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2018-1 Firearm Violence
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Firearm violence is a major national emergency and a public health crisis. The American Trauma Society (ATS) believes it is time for all, including our legislators, to get involved, advocate for new research into this problem, and work towards a shared resolution of this national issue. Expressing our grief and outrage alone has not been an effective tactic for change. We must be proactive instead of reactive, avoid assigning blame, and join together to meet this challenge. Our response must be consistent and continuous until we see an end to the violence.  


The ATS issued an initial statement on firearm violence in 2013. Unfortunately, we are in a position not only to re-issue the initial recommendations, but to expand them to reflect the evolution of the issues and the multi-faceted nature of the situation before the nation. We understand the issues we face today as Americans are more than just about firearms, and our recommendations were developed with that premise in mind. 


Firearm Violence


Gun violence in the United States is a major public health problem that results in tens of thousands of deaths and injuries annually. Firearm-related suicides and homicides were the fourth and fifth leading causes of injury death in the United States in 2015 and together accounted for 36,252 fatalities and 62,873 non-fatal gunshot injuries (1). Nationally, the firearm homicide rate among persons aged 5-34 years slightly exceeded the rate for persons of all ages. From 2006-2016, there were 355,789 violence related firearm deaths and 606,735 non-fatal firearm injuries reported to the Centers of Disease Control and Prevention (CDC). The CDC currently reports violence-related firearm deaths at an age-adjusted rate of 11.48 per 100,000 U.S. citizens, nearly comparable to the rate of motor vehicle traffic deaths at 11.62 per 100,000 (2).


According to the CDC, the direct medical costs of treating fatal gun injuries combined with the economic damages of lost lives totaled $41 billion in 2010 (the most recent year for which data is available) although the Giffords Law Center to Prevent Gun Violence suggests the cost to the American economy is closer to $229 billion in direct expenses every year. The CDC calculates that the cost of treating non-fatal gun injuries was an additional $4.1 billion in persons that required hospitalization that year and an additional burden of $222 million in persons treated and released from an emergency department.  More than money is at stake. Considering the economic burden alone minimizes the intense personal tragedy of lives lost, families shattered, people devastated, and social fabric eroded.    


The ATS recommends limiting civilian access to military-style assault firearms. What makes these firearms unique? The answer does not lie in their appearance. The answer lies in the unique and devastating nature of the injuries caused by high velocity ammunition. Quite simply, military-style firearms are designed for battlefield killing. They can be fired automatically, as found in military versions, or semi-automatically, as found in those sold to civilians, from easily and rapidly exchanged high capacity magazines that can contain 50-100 bullets before the shooter needs to reload (3). The most popular semi-automatic civilian version firearms today are the AR-15 (ArmaLite Rifle, invented in the 1950s). The current U.S. military automatic version of this firearm is the M-16. Automatic versions of similar firearms have been banned from civilian sales in the United States since the 1930s (4). 


Recent examples of the lethality of these firearms can be seen in recent mass shootings including, but not limited to:


  • 2018 Marjory Stoneman Douglas High School with 17 killed and 17 injured.
  • 2017 Las Vegas shooting with 58 killed and 500 injured. 
  • 2016 Pulse nightclub shooting with 49 killed and 53 injured.
  • 2015 San Bernardino shooting with 14 killed and 22 injured. 
  • 2012 Newtown shooting with 27 killed and 2 wounded.


It is because of the lethality of this type of firearm that we recommend it not be sold in the United States and that high capacity magazines be banned. In addition, there should be severe penalties if these firearms or magazines are used in the commission of a crime.  Buy-back programs should be instituted to reduce the number of these firearms in circulation.


The American Trauma Society continues to support a number of specific measures to reduce the destructive effects of firearm injury through the implementation of the following recommendations:


  • Collaboration of medical, private, public, and government groups and citizens to work together actively and urgently toward a common goal of reducing and ultimately eliminating the preventable injury and death resulting from firearms, including mass shootings, homicide, suicide, and unintentional injury.
  • Provide public education on gun safety including collaborative training with law enforcement and sporting organizations.
  • Enhance mandatory and thorough background checks for the purchase of firearms, including at guns shows and auctions.
  • Ban civilian access to automatic and semi-automatic assault style firearms, large ammunition clips, and any device that enables a shooter to fire a large quantity of ammunition over a short period of time, including but not limited to bump stocks.
  • Support active shooter training and drills in all public settings in collaboration with state and local law enforcement agencies.
  • Support gun buy-back programs to assist in reducing the number of firearms in circulation.
  • Increase funding to expand and strengthen the nation’s mental health/behavioral health services.
  • Protect the rights of health care providers to talk to their patients about gun safety.
  • Increase funding for teaching and supporting non-violent conflict resolution.
  • Encourage federal and non-governmental agencies to perform and fund firearm research to determine the most effective interventions to reduce gun violence.
  • Support Stop the Bleed, a national awareness campaign intended to cultivate grassroots efforts that encourage bystanders to become trained, equipped and empowered to help in a bleeding emergency before professional help arrives.  




(1) Murphy SL, Xu JQ, Kochanek KD, Curtin SC, Arias E. Deaths: Final data for 2015. National Vital Statistics Reports; vol 66 no 6. Hyattsville, MD: National Center for Health Statistics. 2017.  Retrieved 15 March 2018 at


(2) Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2015) [Accessed 2018 March 16]. Available from URL:


(3) Large Capacity Magazines. (n.d.). Retrieved from


(4) (n.d.). Retrieved from

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