Stopping the Bleeding Is Not Enough

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In the days that followed the recent mass shooting that occurred at the Pulse nightclub in Orlando, medical societies produced statements consoling the victims and the families of the dead while condemning the actions of the perpetrator who added yet another statistic to the gun violence epidemic in our country. Our professional society, the American College of Surgeons (ACS), similarly released Leadership Comments Following Orlando, a statement that was intended to share the ACS's thoughtful approach to reducing deaths from firearm injuries and mass casualty events with our membership (
Caring for the critically injured, as our colleagues did in the early morning of June 12 is an essential element of a surgeon's core skill set. Much of what we know about treating these types of gun-shot wounds, increasingly seen in cities and towns across the nation, has been learned from battlefield surgeons who cared for similar wounds in Korea, Viet Nam, and the Middle East. We are trained to care for the worst traumatic injuries under some of the worst circumstances to save lives, and we are doing this well. Many of our fellow surgeons within the ACS, however, believe that we are not only in the business of preventing death after injury; we also share a special obligation to prevent injury. We fear that the current debate about gun control has not adequately represented the concerns of the broader medical community about the public's health.
When it comes to injury prevention, physicians and surgeons have moved mountains. Although initially unpopular, Surgeon General Luther Terry's report on the dangers of tobacco to smokers, unborn children, and bystanders was, in fact, a brave and politically charged challenge to the very influential tobacco industry.1 His action was followed by Surgeon General C. Everett Koop's campaign to commemorate Terry by sending a clear, evidence-based message to the American public that smoking can be lethal.2 These actions by doctors affected a significant change in the public's perception of smoking risks and led to legislation that not only validated their work, but also ultimately reduced the incidence of lung cancer deaths in both active and passive smokers. Using data obtained through years of government-funded research, doctors have educated the public and endorsed many other public health initiatives, including mandatory vaccination programs for children that have eradicated common infectious diseases in the country and automobile modifications that have resulted in a significant reduction in preventable deaths and injuries from motor vehicle crashes.
In 2014, the incidence of gun-related fatalities in American teens surpassed deaths resulting from motor vehicle crashes.3 In addition, the rate of suicide by firearm continues to climb, particularly in our aging population.4 Doctors, among others, can no longer in good conscience remain apolitical about firearm violence. We can no longer afford to stand on the sidelines or continue fruitless debate. We must neither accept the inaction of our government to pass comprehensive firearm injury prevention legislation nor allow the restriction of our ability to do research on firearm injuries, while nearly 3 times as many American citizens are killed each year in this epidemic than they are by AIDS and the cost to care for these victims has exceeded the budget of the U.S. Department of Education (
As leaders in surgical care, we must be able to provide forward thinking recommendations for improving injury prevention strategies to stop the growing public health problem that has touched our lives from elementary schools, high schools and colleges, to houses of worship, and the places we seek for safe social interaction—a Christmas party, movie theaters, and most recently a nightclub.
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