We May Feel Helpless, But We Are Not
By Fred Rivara, MD, MPH
As physicians, all of us feel saddened, helpless, and angry when we hear about the latest mass shooting in the US. We are angry about the injustice, whether it be because the victims are innocent children, because the attack was racist, or just because it happened.
It is important to understand that mass shootings are a very small fraction of the deaths from firearms in the US. On May 29, 2022, The New York Times (NYT) reported that 1500 people have died from mass shootings since 2009. What it did not report was that during this same period of time, 475,627 people lost their lives due to firearms. In other words, mass shootings, as counted by the NYT, accounted for 0.3% of firearm deaths. In the US as a whole, about 60% of firearm deaths are suicides; in the state of Washington, as in most western states, it is three-quarters. Unfortunately, there are no accurate data on the number of non-fatal firearm injuries treated in our Emergency Departments and hospitals each year, but there are likely tens of thousands more.
Clearly, firearm injuries and deaths are a major health problem. There are a number of actions that physicians can take to prevent firearm deaths. Washington is one of 19 states and the District of Columbia that has “Extreme Risk Protection Orders” (ERPOs) or so-called “Red-flag laws.”
These laws allow family members, household members, co-parents, and police to petition the courts to both remove any existing firearms and prevent the purchase of firearms by an individual who exhibits behavior indicating they may be at risk of harming themselves or others. They are court orders that last for one year or until the crisis has passed.
While physicians in our state cannot file a petition themselves, they can advise family members of this law and make a police report. These orders can be life-saving when an individual is suicidal or homicidal.
Unfortunately, approximately three-fourths of physicians in Washington are not familiar with these laws, and even fewer have ever counseled families about them.
Washington is also one of a handful of states that have a “Do Not Sell” law, in which an individual can voluntarily register with the county clerk as someone who should not be allowed to purchase a firearm. For individuals with recurrent severe depression, this law makes a great deal of sense and can prevent suicide.
Safe storage of firearms is essential to protect members of the household. The Harborview Injury Prevention and Research Center studies indicate that proper storage of firearms can reduce the risk of accidental shootings by children and suicide by adolescents by as much as 80%.
However, if the household member who is suicidal is also the firearm owner, such in-home storage of firearms is likely not safe, and voluntary out-of-home storage should be considered. The Firearm Injury and Policy Research Program at the University of Washington has created a map (below) that shows locations across the state of gun ranges, firearm dealers, and police stations which will accept firearms to be stored temporarily during times of crises for owners.
It is important to remember that individuals who attempt suicide with a firearm will die 90% of the time, compared with only 2-3% of those who ingest drugs. People who survive a suicide attempt nearly all go on to live full lives and do not subsequently die in another suicide attempt.
Unfortunately, if the first suicide attempt is with a firearm, there will not be a second chance at life.
Finally, it is also important for us as physicians to remember that we are citizens of the state and should make ourselves knowledgeable about policies and legislation that come before our state legislators and our members of Congress.
There is a great deal of evidence that states that place common-sense restrictions on firearm ownership have lower rates of firearm suicide and homicide deaths than states without many restrictions.
We may feel helpless with these waves of firearm deaths, but in fact, we are not. We can help our patients and help our communities to be safe and to preserve life.
Frederick P. Rivara, MD, MPH
Professor of Pediatrics, UW Medicine
Adjunct Professor of Epidemiology, UW School of Public Health
Director, Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center. Dr. Rivara has more than 30 years of experience researching injury prevention.