On February 23, 2004 Mary Seymour, my former colleague in emergency medicine in this town, was one of the first responders to a call involving a house fire in south Kansas City. As soon as she was out of the bus, a sniper opened fire. Two bullets broke four ribs, collapsed her right lung and grazed her heart. Then shit got real when her partner and the police who arrived first rescued the fallen rescuer while taking fire.
I was off that day, so I didn’t work her trauma, but I didn’t have to work it to feel the horror. I’ve been shot at and I’ve had a gun held to my head. I worked a dangerous job that sometimes put me in harms way and more than once, it literally put me on the line of fire. I instinctively reached into the side pocket of my flight suit, took out a tampon and used it to plug a bullet hole in a cop and kept him from bleeding out before he got to surgery.
What I’m saying is, I know my way around an emergency situation and I tend to keep my head while other people freak out and lose theirs, but I don’t get more excited than any situation calls for. I figured out early on that staying calm and paying attention was going to be the way I wanted to go through life. The keeping calm and the paying attention were qualities that served me well in my medical career, first as a first responder and then as a laboratory clinician who responded to traumas in the hospital with four units of O for traumas that needed blood, and I did point-of-care testing. (By the way…everything you think you know about blood banking and blood types is wrong because teevee has never once gotten it right.)
Six weeks after Mary Seymour was critically injured, two more MAST medics were ambushed and gunned down in the firehouse where they were pulling their shift.
Everyone is talking about the firefighters who were shot on Christmas Eve morning after responding to a house fire in Webster, NY and pulling up to a sniper situation like Mary Seymour faced in South Kansas City in 2004. Two firefighters died and two were wounded.
Here’s the dirty little secret…it happens all the time, all over the country. In the average 12-year EMS career, a medic can expect to be assaulted 9.6 times and on average will deal with 17 attempted assaults.
Here is another dirty little secret. Since we can’t prove a negative, we don’t know how many medics have been killed or injured as a result of the GOP-controlled congress zeroing-out the budget for research into gun violence.
I am so sick of this nonsense – and I would be even if I had never been one of the people who has been shot at, threatened, assaulted and stitched up in two places after I was slashed with a knife when a patient in the middle of a full psychotic meltdown lunged at me.
As shock and grief give way to anger, the urge to act is powerful. But beyond helping the survivors deal with their grief and consequences of this horror, what can the medical and public health community do? What actions can the nation take to prevent more such acts from happening, or at least limit their severity? More broadly, what can be done to reduce the number of US residents who die each year from firearms, currently more than 31 000 annually?1
The answers are undoubtedly complex and at this point, only partly known. For gun violence, particularly mass killings such as that in Newtown, to occur, intent and means must converge at a particular time and place. Decades of research have been devoted to understanding the factors that lead some people to commit violence against themselves or others.
Substantially less has been done to understand how easy access to firearms mitigates or amplifies both the likelihood and consequences of these acts.
For example, background checks have an effect on inappropriate procurement of guns from licensed dealers, but private gun sales require no background check. Laws mandating a minimum age for gun ownership reduce gun fatalities, but firearms still pass easily from legal owners to juveniles and other legally proscribed individuals, such as felons or persons with mental illness. Because ready access to guns in the home increases, rather than reduces, a family’s risk of homicide in the home, safe storage of guns might save lives.2 Nevertheless, many gun owners, including gun-owning parents, still keep at least one firearm loaded and readily available for self-defense.
The nation might be in a better position to act if medical and public health researchers had continued to study these issues as diligently as some of us did between 1985 and 1997. But in 1996, pro-gun members of Congress mounted an all-out effort to eliminate the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC). Although they failed to defund the center, the House of Representatives removed $2.6 million from the CDC’s budget-precisely the amount the agency had spent on firearm injury research the previous year.
Funding was restored in joint conference committee, but the money was earmarked for traumatic brain injury. The effect was sharply reduced support for firearm injury research.
To ensure that the CDC and its grantees got the message, the following language was added to the final appropriation: “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”
Precisely what was or was not permitted under the clause was unclear. But no federal employee was willing to risk his or her career or the agency’s funding to find out. Extramural support for firearm injury prevention research quickly dried up. Even today, 17 years after this legislative action, the CDC’s website lacks specific links to information about preventing firearm-related violence.
When other agencies funded high-quality research, similar action was taken. In 2009, Branas et al published the results of a case-control study that examined whether carrying a gun increases or decreases the risk of firearm assault. In contrast to earlier research, this particular study was funded by the National Institute on Alcohol Abuse and Alcoholism. Two years later, Congress extended the restrictive language it had previously applied to the CDC to all Department of Health and Human Services agencies, including the National Institutes of Health.
These are not the only efforts to keep important health information from the public and patients. For example, in 1997, Cummings et al used state-level data from Washington to study the association between purchase of a handgun and the subsequent risk of homicide or suicide. Similar studies could not be conducted today because Washington State’s firearm registration files are no longer accessible.
The nation is in shock right now. First we were shocked by the Jevon Belcher and Kasandra Perkins murder-suicide. The anger at Bob Costas for reading Jason Whitlock’s column word-for-word hadn’t even cooled yet when the school shooting in Newtown, Connecticut happened. And then before the funerals there were even over, four volunteer firefighters were shot, two fatally, as they responded to a call in Webster, NY.
In Florida, it’s illegal (although a federal judge has stayed the law for now) for a pediatrician to ask about guns in the home and the law allows for stripping medical professionals of their licenses if they “harass” or “discriminate against” gun owners. Stayed or not, it has had a chilling effect and kids will undoubtedly die as a result.
Military commanders used to have the right to discuss personal weapons with those in their command, but last year, as the bodies from suicides and murder-suicides piled up in post towns all over the country, the tea-party/NRA-beholden Congress inserted a little-noticed provision into the Defense Bill that prevents commanders from initiating such conversations. Because hey, liberty! Freedom! Second Amendment!
I knew the job was dangerous when I took it, but I took it anyway. And I didn’t just do it, I did it well. There are a hell of a lot of people still on this side of the sod because I kept my head when the situation went south in a big, big hurry.
You count on people like us to save your ass when an emergency happens. And do you know who we count on?
We count on Congress.
And we have been failed. Miserably.
No one is served by silencing studies or science. That doesn’t change reality; it just betrays the cowardice and fear of the gun lobby and their ideologically pathological and morally bankrupt sycophantic pets from red, gerrymandered districts.
We shouldn’t have to fight with one hand tied behind our back by a congress that obviously holds us in contempt, or they wouldn’t be actively trying to suppress the studies and the science that might save our lives.
The blood of first responders is on the hands of every American who didn’t bother voting or who doesn’t work actively to overcome the GOP majority in the House and take back the lower chamber, gerrymandering or not, so that the science can be done that might save the life of someone you love – or, more likely, save the life of someone who may go on to save your life or the life of someone you love.