Following the horrible school massacre in Newtown, Connecticut, there has been an outpouring of grief and a lively discussion about violence and the impacts of firearms in our society.
Although much attention has focused on mass shootings, we should recognize that serious and fatal firearm injuries occur every day in our nation.
To help guide a rational discussion of these issues, a brief description of the public health approach to injury and violence prevention and control may be useful.
The late Dr. William Haddon, Jr., a pioneer in highway safety, developed a matrix for analyzing motor vehicle crashes. It included time periods (pre-event, event, and post-event), and a variety of strategies for analyzing risk factors and developing mitigating actions or policies. Examples in highway safety have included: better road design, safer cars, driver licensing requirements, and speed and DWI enforcement (pre-event); safety belts and airbags (event); and EMS and trauma care (post event).
Although deaths and injuries from motor vehicle crashes continue to be a major public health problem, the rates of serious injuries and deaths in the United States have declined steadily since the 1960s.
Using a comprehensive matrix approach can be adapted to other injury problems, including firearm injuries and deaths. It can help us better understand that no single policy or strategy can solve the problem, but some strategies will produce greater results than others.
A matrix to analyze firearm injuries could include: the lethality of weapons than can be sold legally (e.g. semi-automatic); types of ammunition; sizes of ammunition clips; expanded background checks; better screening and treatment of potentially dangerous mental conditions;
More safety training; and safe storage practices (pre-event); safety and emergency plans and procedures; quick access to 911 and law enforcement (event); EMS and trauma care; criminal investigations; and crisis counseling for survivors (post event). These are just a few examples.
Whether having more people armed to confront dangerous situations would have positive or negative effects is an issue that should be studied carefully.
Evaluation studies should be conducted routinely to help determine which strategies and policies are working and which of them aren't.
Before an injury prevention and control plan is developed, the magnitude of the problem and risk factors should be analyzed.
In 2000, a study was published in Alaska Medicine (Volume 42, Number 1) titled: "Serious and Fatal Firearm Injuries Among Children and Adolescents in Alaska: 1991-1997." During that seven year period, firearms were the leading cause of injury death among youth aged 19 and younger in Alaska - more than from motor vehicle crashes or any other cause. There were 222 serious hospitalized injuries and 165 fatal injuries. Of the 387 total serious and fatal injuries, about one-third were unintentional (accidental), a third were suicides or attempts, and about one fourth were homicides or assaults. About 5 percent were of unknown intent. There were 19 serious and 8 fatal injuries among children aged 9 and younger. The vast majority of the serious and fatal injuries were among youth aged 10 through 19.
The authors concluded: "This study suggests that many children and adolescents in Alaska who were injured by firearms, or who caused injury to other children and youth by firearms, had easy access to them. Efforts should be made to convince adults not to let children or at-risk teenagers have unsupervised access to firearms, and to promote safe storage of firearms."
It would be interesting to see this study updated with more recent data so we could determine if there has been any improvement in the numbers and rates of firearm injuries and deaths among our youth.
Although the investigation in Newtown, Conn., is continuing, reports suggest that Nancy Lanza knew her son, Adam, was at risk. We don't know yet how he obtained access to her firearms.
Using a Haddon-type matrix, we could probably determine several ways this tragic event could have been prevented or mitigated, as well as other tragic firearm shootings that occur virtually every day in the United States.
Mark S. Johnson retired from the Alaska Division of Public Health in 2004 as Chief of Community Health and Emergency Medical Services. He currently serves on the Alaska Trauma System Review Committee and Chairs the Alaska Emergency Medical Services for Children Advisory Committee.
By MARK S. JOHNSON