Looking forward – April 2018

On February 28, the leadership of the American College of Surgeons (ACS) sent an open letter to all members of the College, which provided an update on the ACS violence prevention strategy. Following is a reprint of that letter.

Dear Colleague,

On Valentine’s Day 2018, the nation once again witnessed a tragic mass casualty event, reigniting the national debate over the best means of preventing firearm injuries and deaths. The survivors of the shooting at Marjory Stoneman Douglas High School, Parkland, FL, have inspired a renewed sense of activism among our nation’s youth. For its part, the leadership of the ACS has developed an action plan to address the problem as a public health issue.

The College’s longstanding position

The ACS first issued a Statement on Firearm Injuries in 1991. That statement has been revised and updated twice since then—once in 2000 and again in January 2013. The most recent Statement on Firearm Injuries states that because gun violence continues to be a daily event in the U.S. and mass casualties involving firearms threaten the health and safety of the public, the College supports the following:¹

• Legislation banning civilian access to assault weapons, large ammunition clips, and munitions designed for military and law enforcement agencies
• Enhancing mandatory background checks for the purchase of firearms to include gun shows and auctions
• Ensuring that health care professionals can fulfill their role in preventing firearm injuries by mental health screening, patient counseling, and referral to mental health services for those with behavioral medical conditions
• Developing and promoting proactive programs directed at improving safe gun storage and the teaching of nonviolent conflict resolution for a culture that often glorifies guns and violence in the media and gaming
• Conducting evidence-based research on firearm injury and creating a national firearm injury database to inform federal health policy

The 2013 statement was issued soon after a gunman killed 20 first-graders, six adults, and himself during a December 2012 mass shooting at Sandy Hook Elementary School, Newtown, CT. That mass casualty incident also spurred ACS Regent Lenworth M. Jacobs, Jr., MD, MPH, FACS, to establish the Hartford Consensus, which, in turn, led to the development of the Stop the Bleed^® program aimed at training individuals to act as immediate responders in mass casualty situations. This vitally important program has trained more than 100,000 people, turning bystanders into immediate responders. Fellows of the College have been inspirational leaders of the Stop the Bleed program in communities around the globe.

The situation today

Since Sandy Hook and as of press time, at least 239 school shootings, including the Parkland, FL, massacre, have occurred nationwide. In those episodes, 438 people were shot, of whom 138 were killed.² In addition, mass casualty incidents have taken place at the Navy Yard, Washington, DC; Inland Regional Center, San Bernardino, CA; Pulse nightclub, Orlando, FL; a historic black church in Charleston, SC; the Las Vegas, NV, strip; and a church in Sutherland Springs, TX. These are just the most notorious incidents in recent history.³ Within the first two months of 2018 alone, a total of 2,292 Americans died and 3,900 were injured as the result of gun violence.⁴

The leadership of the ACS finds these data distressing. For the last four years, the ACS Committee on Trauma (COT) has been working on an action plan to reduce the burden of firearm violence. It is a consensus plan that has been built on broad input from all different points of view. The strategies outlined in this plan have been presented at the ACS Clinical Congress, published in the October 2017 Bulletin, and thoroughly discussed with the ACS leadership.

Recently, the ACS Board of Regents, the COT, and other concerned Fellows developed nine action steps. These activities, which were still being refined at press time by the newly formed COT Firearm Strategy Team (COT-FAST), are as follows:

• The College will continue its strong support for the development of trauma systems across the country and for the Stop the Bleed program to provide public education for bleeding control and access to bleeding control kits in public places.
• The ACS COT-FAST has started to convene a group of firearm-owning Fellows to discuss firearm injury prevention strategies that they could support and for which a durable advocacy platform could potentially be developed.
• The ACS and the COT are moving forward with conducting a broad survey of the ACS membership to better understand Fellows’ views on firearm ownership and firearm injury prevention strategies.
• The ACS has developed multiple collaborative partnerships with other organizations that share the College’s interest in decreasing firearm injuries and death. The COT has been tasked with the goal of working with these organizations to encourage partnerships to reduce injuries and deaths from firearm-related injury.
• Current COT prevention strategy efforts are moving to the implementation stage, including safe firearm storage initiatives, hospital-based violence intervention programs, and guidance for physicians to counsel patients on safe firearm ownership. The goal of these programs is to reduce all violence-related injuries.
• Research
  • The ACS is developing a plan and structure for conducting research in this area. This proposal will include development of a firearm injury research agenda by the COT and support for an COT clinical scholar focused on this area.
  • The ACS strongly supports both federal and nongovernmental funding of high-quality firearm injury and firearm injury prevention research. The COT has partnered with and supported the American Foundation for Firearm Injury Research in Medicine efforts to support philanthropic funding for research.
• The ACS programs described previously promote responsible firearm ownership and nonviolent conflict resolution.
• The ACS is committed to working in collaboration with the mental health community in support of increased funding for mental health programs.
• The ACS is supportive of work to enhance background checks and support and strengthen enforcement of laws and regulations designed to keep firearms out of the hands of criminals and those individuals who are mentally ill.

It’s everyone’s problem

COT-FAST is working to evaluate and develop strategies that would be effective, while preserving the liberty of responsible firearm owners. The leaders of this effort realize that the vast majority of gun owners in the U.S., including Fellows of the College, are highly responsible and use their firearms for purposes of sport and self-defense. We feel confident the nine steps outlined in this letter balance personal freedom with responsibility.

We also believe that the significant increase in mass shootings poses a real public health problem. We understand that not all our Fellows agree on firearms, but the College is dedicated to improving care for the surgical patient, and as frontline caregivers for survivors of these tragedies, we must convene and lead where these issues are concerned. We are actively partnering with other health care organizations and societies to develop and implement a research strategy.

Everyone shares this problem. Everyone owns this problem. The COT-FAST and the rest of the ACS leadership are meeting regularly by conference call and in person to move forward and finalize our next steps. We welcome all points of view, and we invite you to offer your suggestions on the College’s role moving forward.

Sincerely,

Barbara L. Bass, MD, FACS ACS President

Leigh A. Neumayer, MD, MS, FACS Chair, ACS Board of Regents

Ronald M. Stewart, MD, FACS Chair, ACS Committee on Trauma

David B. Hoyt, MD, FACS ACS Executive Director

References

1. American College of Surgeons. Statement on Firearm Injuries. Available at: www.facs.org/about-acs/statements/12-firearm-injuries. Accessed February 27, 2018.
2. Patel JK. After Sandy Hook, more than 400 people have been shot in over 200 school shootings. New York Times. Available at: www.nytimes.com/interactive/2018/02/15/us/school-shootings-sandy-hook-parkland.html. Accessed February 27, 2018.
3. Democracy in America: The banality of mass murder: America’s latest school slaughter. The Economist. Available at: https://www.economist.com/blogs/democracyinamerica/2018/02/banality-mass-murder. Accessed February 27, 2018.
4. Gun Violence Archive. Available at www.gunviolencearchive.org. Accessed February 27, 2018.