons to police
  • Innovative technology, such as guns that will shoot only if they recognize the handprint of the owner
  • Non-partisan research of firearm injuries
  • Reduced media attention to mass shootings to prevent copycats
  • Awareness of mental health warning signs

“This is a complex and multifaceted problem,” said Ronald Stewart, MD, FACS, University of Texas Health Science Center, San Antonio, TX. “We need to commit to the values of civility, professionalism, humility, and mutual respect. We know we have to address structural violence, that we have more work to do.”

Additional Information

The Panel Session, Firearm Injuries in the United States: A Public Health Approach Centered Upon Partnership and Engagement, was held October 22, at the 2018 Clinical Congress of the American College of Surgeons in Boston. Program, webcast, and audio information is available online at

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