Special Session details ACS membership survey results on firearm injury prevention

Left to right: Dr. Stewart, Dr. Kuhls, and Dr. Campbell
Left to right: Dr. Stewart, Dr. Kuhls, and Dr. Campbell

Firearm violence is a growing cause of injury and death in the U.S. More than 30,000 people a year die from firearm injuries, with approximately 60 percent of these deaths attributed to suicide. Recent data show that firearms now cause more deaths than motor vehicle crashes. And although mass shootings represent a small absolute amount of the firearm-related murders each year, they are becoming more frequent and more deadly.

Surgeons—specifically, trauma surgeons—primarily are responsible for treating the victims of gun violence.

It is within this context that the American College of Surgeons (ACS) Committee on Trauma (COT) in 2018 commissioned a survey of approximately 55,000 members of the ACS to gauge their demographic status (race, gender, ethnicity; urban or rural practice location; firearm ownership; and so on) and attitudes on a variety of issues related to firearm violence and control measures. During a Tuesday morning Special Session, leaders from the ACS COT and ACS Trauma Programs detailed the results of the survey.

Guns are largely understood to be a personally and politically polarizing issue in the U.S., but the survey revealed consensus on a variety of firearm issues. “There are concrete steps we can take to work together and to make progress that cross divides to address gun violence as a medical and public health problem, not a political one,” said Ronald M. Stewart, MD, FACS, Medical Director, ACS Trauma Programs. The survey results are summarized as follows.

Dr. Stewart provided an overview of the respondent demographic and firearm experience information. Of more than 11,000 respondents to the survey, most were Fellows, and a large majority were male and non-Hispanic whites. More than 80 percent had fired a gun, and more than 60 percent had firearm training; 42 percent stored firearms in their homes, mostly in gun safes. Approximately two-thirds of the respondents have treated victims of gun violence in their practices.

Approximately three-quarters of the respondents think it is either very or extremely important that the ACS support public policy initiatives to reduce the prevalence of firearm-related injuries. 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 support among respondents 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.

Brendan T. Campbell, MD, MPH, FACS, the Donald W. Hight Endowed Chair in Pediatric Surgery, Connecticut Children’s Medical Center, Hartford, and Vice-Chair, ACS COT Injury Prevention and Control Committee, detailed the survey results relative to firearm ownership status (firearm in home versus no firearm in home) and practice location (rural versus urban).

There was significant support across firearm ownership status for enhancing the Nation Instant Criminal Background Check System (NICS) and preventing seriously mentally ill persons from purchasing guns. However, there were disparities between the groups in restricting civilian access to high-capacity, semiautomatic firearms, with most gun owners not at all supportive, whereas non-owners were extremely supportive. The breakdown for these questions was similar for the rural/urban divide, with most supporting mandatory NICS use and a divide in restricting high-powered semiautomatic weapons.

Deborah A. Kuhls, MD, FACS, FCCM, director, University Medical Center of Southern Nevada, Las Vegas, trauma intensive care unit, and Chair, ACS COT Injury Prevention and Control Committee, analyzed the results through the lens of gender, race, and ethnicity. Both men and women largely supported ACS advocacy for policy initiatives to reduce firearm injuries, but women were considerably more likely than men to say that personal gun ownership is harmful, though the majority believed it is both beneficial and harmful. Women and men both were supportive of concepts such as preserving physicians’ rights to counsel patients on safe firearm ownership, advocating for federal firearm violence research funding, and enhancing the NICS, though men were much more likely to not at all support restricting civilian access to high-powered semiautomatic weapons.

Race and ethnicity breakdowns again showed mostly agreement on these issues, with strong support across the spectrum for mandatory background checks before gun purchase and allowing physicians to provide counsel on firearm safety to patients, and a lack of support for allowing trained teachers to carry firearms. White respondents were less likely to support restricting access to high-powered semiautomatic weapons and prohibiting mentally ill persons from purchasing guns than other groups.

Dr. Kuhls concluded with a summary of results from the historic Medical Summit on Firearm Injury Prevention, which the ACS hosted earlier this year and included representatives from 47 organizations dedicated to addressing this public health crisis. The nine consensus statements reached at the summit recommend recognizing the crisis, researching it using a disease model with increased funding, engaging firearm owners and communities, empowering the medical community to counsel and screen patients, and committing professional organizations to action.