Commentary: Our Lane Needs All of Us

January 25, 2019

#ThisIsOurLane, but Our Lane Needs All of Us: EM Physicians Speak Out on Gun Violence

by Kristen L. Mueller, MD, Assistant Professor, Division of Emergency Medicine, Washington University School of Medicine and Megan L. Ranney, MD, MPH, Department of Emergency Medicine, Alpert Medical School, Brown University

On November 7, 2018 the NRA responded to “Reducing Firearm Injuries and Deaths in the United States: a Position Paper from the American College of Physicians” by telling doctors to “stay in your lane” and stay out of the discussion of firearm access, regulation, and injury prevention—asserting that this is outside the scope of our practice and experience.

Nothing could be further from the truth.

Firearm injury and death in the United States has long been classified as a public health epidemic; over 116,000 people were injured and more than 38,000 people died from firearm injury in the United States in 2016 alone, and the number of firearm homicides and suicides are increasing across the country. Many major medical organizations, including the American College of Emergency Physicians, have been calling for a public health approach to firearm violence and injury prevention for years.

To those who told us to “stay in our lane,” we say: where have you been?

Where were you at 11pm on a Saturday night when we could barely pump blood back into a child fast enough to stop him from bleeding out? Where were you when we had to tell his parents that their 17-year-old son is paralyzed from the neck down, and that his dreams of attending college in a few months on a football scholarship are over? Where were you when this same patient came back again and again with post-traumatic stress disorder, chronic pain, and new sacral decubitus wounds? Did you help get his medical care covered? Did you help him find a way to attend college? Did you help him find him a place in a skilled nursing facility when his parents could no longer care for him safely at home? We did this. That is the work of physicians and other health care professionals.

Where were you the night that that we took care of a 40 year-old father who shot himself in the head, and died shortly thereafter? He was one of only a handful of people who attempted suicide with a gun that survived transport to the hospital to receive care – among the thousands of patients with gunshot wounds that we care for day in and day out. Where were you when we looked his teenage daughter in the eye and gave her this news that would change her life forever? Did you advocate for safe storage of firearms, particularly in times of suicidal crisis? Did you help fund mental health care in this country? We did this. That is the work of physicians and other health care professionals.

Where were you the night that we tried to save one of our own, shot and killed by her partner while at work at her own emergency department? Did you help develop measures to protect women whose abusive partners have a gun? Did you help develop screening tools for women experiencing domestic violence, and help connect them to services to keep them safe? We do this. That is the work of physicians and other health care professionals.

And where were you on the nights when we cried for the lives we could not save? When in our despair, some among us picked up the gun, pointed it at ourselves, and pulled the trigger? Did you push for measures to prevent physician burnout? To help medical providers debrief after a challenging case? To make family and medical leave more accessible after caring for trauma victims? We do this, too. We stand up for our own: our doctors, our nurses, our social workers, our pre-hospital providers.

You see, this has always been our lane. Whether we own guns or not, whether we work at a critical access hospital or in the busiest urban ED, we have always known the all-too-human toll of bullets on human bodies. And we have all sworn the Hippocratic Oath “to respect the hard-won scientific gains of those physicians in whose steps [we] walk, and gladly share such knowledge as is [ours] with those who are to follow…[and we] prevent disease wherever we can, for prevention is preferable to cure”

As emergency physicians, we are on the front lines of every epidemic. When influenza hits, we are there. When Ebola threatens, we are there. When you need care 24/7/356 we are there. Why would our response to the firearm epidemic be any different? Public health crises call for evidence-based solutions. The reduction in deaths from car accidents over the last 20 years didn’t just happen–this was a concerted effort between physicians, other health care providers, policy makers and innovators to improve regulation of car safety measures, driving laws, and driver education. Now, in the face of CDC and NIH funding restrictions, doctors are meeting this need again. We are leading organizations, such as the American Foundation for Injury Reduction in Medicine (AFFIRM), to side-step political divides and provide a new way forward. An evidence-based public health approach isn’t about “my lane” or “your lane.” It’s about coming together to innovate our way out of this epidemic.

We are done waiting for someone else to tell us when it will be our turn to stop these injuries from happening. Our patients, our communities, and our colleagues deserve better. And while the doctor most definitely is in on this issue, we would never tell anyone else to “stay in their lane”. Instead, we invite you to join us – in our lane of healing, of safety, of injury prevention, of evidence-based medicine. This road is long and winding, but if we journey together imagine the new horizons we can reach.

References

1. Surprise: Physician Group Rehashes Same Tired Gun Control Policies. National Rifle Association-Institute for Legislative Action, 2018. (Accessed 30 November 2018)

2. Kegler SR DL, Mercy JA. Firearm Homicides and Suicides in Major Metropolitan Areas — United States, 2012–2013 and 2015–2016. 2018;MMWR Morb Mortal Wkly Rep:1233-7.

3. Weinberger SE, Hoyt DB, Lawrence HC, 3rd, et al. Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Annals of internal medicine 2015;162:513-6.

4. Ranney ML, Fletcher J, Alter H, et al. A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research. Annals of Emergency Medicine 2017;69:227-40.

5. Lasagna L. Hippocratic Oath–Modern Version. WGBH Educational Foundation for PBS and NOVA online; 1964.

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This blog was reprinted with permission from the author(s) by The Institute for Public Health at Washington University in St. Louis. Subscribe to our monthly or quarterly e-newsletters or follow us on Twitter and Facebook to receive notifications about our latest blog posts.

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