In November, after the American College of Physicians published a position paper on firearms and safety in a medical journal, the National Rifle Association publicly warned doctors to “stay in their lane”. Surgeons around the U.S. responded by posting grisly photos and stories of treating shooting victims—and the hashtag #ThisIsOurLane was born.
Now, a new study published in JAMA Surgery finds that people who go to the hospital after being shot die from their injuries just as often as they ever have, despite improvements in survival for other types of trauma victims.
The researchers compared the numbers of people who left the hospital after gunshot wounds with those who left after car accidents. The victims of both types of trauma are injured by external forces and arrive at the hospital in an ambulance requiring urgent care, usually by a trauma team. Surgeons often engage with both types of patients and care for them in similar ways, says Dr. Robert Tessler, lead author of the study and a surgery resident at the University of Pittsburgh Department of Surgery.
Yet although they are treated similarly, the percentage of victims who leave the hospital alive in each case is quite different. Improvements in trauma and surgical procedures, as well as preventive policies, have meant that many more people survive after car accidents in 2013 than survived in 2003, the study says. But the number of shooting victims whom hospitals cannot save has not changed in the same time period.
Using a decade’s worth of data from the National Trauma Data Bank National Sample Program and the CDC’s Wide-Ranging Online Data for Epidemiologic Research, the study found that there was an annual average 0.17% decline in the number of car accident accident victims who doctors could not save, while the number of gunshot victims who became fatalities showed no such drop. While that percentage seems small, it represents hundreds of lives a year.
From a surgery standpoint, “we should be and probably are as good at taking care of firearm injuries as we are of injuries related to car crashes,” says Tessler, who did the study while he was at Harborview Injury Prevention & Research Center at the University of Washington. “If we’re getting better at one group of patients, we should be getting better at the other. But we’re not getting better at firearm injuries.” This suggests that firearm injuries may be getting more severe over time, he says.
The study does not identify why there has been no concurrent decrease in the number of shooting victims who perish either in the hospital or before they arrive. But Tessler points out that there has been for many years a wealth of publicly available, detailed information about what causes traffic accidents. This has led to many interventions: speed limits, drunk- and distracted-driving laws, banked roads, new braking technology and more widespread use of such traffic-calming measures as speed humps and chicanes. “The science behind how to make cars safer is so impressive and effective,” says Tessler.
No such granular detail exists for firearm deaths—even as the CDC reported in November that gun deaths are on the rise in the U.S. “Are the proportion of people being shot with high caliber weapons? How many times are they shot—are they being shot with a semi-automatic, multiple times at once?” Tessler says. Such information might help ascertain whether it’s the type of ammunition or the type of gun that’s hampering surgeons from saving more victims. Similarly, Tessler believes that understanding shooters’ behavior is a public health issue akin to understanding drivers’ behavior, because then public policy directives can be formed to address it.
Of course, cars and guns have different purposes. One is to get you somewhere quickly and efficiently, and the other is to hit a target. But Tessler, who acknowledges that he has participated in advocacy for gun safety, notes that people are prepared to make cars slightly less effective at their job—slowing them down with traffic lights and stop signs and roundabouts—for the sake of safety. They might also take the same attitude toward guns, and reduce their efficiency to make them safer.
As for the NRA’s charge that doctors are straying out of their area of expertise in taking a stance on firearms, Tessler disagrees. “These are our patients,” he says, of the people who come into the hospitals’ operating rooms. “We need to advocate for them as much in the street as in the O.R.”