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Ending Gun Violence Is Our Lane

Barsotti, Christopher, MD

doi: 10.1097/01.EEM.0000552804.25939.a3

Dr. Barsotti is a founder and the chief executive officer of the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) and an emergency physician at Berkshire Medical Center in Pittsfield, MA, and Southwestern Vermont Medical Center in Bennington, VT. He is also the immediate past chair of the Trauma and Injury Prevention Section of the American College of Emergency Physicians, the current secretary/treasurer of Vermont ACEP, and a member of the Massachusetts Medical Society committees on preparedness and violence intervention and prevention. Follow AFFRIM on Twitter at @ResearchAFFIRM. Find more information about AFFIRM at

The problem of gun violence is more than bullet holes.

Emergency physicians know how deep this problem runs. We conduct threat assessments of patients who demonstrate dangerous behaviors with legally-owned firearms, comfort the families of victims we couldn't resuscitate, help survivors learn to live with their new disabilities, and prepare for the next inevitable catastrophe with active shooter drills and mass casualty plans. We also see firsthand the toll gun violence takes on the psychological and social health of our communities.

But, more importantly, we know that it doesn't have to be this way.

Gun violence is an unrelenting epidemic that kills and wounds 120,000 people each year, threatens the lives of hundreds of thousands more, and creates pervasive fear of violence in our schools and places of worship and celebration.

If physicians can address gun violence in the same way we have addressed every other health crisis, we will find solutions to decrease firearm victimization, injury, and death. We checked the HIV epidemic without taking away sex. We slashed the mortality rate from motor vehicle trauma by improving cars, roads, and the behaviors of those who use them without taking away cars. The same is possible for firearms.

By employing public health methods, physicians can identify the causes of gun violence, learn who is at risk, understand what works to prevent or mitigate injuries, and scale up successful interventions. We can develop layered systems to optimize care, mitigate risk, promote resilience, and reduce harm at every opportunity. Policy change is important, but we can't legislate our way out of this problem.

It's going to take research. Unfortunately, gun violence prevention research has been systematically underfunded for decades because of the 1996 Dickey Amendment. Despite 20 years of advocacy by the medical professions, Congress continues to appropriate $0 to the Centers for Disease Control and Prevention for gun violence prevention research. It's time to seek alternative solutions.

The American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) was founded last year by physicians to fund gun violence prevention research through private sector partnerships and to sponsor the development of evidence-based recommendations to diminish the injury burden. AFFIRM created a bypass to the partisan blockade of gun violence prevention research in partnership with its coalition of medical organizations, including the American College of Emergency Physicians, the American Medical Association, the American College of Surgeons, and the American College of Physicians, among many others.

With this backdrop, the #ThisIsOurLane physician movement erupted Nov. 8 after the National Rifle Association (NRA) scolded physicians on Twitter to “stay in their lane” in response to a position paper on firearm injuries published in the Annals of Internal Medicine. (2018;169[10]:704; At the same time, Thousand Oaks, CA, became the latest chapter in the American epidemic of mass gun violence.

Recruiting the energy and talent of more than a dozen physician authors nation-wide, AFFIRM responded with an open letter that decisively staked our claim in the fight to end the epidemic of gun violence in America. ( Our letter had garnered more than 40,000 health care signatures as of Dec. 1, and confirms that we have the expertise, workforce, and collective will of medicine to end this epidemic.

AFFIRM's first requests for proposals were just released in partnership with the Emergency Medicine Foundation and Emergency Medicine Residents' Association, and are available at

In partnership with the Illinois College of Emergency Physicians and University of Illinois at Chicago faculty, we are currently raising funds to study the intersectional issues of gun violence and intimate partner violence in honor of Tamara O'Neal, MD. Anyone wishing to support this fund may contribute at

Physicians who wish to increase the impact of the #ThisIsOurLane discussion by writing a perspective piece ( for our webpage are encouraged to contact us at

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