Gun Violence

On November 7th, the NRA sent out a tweet that would shock the medical community. The tweet, in response to a recent article in the Annals of Internal Medicine, blasted physicians for being “anti-gun” and chastised them to “stay in their lane.” Hours after the tweet went out, a gunman walked into a bar in California and killed 12 people.

Gun violence is an ever present reality in America. According to data from the Gun Violence Archive, a non-profit organization that tracks gun violence, there have already been 307 mass shootings in the year 2018 (“mass shooting” defined as an event where 4 or more individuals are shot and/or killed, not including the perpetrator). This number, while incredibly alarming, does not account for all of the incidents that involve smaller numbers of victims. In total, there have been 12,872 deaths from gun related deaths and 24,893 gun related injuries in 20181. Every year, an average of 32,000 individuals in the country die from gun related injuries-from violence, suicide, or even accidents2. Gun related deaths remain the second leading cause of death among adults and adolescents right after motor vehicle accidents. These rates rank among the highest among industrialized nations3.

As emergency medicine physicians, we see the deadly consequences of these numbers first hand.  According to a recent study, over 700,000 patients came into emergency departments with gun related injuries from 2008-20144. We are to receive these victims when they enter the hospital and lead the efforts at initial stabilization and resuscitation. Unfortunately, we are also the ones that have to inform loved ones when these injuries claim the life of the victim. Exposure to these horrific injuries is not without consequence; a recent study that sampled over 500 emergency medicine physicians found that approximately 15% of them suffered from PTSD as a result of their work5. Not surprisingly, PTSD increases a physician’s risk of burnout, depression, and even suicide6.

As emergency physicians, we see and treat the majority of firearm injuries. Despite this being a forefront issue in politics for the past several years, the 2018 CDC report shows that there have been continually increased deaths from firearms over the past several years in all communities. The American College of Physicians recently published a position paper on November 20th, 2018, gathering peer-reviewed articles that demonstrate how physicians can approach the issue in a multi-faceted approach to reduce firearm violence while staying consistent with the Second Amendment7. A big aspect of addressing the issue is becoming informed. As providers, we must be aware of the current research concerning gun violence. We must be up to date on current gun safety measures and incorporate gun safety counseling into our discussions with patients. We must also educate ourselves on the laws, or sometimes lack thereof, surrounding this issue and advocate for changes designed at increasing the public’s safety. It is imperative, for the benefit of our patients that we now engage in firearm safety as a public health issue and push for evidence based changes in the medical and legal community.


  1. Gun Violence Archive [Internet]. 2018. Available from:
  2. Centers for Disease Control and Prevention. FastStats: All Injuries. Accessed at 
  3. Richardson EG,  Hemenway D.  Homicide, suicide, and unintentional firearm fatality: comparing the United States with other high-income countries, 2003.J Trauma. 2011;70:238-43
  4. Gani F, Sakran J, Canner J. Emergency Department Visits for Firearm-related injuries in the United States, 2006-14.  Health Affairs. 2017 Oct; 36(10): 1729-38
  5. Vanyo L, Sorge R, Chen A, Lokoff D. Posttraumatic stress disorder in emergency medicine residents. Ann Emerg Med. 2017 Dec; 70(6): 898-903
  6. Schernhammer, E. and Colditz, G. Suicide rates among physicians: a quantitative and gender assessment (meta analysis). Am J Psychiatry. 2004; 161: 2295–2302
  7. Butkus R, Doherty R, Bornstein S. Reducing firearm injuries and deaths in the United States: a position paper from the American College of Physicians. Ann Int Med. 2018; 169: 704-707

Approved December 2018

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