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Standing AFFIRM

Firearm Access Raises Teen's Risk of Injury, Death

Zeidan, Amy MD

doi: 10.1097/01.EEM.0000604548.74605.da
Standing AFFIRM

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Many physicians are first exposed to the devastation of firearm injuries at work. My first experience came much earlier, when I was 13.

I remember the day vividly—a magnificent, warm Minnesota fall day. My mom and I were excitedly preparing for my dad and brother to return from a weekend of hunting. Amid our preparations, the phone rang loudly.

Silence.

“What?”

Silence.

“OK.”

My mom called to me. “There's been an accident, and it's very bad.”

We drove in silence for 20 minutes until we arrived at the hunting area. When we arrived, we saw an ambulance parked nearby. Its lights and sirens were silent. We were instructed to follow the ambulance to a nearby funeral home.

We walked into a large frigid room. In the center of this room was a body bag on a gurney. “We need to see him,” my mom commanded.

The funeral home director unzipped the body bag starting at the head, but could only make it to his chest before turning away.

Small splatters of blood remained on my brother's face, although the EMS crew did their best to clean him up. His freshly adjusted braces glistened. I thought I detected a smile as the corner of his lips turned upward. He was pale, lifeless, and part of his frontal and parietal skull was gone.

I touched him. He was cold. He was gone.

Weeks after that horrific event, we learned that the safety of the gun had malfunctioned. Had he taken his own life or was this an accident? He had shown no obvious signs of depression or suicidality. He took the required certification courses to operate a gun. It took us years of agonizing over the cause of his death before we accepted that we would never know for sure.

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Not Anti-Gun but Pro-Safety

In 1999, the year my brother died, unintentional injury was the number one cause of death for his age group, 15-24. (CDC Fatal Injury Data. http://bit.ly/2mnjHH7.) Suicide was the third cause of death for his age group, with fatal firearm injuries as the primary cause of all suicide deaths. The data looked shockingly similar in 2017, 18 years later.

A few studies have compared firearm injuries in rural and urban areas. The results indicated that the risks of firearm injuries and deaths are high for teenagers in both locations. Suicides, usually among men, account for the majority of gun deaths in rural areas. (Am J Public Health. 2004;94[10]:1750; http://bit.ly/31ug1mf; J Am Board Fam Pract. 2001;14[2]:107; http://bit.ly/31sCtfB.) Male teenagers in urban settings are at greater risk of firearm fatalities and injuries secondary to assault, but suicide still accounted for a high percentage of gun deaths. (Pediatrics. 2018;142[2]. pii: e20173318; http://bit.ly/31qM3zC.)

Rural areas face additional barriers of prolonged discovery time and transport time to trauma centers. They generally have high injury and mortality rates, meaning those living in rural areas are more likely to die from traumatic injuries. (Am J Public Health. 2004;94[10]:1689; http://bit.ly/31CXvZj.) Not surprisingly, prehospital deaths from trauma increase as the distance to a hospital increases. (J Trauma. 2010;69[3]:633.)

These statistics support my experience working as an EP in rural and urban settings. Twenty years later and it seems that depressed teenage boys have easier access to firearms than to mental health care. Studies have shown that those who own or have access to firearms are more likely to experience firearm injuries and fatalities. (Arch Pediatr Adolesc Med. 1999;153[8]:875; http://bit.ly/304z6yc.) A study by Johnson and colleagues revealed that 80 percent of adolescent suicides involved firearms and that most adolescents committed suicide at home using a gun owned by a parent. (Suicide Life Threat Behav. 2010;40[6]:609; http://bit.ly/306itlB.)

My brother was approximately 100 miles from a Level I trauma center, and the gun he was using belonged to our family and was typically locked in a gun safe. He fit all of the statistics.

Teenagers with access to firearms are at risk of harm and death, regardless of where they reside. Since my brother died, few interventions that could have prevented his death have been implemented. I am not anti-gun or anti-hunting, but I am pro-safety. It is imperative that we support research that allows us to better understand the data surrounding firearm injuries and their complex relationships. We owe it to my brother and so many like him to change the statistics.

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Dr. Zeidanis an assistant professor of emergency medicine at Emory University in Atlanta, GA. Follow her on Twitter @amyjwal.

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