13 recommendations from trauma surgeons for reducing gun injury

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A group of trauma surgeons — more than three-quarters of whom are gun owners — has released a series of recommendations for reducing firearm injury and death. The recommendations represent a broad consensus of surgeons from across the U.S., and they include a wide spectrum of strategies for reducing gun injury.

The surgeons are part of the Firearm Strategy Team (FAST) Workgroup, an ad hoc committee of the American College of Surgeons Committee on Trauma. The group consists of 22 surgeons, 18 of whom describe themselves as passionate firearm owners.

The FAST Workgroup detailed their recommendations in a paper published online in the Journal of the American College of Surgeons. “We came to realize that the community of firearm owners are often approached as part of the problem, but less commonly approached as part of the solution,” the authors noted.

“Preventable injury, disability and death from intentional violence related to firearms is unquestionably a major public health problem in the U.S.,” said Ronald Stewart, MD, FACS, medical director of ACS Trauma Programs. “We set out to address the issue by employing a broadly inclusive consensus strategy within the Committee on Trauma. We took all viewpoints into account and, working within the FAST Workgroup, engaged surgeons who are experienced firearm owners.”

The group’s final recommendations cover multiple strategies for increasing firearm safety and reducing gun violence while preserving the right to own and use a firearm:

1. Require background checks for private sales and transfers of firearms

The Fix NICS Act of 2017 requires federally licensed dealers to conduct background checks on all gun sales and transfers through the FBI’s National Instant Criminal Background Check System (NICS). However, there is no such requirement for private gun transactions. The FAST Workgroup supports requiring NICS background checks for all private-party gun sales and transfers.

2. Require that firearms be registered (just like cars and homes)

The workgroup supports the creation of a firearm registration database. “We believe firearm registration and the ability to track a registered firearm is important to aid law-enforcement professionals in preventing the illegal sale of firearms to those who cannot pass a background check due to criminal activity or serious mental illness,” the authors wrote.

3. Consider reclassifying certain firearms with significant offensive capability

Under the National Firearms Act, weapons such as fully automatic machine guns and explosive devices are regulated as class III weapons. “We recommend a formal reassessment of the firearms designated within each of the National Firearms Act classifications,” the workgroup reported. “For instance, high-capacity, magazine-fed, semi-automatic rifles should be evaluated, and consideration given to reclassification as a National Firearms Act class III firearm or a new class designation.”

4. Endorse formal firearm safety education for all new gun owners

In addition, the workgroup endorsed effective hunter safety and gun handling education. Training programs should stress the four key rules of gun safety: “assume the gun is always loaded; finger off the trigger until ready to fire; never point at anything you do not intend to kill or destroy; and always check all chambers before cleaning.”

5. Endorse adult supervision of minors using firearms

“We recommend direct adult supervision in the use of firearms for children younger than 12 years and indirect supervision for children between the age of 12 and 18 years, where not already state-regulated,” the authors wrote.

6. Hold gun owners responsible for events resulting from unsafe storage

The FAST Workgroup agreed that firearm owners should be required to store guns in a safe and controlled manner. “Owners who do not provide reasonable, safe firearm storage should be held responsible for adverse events related to discharge of their firearm(s),” the workgroup concluded. “This includes the responsibility for the use of a stolen firearm, unless there has been timely reporting of a stolen weapon made to law enforcement.”

7. Strengthen programs to keep firearms from “imminent threat” individuals

“For individuals who are deemed an imminent threat to themselves or others, firearm ownership should be temporarily or permanently restricted based on due process,” the authors wrote. The group recommended that mandatory reporting requirements and programs for removing firearms from high-risk individuals should become standard.

8. Use anti-terror strategies to predict, detect and detour mass shootings

The workgroup recommended treating mass shooting events as terrorism. As part of this recommendation, the group encourages law enforcement agencies to use risk-mitigation strategies for predicting and preventing mass gun violence within the limits of the Fourth Amendment.

9. Encourage the development of technologies that make firearms safer

The surgeon group supports the development of firearm technologies that reduce the risk of self-harm, unintentional discharge and unintended use by a non-owner.

10. Fund firearm research at a level that matches the burden of firearm injury

As with any healthcare condition, research is required to reduce firearm injury.

11. Conduct firearm research in a non-partisan manner

According to the FAST Workgroup, studies should address the root causes of gun violence, effective gun safety strategies, differences in firearm lethality, the role of media content in gun violence and other research topics.

12. Media coverage should not provide mass shooters with notoriety

“We have concerns that the manner and tone in which information is released to the public and covered by the media likely leads to ‘copy-cat’ mass killers,” the workgroup reported. “The public, professionals in law enforcement, and the press should take steps to eliminate notoriety of the shooter and take an editorially muted approach to the coverage of these events.”

13. Encourage “see something, say something” for mental health warning signs

The FAST Workgroup acknowledged the roles of social isolation and mental health in gun violence. They recommended that teachers, parents and others be alert to mental health warning signs and be ready to provide referrals to mental health professionals. This is especially important when “signs of violent ideation, thoughts, or actions become evident.”

A framework for discussion

The FAST Workgroup acknowledged that it does not represent the views of all firearm owners, or all surgeons for that matter. However, the group is optimistic that its recommendations will improve the understanding of firearm injury and could ultimately increase public safety.

“We hope this carefully developed report provides a framework for discussing policy issues related to firearm violence, which has become a public health crisis in the U.S.,” said ACS Executive Director David B. Hoyt, MD, FACS. “These injury prevention recommendations may also open up a wider dialog with others who share our similar interest in addressing firearm violence as a public health problem.”

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