Common Sense

AAEM Signs On to Support AFFIRM

On November 7, 2018 the National Rifle Association (NRA) tweeted, “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.” This tweet was in response to the publication of “Reducing Firearm Injuries and Deaths in the United States: A Position Paper from the American College of Physicians.”1 On November 19, 2018, we sadly learned of the death of Dr. Tamara O’Neal, a member of our Resident and Student Association (AAEM/RSA), along with two others at Mercy Hospital, in Chicago. Just one year prior, we lost our own Dr. Kevin Rodgers, AAEM president from 2015-2017, to gun violence. He was a leader, friend, mentor, father, and husband, and is so dearly missed. It is now time for all of us to unite and put our political and cultural differences aside because we are not just treating this epidemic — we are the victims of this epidemic.

Emergency medicine and trauma surgery developed out of lessons learned from war. On the battlefield, no one questions whose lane is whose. Rather, everyone works together to create a common lane focused on saving as many lives as possible. The first emergency system in the U.S. developed during the American Civil War, and it was modeled after the French, who established a system about 100 years earlier during the Napoleonic wars. Triage, first aid, and rapid transport might have been rudimentary, but this was only the beginning. It would take over 70 years for the first hospital-based emergency department to open its door, which was still many years before emergency medicine became a specialty. In 1946, the Hill-Burton Act provided grants for hospitals, which were required to have emergency departments. At that time, emergency medical services were often run by funeral services.

During the Korean War, helicopters replaced ambulances for more rapid transport times to save lives. Dr. R. Adam Cowley dedicated his life to trauma care and coined the term, the “golden hour.”

“There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later — but something has happened in your body that is irreparable.”2 The lessons learned on the battlefield were brought home to advance trauma care in the U.S. “Collaboration between civilian and military health systems started at least 100 years ago,” said David B. Hoyt, MD FACS, executive director of the American College of Surgeons. “These partnerships helped advance care both during peacetime and during times of conflict.”2

Both the Korean and Vietnam Wars brought to light that emergency care back home could not compare to the care provided during those wars. But it was not until 1966, after a landmark report by the National

Academy of Sciences, “Accidental Death and Disability: The Neglected Disease of Modern Society,” that traffic injury was reported to be an epidemic. That year, after more than 1.5 million citizens died from car accidents, President Lyndon Johnson said “Safety is no luxury item, no optional extra; it must be a normal cost of doing business.”3 And with the help of Congress, he signed the National Traffic and Motor Vehicle Safety Act and the Highway Safety Act into law. The automobile industry did not tell doctors to stay in their lane.

Physicians are a crucial component and integral part of our public health system. In an unprecedented bill that passed in 1996, the Dickey Amendment prohibited the use of the Centers for Disease Control and Prevention (CDC) funds for advocacy or promotion of gun control, thus limiting funds for research. Other states went even further to limit the ability of a physician to even ask about gun ownership. Florida implemented the Firearm Owner’s Privacy Act (FOPA), becoming the first state to actively prohibit questioning, screening, and education by physicians on firearm safety. This NRA sponsored law does not allow physicians to ask questions concerning the ownership of a firearm or to counsel a patient about firearm ownership during an examination. Penalties to physicians for noncompliance included fines of up to $10,000 and/or risk of having one’s medical license revoked. FOPA was eventually overturned in 2017, when a group of physicians who questioned the constitutionality of its legal terms carried a case against FOPA to the Florida Supreme Court.

I am a proud weapon owner — the issue is not about banning guns, the issue is about stopping the bullet. Right now, research is the key for making progress in firearm injury prevention. This is a public health emergency, not a political debate. History has proven over and over that research and then the collaboration of all stakeholders working together saves lives. After motor vehicle deaths were recognized as an epidemic, research along with common sense laws have led to the decline of deaths by motor vehicles by 29% percent in the last 15 years; there has been a 90% decrease since the 1950’s (see table 1).4 Mandatory seatbelts save lives. Setting alcohol limits for operating a motor vehicle saves lives. Mandatory carbon monoxide detectors in homes and buildings save lives. Research with physician involvement has saved lives through: vaccines, HIV screening, and treatment, and tobacco control just to name a few.

Table 1

Table 2

In 2016, more than 38,658 lives were lost to firearms, with suicides the highest cause, followed by assaults, and then accidents (see table 2).5 The problem is multifactorial, and thus, the importance for government and private research to investigate options for injury reduction. Initiatives like #StoptheBleed campaign launched by the American College of Surgery that train lay persons to apply tourniquets in response to mass shootings need further support and funding.

The American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) is a non-profit corporation comprised of health care leaders and researchers who seek to end the epidemic of gun violence through research, innovation, and evidence-based practice. At our last AAEM Board meeting, your AAEM leadership voted unanimously to partner with AFFIRM. We join the clear message being sent to the public and to the NRA that #ThisIsOurLane. We are the front line providers, and we will be at the forefront of the solution.

AFFIRM Key Statistics

  • 38K deaths (13K homicides per year; 23K suicides) per year; 84+K nonfatal injuries per year
  • 200 injuries per day. 100 deaths per day. Deaths are going up.
  • 60% of gun deaths are suicide.
  • 98% of Americans know someone who has been personally affectedby gun violence.
  • Many doctors (~40% per non-scientific surveys) are gun owners.

The AFFIRM Approach

 

References

1. Butkus R, Doherty R, Bornstein SS. Reducing firearm injuries and deaths in nthe United States: a position paper from the American College of Physicians. Ann Intern Med 2018;169:704-707.

2. https://www.umms.org/ummc/health-services/shock-trauma/about/history

3. https://www.history.com/this-day-in-history/president-johnson-signs-thenational-traffic-and-motor-vehicle-safety-act

4. http://vpc.org/regulating-the-gun-industry/gun-deaths-compared-to-motorvehicle-deaths/

5. https://injuryfacts.nsc.org/home-and-community/safety-topics/guns/datadetails