CHICAGO: Today, leaders of the American College of Surgeons Committee on Trauma (ACS COT) publicly released a set of common sense strategies to reduce firearm-related injury and death by making the ownership of firearms as safe as reasonably possible. This approach is intended to foster dialogue among individuals and policymakers on both sides of the firearm ownership debate with the hope of achieving common ground and identifying solutions that address the safe handling of firearms and addressing the violence that drives their misuse.
The article outlining this approach has been published as an “article in press” on the website of the Journal of the American College of Surgeons in advance of print publication.
For decades the ACS COT has advocated for effective prevention of injuries and deaths from firearm violence. Many of these efforts have stalled because of a lack of consensus among surgeons and the public about the best ways to proceed. Over the last few years, the ACS COT has made a concerted effort to bridge the divide between those who believe firearms are generally beneficial and a measure of personal liberty and those who believe firearms are generally harmful and limit personal liberty due to the risk of harm.
“We committed ourselves to a process that built on three broad areas: One was to approach firearm injuries as a medical, not a political, problem. Second, we decided to evaluate and promote evidence-based programs that prevent violence—the underlying cause of firearm injuries and deaths—and can be implemented in trauma centers, and third, a commitment to do our best to create a collegial, professional dialogue around the steps we could take to reduce firearm injuries and deaths,” said Ronald M. Stewart, MD, FACS, San Antonio, Tex., who served as Chair, ACS COT (2014-2018), when the Consensus Strategy was developed.
The ACS COT’s Consensus Strategy views firearm injury and mortality in the larger context of violence toward oneself or others, which is a major cause of unnecessary injury and death in the United States, claiming on average 175 American lives every single day.*
“To reduce death and disability associated with firearm injuries, we have to think about the strategies that cover the entire spectrum of violence-related events: how firearms are stored in the home, recognition that people who are at risk of self-harm or domestic violence should not have access to weapons, and addressing the causes of interpersonal violence. These strategies don’t get a lot of attention. These are not controversial ideas. All are achievable and could make a huge impact in terms of reducing injury, disability, and death,” said Eileen M. Bulger, MD, FACS, Seattle, Wash., current ACS COT Chair.
Violent Intentional Injuries and Deaths Are a Neglected Public Health Crisis
In 2016, the most recent year for which data are available, a firearm was involved in 51 percent (22,938) of suicides and 75 percent (14,415) of homicides. Since 1999 there has been a 17 percent increase in firearm-related intentional injury death rates; over the same time period, there was a 22 percent decrease in traffic-related deaths.*
Since 2014, the ACS COT has been engaged in a firearm-injury prevention consensus-building project that involved surveys of its members and the ACS Board of Regents and Board of Governors, town hall meetings, and outreach to a broad group of stakeholder organizations.
“More than half of the survey respondents hold the view that firearms are beneficial and important for personal liberty and self-protection. About a third believe that firearms make us less safe, and about 15 percent don’t have a strong opinion either way,” said Dr. Stewart.
Yet the vast majority of the surgeons in the surveys agreed on a broad range of policies related to reducing firearm injuries and deaths, including gun safety features, mandatory background checks, funding for research on gun violence, counseling on safe firearm ownership, and improving mental health screening and treatment, according to Dr. Stewart.
“The town hall meeting we hosted for the entire ACS COT was professional and instructive. We learned from these efforts that preventing injury from firearms was a high priority for all, that violence is the proximate cause of firearm injuries, and violence prevention strategies should be a critical focus. By being civil and collegial, we learned that we could stimulate creative problem solving,” Dr. Stewart added.
Consensus-Building Strategy for Reducing Firearm Violence
As a starting point for engaging other professionals, policymakers, and the public, the ACS COT offers four broad policy principles that can reduce violence by focusing on the safety of firearm ownership.
- Anyone who is a danger to themselves or others should not have a firearm.
- Responsible firearm ownership includes safe storage, education, training, and a commitment to keep firearms out of the hands of family members at high risk of self-harm, unlawful purchasers, and violent offenders.
- Mental health access and treatment must be improved.
- Identify, understand, and address the underlying causes of violence.
“We have engaged people on both sides of this issue to help come up with solutions. We have had conversations with national organizations on both sides of the issue. We want to see people who are passionate about dealing with this problem come together. There is a lot more we can agree on. We are getting the conversation started,” Dr. Bulger said.
Moving forward, the ACS COT calls for an environment of civil discourse for these discussions. The authors write that in the past, “rather than effectively addressing violence, the two conflicting narratives are a war of words that, at least to us, foreshadows violence. The time is now to end this non-constructive debate. To do so requires crafting a common, inclusive narrative that resonates with most Americans.” They propose a starting point for such a narrative and conclude, “If we come together, focusing our efforts on reducing violence while making firearm ownership as safe as reasonably possible, we can and we will save thousands of American lives every year.”
Additional authors and leaders of the ACS COT strategy are Deborah A. Kuhls, MD, FACS, Las Vegas, Nev., Chair of the ACS COT Injury Prevention Committee, and Michael F. Rotondo, MD, FACS, Rochester, N.Y., former Chair of the ACS COT.
"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.
Citation: Freedom with Responsibility: A Consensus Strategy for Preventing Injury, Death, and Disability from Firearm Violence. Journal of American College of Surgeons. Available at http://www.journalacs.org/article/S1072-7515(18)30275-8/fulltext.
* Centers for Disease Control and Prevention. About Underlying Cause of Death, 1999-2016. Available at: http://wonder.cdc.gov/ucd-icd10.html. Accessed April 16, 2018.
