ACS Calls for Urgent, Bipartisan Action to Address Firearm Violence

ACS COT has proven that people who significantly differ in their views on firearms can and will enthusiastically work together to reduce unnecessary death and suffering from firearm-related injury and intentional violence.”

—Ronald M. Stewart, MD, FACS

On June 2, leaders from the American College of Surgeons (ACS) gathered to call for bipartisan solutions to reduce the rising numbers of deaths and serious injuries that are arriving in trauma centers on a daily basis because of firearm violence.

During an ACS news conference at its Washington, DC, office, surgeons outlined important attainable steps that can be taken to accelerate an effective response to reduce firearm violence.

“Firearm violence is a growing public health crisis that must be immediately addressed. This is a public health crisis, not a political debate. The ACS is committed to crafting solutions that save lives and minimize preventable death,” said ACS Executive Director Patricia L. Turner, MD, MBA, FACS. “We are unwilling to wait for another tragedy to befall another community when we believe we have a series of actions that will have an impact.”

She explained that trauma surgeons are practical problem solvers who see and live through this crisis every day treating patients who are victims of attempted suicides and homicides, and who suffer other grievous injuries from firearms. “We must be an integral part of the solution to reduce the rising number of deaths we see every year.” Dr. Turner said the ACS wants to work with and educate legislators about firearm injury prevention “so that we can incorporate what we know in a data-driven way.”

FAST Recommendations Provide Common Ground

The ACS Committee on Trauma convened the Firearms Strategy Team (FAST) in 2017 consisting of highly regarded trauma surgeons, many of whom are firearm owners. Their singular mission was to develop an effective strategy to reduce firearm injury, death, and disability. The recommendations, first introduced in 2018 and renewed in 2022, are the product of broad consensus.

The recommendations made by FAST cover 13 areas and include background checks, registration, licensure, firearm education and training, safe storage practices, red flag laws, addressing mental health issues, and more research to better inform an approach going forward and to help address the root causes of violence. The full-text article appears in the Journal of the American College of Surgeons at bit.ly/3OgEmE3.

“These comprehensive recommendations provide a road map to a solution and can have an immediate impact on saving lives,” said Eileen M. Bulger, MD, FACS, Medical Director of ACS Trauma Programs and one of the leaders who helped develop the FAST recommendations.

From the Frontlines

Trauma surgeon Ronald M. Stewart, MD, FACS, provided a front-line perspective of the crisis. Dr. Stewart, chair of the department of surgery at University Hospital, San Antonio, TX, explained he has been in the unfortunate position of caring for victims from two of the largest mass shootings in modern US history—Sutherland Springs First Baptist Church and the Uvalde School shooting—and described the injuries inflicted by high-velocity weapons as “horrific.” The patients he treated all have a long road ahead to deal with both the physical and emotional impact of this shooting. “This moment of crisis will have a lifetime of impact on these innocent souls. Our teams are working to facilitate healing in a way that minimizes long-term effects,” he said.

Dr. Stewart, a former Chair of the ACS COT, credited decades of work from the COT in setting organized, regional trauma systems of care that make real lifesaving difference in communities. “In many ways, South Texas has a model trauma and emergency healthcare system built on the ACS model.” He also pointed out that newer recommendations to administer whole blood quickly to seriously injured shooting patients are now a factor in saving lives. He commended ACS trauma leaders for advocacy work in educating and training people who are bystanders to control serious bleeding through its STOP THE BLEED^® program as another lifesaving measure that’s made an impact on improving survival. But he pointed out that these are treatments, “and treatment is not enough; these tragedies are preventable. We can prevent these atrocities.”

As for the severity of the problem, he noted that in 2020 firearm injuries became the leading cause of death among children and adolescents.

Dr. Stewart believes that the “ACS COT has proven that people who significantly differ in their views on firearms can and will enthusiastically work together to reduce unnecessary death and suffering from firearm-related injury and intentional violence.”

Broad Support for Consensus Recommendations to Reduce Firearm Violence

Patrick V. Bailey, MD, MLS, FACS, a pediatric surgeon and the Medical Director of the ACS Division of Advocacy and Health Policy, observed that the FAST recommendations were developed through “a very deliberative process that included the participation and perspective of other surgeons who like me were also gun owners, but who seek to reduce the impact of gun violence on our country.” Dr. Bailey does not believe these recommendations “pose an undue burden on the rights of individual gun owners” and said that he hopes these recommendations will be viewed by a US Congress that comes together in a bipartisan way to “enact substantive legislation directed at mitigating gun violence.”

Other Initiatives Provide Pathways

Other advocacy work initiated by the ACS COT that was highlighted at the briefing included a brief overview by Dr. Bulger of the Improving Social Determinants to Attenuate Violence (ISAVE) workgroup. ISAVE presents strategies for trauma centers to address the root causes of violence. The work that came out of the COT’s 2019 Medical Summit on Firearm Injury Prevention also was highlighted. The Summit included active participation by 44 professional organizations that gathered to identify collaborative ways to address the firearm violence problem. The organizations developed recommendations based on a consensus of all participating groups.

At the close of the summit, a comprehensive public health and medical approach emerged that included focusing on recognizing firearm injury as a US public health crisis and taking a comprehensive public health and medical approach to address it, researching the issue using a disease model, engaging firearm owners and at-risk communities to develop firearm injury prevention programs, and empowering the medical community to function in the best interest of its patients in a variety of palpable ways. Full proceedings from the summit were published in the Journal of the American College of Surgeons, available at bit.ly/3HiSHxN.

The important work started at the inaugural Medical Summit on Firearm Injury Prevention will continue, Jeffrey Kerby, MD, PhD, FACS, Chair of the ACS COT, announced. “This fall, we will reconvene and cohost the summit to bring together subject matter experts from across the House of Medicine. We must continue to build our collective will and work creatively to address the root causes that have led to this epidemic,” he said. Dr. Kerby believes the ACS COT recommendations provide an immediate path for moving forward.

Dr. Kerby, the Brigham Family Endowed Professor and director of the division of trauma and acute care surgery, department of surgery, University of Alabama at Birmingham (UAB), noted that he regularly speaks with trauma surgeons across the nation. “We are all deeply disturbed by the inordinate amount of firearm injuries and death we must constantly address. My own trauma center has seen a 40% increase in the number of firearm-related injuries just in the last two years, and these numbers continue to increase. We are in the midst of an epidemic of firearm violence, and we need to act. I have to believe that as a country, we can do better.”

Click here to view the full news conference.