This column on several occasions has focused on firearm violence and the American College of Surgeons’ (ACS) efforts to help find solutions to this epidemic that continues to have tragic consequences for our patients and colleagues. Some members of other organizations and the ACS argue that this problem falls outside the purview of medical organizations, telling surgeons and other physicians that they “should stay in their lane.” These comments on social media spurred many health care professionals, particularly trauma care providers, to develop the hashtag #thisismylane and to share their stories with the public.
Making the personal public
A prominent leader of this movement is Joseph V. Sakran, MD, MPA, MPH, FACS, director, emergency general surgery; associate chief, division of acute care surgery; and assistant professor of surgery, Johns Hopkins Hospital, Baltimore, MD. A gunshot wound survivor, Dr. Sakran recently wrote in The Atlantic Monthly, “For me, of course, it’s all just one lane,” adding, “Obviously, most surgeons cannot relate to the problem of gun violence quite so intimately. But it’s incumbent on them not to stay in just one lane—to accept that prevention must be our purview as much as mitigation.”*
He further noted that universal background checks, violence intervention programs, and red flag laws can all reduce the incidence of firearm-related injury and death. Trauma surgeons are well aware of these facts and are well positioned to explain what they’ve witnessed personally.*
COT efforts to achieve consensus
Dr. Sakran’s observations about surgeons’ role in addressing this crisis are aligned with the recent efforts of the ACS Committee on Trauma (COT). With the leadership of Past-COT Chair and current Medical Director, ACS Trauma Programs, Ronald Stewart, MD, FACS, and present COT Chair Eileen Bulger, MD, FACS, the committee has sought to develop a consensus-based approach to addressing firearm violence as a public health issue.
The ACS first issued a “Statement on Firearm Injuries” in 1991. That statement has been revised and updated twice—once in 2000 and again in January 2013. 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. Since Sandy Hook, hundreds of mass shootings have occurred, and tens of thousands of U.S. citizens die annually from firearm violence. Most recently, the ACS Board of Regents, the COT, and other concerned Fellows developed nine action steps, which have been reviewed and refined by the COT Firearm Strategy Team (COT-FAST).
Composed of 22 ACS Fellows and members of the COT and the Board of Regents, including many passionate firearm owners, the COT-FAST has evaluated and developed strategies that would be effective in reducing firearm deaths and injuries while preserving the liberty of responsible firearm owners. In November 2018, the COT-FAST released an initial set of recommendations to move toward the development of an effective and durable strategy for reducing firearm injury, death, and disability in the U.S. The workgroup’s 13 recommendations were published in the Journal of the American College of Surgeons and put forth in an advisory capacity.†
Consensus was reached through a variety of interactions, including multiple surveys of surgeons, internal town hall meetings, focus groups, conference calls, and numerous small group meetings across the nation. All members of the FAST Workgroup needed to agree on a recommendation before it could be included in the final report. The workgroup acknowledges that it does not represent the views of all firearm owners or all surgeons, but it does maintain that these recommendations will increase public safety and improve our understanding of firearm injury in the U.S.
Listening to all ACS members
To capture the sentiments of the broad ACS membership, the Board of Regents and COT commissioned a survey to assess members’ experience with firearms, ownership of firearms, and attitudes about firearms and ACS advocacy for specific firearms policies. The UIC (University of Illinois-Chicago) Survey Research Laboratory (SRL) was responsible for data collection. Data were collected from July 31 to October 7, 2018.
A total of 54,543 active and retired members were invited to participate in the survey; 11,147 members completed the survey, for an overall response rate of 20.4 percent. Most respondents are Fellows (68 percent), male (77.8 percent), and white (77.5 percent). Nearly half of the respondents (45.1 percent) practice in large cities, fewer than one-quarter have served in the military, and slightly more than 60 percent have no children younger than 18 years old living in their home. Approximately two-thirds of the respondents provide care to patients injured by firearms as part of their practice.
Most respondents (83.2 percent) said they have fired a gun and have received firearms training, with variances by practice location, military experience, gender, age, and race. Respondents with military service, men, and older respondents have more experience with firearms and have undergone more firearm training.
Less than half of the respondents (42 percent) said they store a firearm—most commonly rifles, shotguns, or handguns—in the home. Type of firearm and storage location vary by geographic location, practice type, member type, military service, gender, and age. Respondents in cities are more likely to own handguns, whereas respondents in rural areas are more likely to own rifles and shotguns. Retirees, Fellows, and Affiliate Members are more likely to have a firearm in the home than are Residents and Associate Fellows. Members with military experience, men, and older individuals also are more likely to have firearms in the home.
The two most common reasons respondents offered for gun ownership are self-defense/protection (75.2 percent) and target shooting (73 percent). Nearly 75 percent of the respondents said they believe firearm ownership is a constitutional right. However, 50 percent also believe that firearm ownership is both beneficial and harmful, and 45 percent believe it neither protects nor limits personal liberty. The biggest differences in these beliefs are by gender. Three times as many men as women think firearm ownership is beneficial, whereas twice as many women as men believe it is harmful.
Approximately three-quarters of the respondents think it is important that the ACS support public policy initiatives to reduce the prevalence of firearm-related injuries, with 57.5 percent saying it is extremely important and 17.5 percent indicating it is very important. With respect to specific policies, the one with the least support is allowing trained teachers and officials to carry concealed weapons in kindergarten through 12th grade schools. The policies with the greatest degree of support are preventing people with serious mental illness from purchasing firearms, increasing penalties for purchasers who provide guns to individuals illegally, and increasing penalties for dealers who sell firearms through illegal means or who bypass background checks.
At press time, the COT and ACS leadership were reviewing the survey data, and the results will be made available to the membership in the future. In the meantime, we believe these results demonstrate that, in general, ACS members support many initiatives related to firearm policy and that your views are closely aligned with the strategies set forth by the COT and other College leaders to date. With your input, we believe the ACS is close to finalizing a framework for discussing policy issues related to firearm violence. We look forward to collaborating with other organizations that share our interest in addressing firearm violence as a public health problem.
We will continue to call for sensible, reasonable firearm regulatory policies that protect the rights of law-abiding and responsible firearm owners, while safeguarding the safety and quality of life of all U.S. residents. As Dr. Sakran and other members of the #thisismylane movement have stated, surgeons and other trauma care professionals are acutely aware of the devastating effects of firearm violence on the public well-being. We cannot remain silent.
If you have comments or suggestions about this or other issues, please send them to Dr. Hoyt at email@example.com.
*Sakran J. Ideas: I’m a trauma surgeon and a shooting victim. I have every right to speak out on gun violence. Available at: www.theatlantic.com/ideas/archive/2018/12/trauma-surgeons-should-speak-out-gun-violence/578212/. Accessed December 29, 2018.
†Talley CL, Campbell BT, Jenkins DH, et al. Recommendations from the American College of Surgeons Committee on Trauma’s Firearm Strategy Team (FAST) Workgroup: Chicago Consensus I. Available at: www.journalacs.org/article/S1072-7515(18)32155-0/fulltext#sec2. Accessed January 1, 2019.