Gunned down

Last month’s Bulletin column titled “Assaulted” reported an increasing trend toward violence across the nation. What do the following cities have in common this year: Dover, DE; Chardon, OH; Aurora, CO; Oak Tree, WI; College Station, TX; Chicago, IL; New York, NY; Seattle, WA; Norcross, GA; Philadelphia, PA; Tempe, AZ; Oakland, CA; and Miami, FL? They are all sites of multiple-victim shootings that involved at least three or more people injured or killed.

As of the middle of August, 25 individual occurrences of multiple-victim shootings were reported throughout the U.S. this year, averaging out to one incident every 8.6 days. These shootings accounted for 185 wounded and 83 dead. Of the 25 incidents, eight were gang-related and 18 took place in public places.* Many of the shootings involved a gunman with no relationship to the victims and several took place in broad daylight. Several occurred in cities with very strict gun control; others occurred in locations that allow concealed weapons. No specific type of weapon was common to each of these incidents.

Figure 1. Hospital discharge status

To examine the occurrence of firearm-related assaults in the National Trauma Data Bank® (NTDB) research dataset for 2010, admissions medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Specifically searched were external cause of injury E codes 965.0 (assault with handgun), 965.1 (assault with shotgun), 965.2 (assault with hunting rifle), 965.3 (assault with military firearm), and 965.4 (assault with unspecified firearm). A total of 23,937 records were uncovered; 18,410 records contained a hospital discharge status, including 15,496 patients discharged to home, 1,132 to acute care/rehab, and 488 sent to skilled nursing facilities; 1,294 died (see Figure 1).

These patients were 89.9 percent male, on average 28.2 years of age, had an average hospital length of stay of 6.7 days, an intensive care unit length of stay of 6.1 days, an average injury severity score of 11.9, and were on the ventilator for an average of 5.5 days. Of the 13,345 that were tested for alcohol, 5,424 (41 percent) were found to be positive. The line graph in Figure 2, demonstrates the peak age ranges for firearm assault victims.

Figure 2. Firearm assaults by age range

Multiple-victim shootings in the U.S. are turning into a weekly occurrence that may happen in a public place, take place at any time of the day, and are often unrelated to gang activity. The solutions to this problem are neither easy nor quickly apparent. Everyone needs to work together to solve this multifactorial issue.

Fortunately, there are trauma centers and trauma systems throughout the country that have mitigated the impact and body count of these occurrences. These trauma centers often function at a financial loss, and there is little federal or state support for their lifesaving activities. Each of us needs to play a part in fighting interpersonal violence as well as preserving trauma care as we know it. No one wants to go to his or her house of worship or go to see a movie and be concerned about being gunned down or not having access to a trauma center. (For more information, visit the ACS website.)

To access the American College of Surgeons position statement on firearm violence, visit the Committee on Trauma’s Subcommittee on Injury Prevention’s website.

Throughout the year, we will be highlighting data through brief reports in the Bulletin. The NTDB Annual Report 2011 is available on the ACS website as a PDF file and as a PowerPoint presentation at In addition, information regarding how to obtain NTDB data for more detailed study is available on the website. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at

Statistical support for this article has been provided by Chrystal Caden-Price, Data Analyst, NTDB.

*Brady Campaign to Prevent Gun Violence. Mass Shootings in the United States Since 2005. Available at: Accessed August 2, 2012.

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