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images (1)Last night I was at a local pub listening to a band when suddenly everyone’s eyes were drawn to the television over my head. Straining to look around and see what had happened (another airplane crash, Lance Armstrong caught doping as a spectator in the Tour de France?) I read that a verdict was in regarding the death of Trayvon Martin. As the “Not Guilty” verdict was read, the crowd seemed relieved that the shooter would walk away (though civil proceedings will almost certainly follow). I must admit, I have not been following the trial. To me the entire episode was a tragedy.

As we were walking home, we ran into a neighbor and fell into conversation about the events. My wife, who followed the story, pointed out that the shooter was not participating in a neighborhood watch event but was going to the local “big box” to purchase groceries with HIS GUN IN HIS POCKET when he stopped to follow a “suspicious character.” Made me wonder how many of my neighbors are packing heat and why would they feel compelled to do so.

In my home town of Baton Rouge, Louisiana in 1992, Japanese exchange student Yoshihiro Hattori was going to a party and knocked on the wrong door. Mistaken for a burglar intent on home invasion (he was dressed in a tuxedo recreating John Travolta’s look in Saturday Night Fever) and not understanding the meaning of the word “Freeze” in the context of potential victim-of-gun-violence lingo he was shot and killed by the home owner. The home owner was charged with manslaughter and later acquitted with the court identifying that the shooter had a right to use lethal force to “protect himself.”.  In 2005 there were 30694 people who died of gun violence. When a gun is pointed at a person and the trigger is pulled, about 1 in 3 people with die prior to reaching  the hospital. Since the death of Yoshihiro, laws have been changed. in 35 states anyone requesting a concealed carry permit must be given a permit. In 2 states, no permit is needed. In my home state of Louisiana, where the gun laws were “liberalized” after this shooting, about one in every 10000 people can expect to die from a gun shot. Half of these from their own hand.

So, what should my response as a medical educator be? Gun violence is a serious public health issue. It costs about $2 billion in direct costs, and because it overwhelmingly affects young people, there are about $100 billion in indirect costs (loss of future productivity, health care costs for the rest of their lives, etc.). How should we as physicians and educators be involved in the prevention of this often needless tragedy?

First, as with any complex illness we need to be aware who is really at risk and target those people. The belief in our society is that personal risk of violence at the hands of a stranger is great and mitigated by the presence of a gun. Unfortunately, research on gun violence is sketchy at best. Recently, the Robert Wood Johnson foundation published the findings of Andrew Papachristos on their website. He found that a lot of the potential victims (41%) come from a very small circle of people at risk (about 4% ) in a given community. Many of our Academic Health Centers sit in these at risk neighborhoods (and have benefited from caring for trauma victims). Based on this, those of us interested in teaching prevention should be promoting our Academic Health Center’s involvement in these high risk communities through partnering with community organizations.

Second, we need to teach our learners how to preach gun safety. A gun in the home is associated with violence to the people living in the home. About 25% of households report having a handgun (and there are guns enough for almost every citizen already in circulation in this country). These guns should be locked up, especially when there are children in the house. In one of the few studies done of trauma center workers (in Birmingham in 1994) 33% of those with children (who presumably knew better) did not keep the weapons properly stored.

Third, we need to understand and teach risk assessment. Our well child form has a question regarding guns in the home which we ask all parents. If the answer is “yes, there are guns in the home” there is then a prompt that directs us to ask about storage and safety methods. This is because, though patients perceive the societal risk to be great, we need to understand and preach that societal risk is small and localized. The greater risk when a gun is present is to a family member or a stranger that happens to get in the way. For us to convince our patients of that we need to understand and believe it ourselves.

Fourth, we need to fight against willful ignorance. In Florida, where the Trayvon Martin was shot, a law was passed (later blocked) barring physicians from asking about weapons in the home. It is important for health care professionals to be clear and of one voice, the opportunity for gun violence is lessened greatly when there are NO guns in the home and lessened when the guns that are there are stored safely.