Road rage: Where we go after the "this is our lane" social firestorm

From the first draft of this article to its final version, more than 20 mass shootings happened following the Oct. 27, 2018, Pittsburgh synagogue massacre.1

The nation paused in horror after Pittsburgh, but those pauses are becoming shorter. These horrific events happen with great frequency; there is a proliferation of firearms in circulation today and very few barriers to acquiring a firearm. As one Vox writer put it, “these factors come together to make it uniquely easy for someone with any violent intent to find a firearm, allowing them to carry out a horrific shooting.”2

Faced with the enormity of these events, some healthcare organizations are reframing the issue to address it as a health issue rather than only a criminal justice concern.

“We should think of it as a problem that affects our health and one that we want to find healthy solutions to,” said Sandro Galea, dean of Boston University’s School of Public Health and professor of epidemiology.3

As Pam Rask, president of the Oklahoma Public Health Association, noted: Gun violence isn’t inevitable ... Can we stop isolated actors from assaulting their fellow citizens? Perhaps not. But we can certainly prevent senseless carnage through thoughtful gun safety, violence reduction and common-sense gun policies.

Pittsburgh may become a distant memory to some by the time you read this — perhaps Thousand Oaks, Calif., too — in the same way that Parkland, Fla.; Santa Fe, Texas; or even Las Vegas, Nev., have for some of us.

A fast lane to criticism

Facing these numbers, physicians are speaking out. The American College of Physicians (ACP) updated guidelines for reducing gun-related deaths in late 2017.4 Those guidelines were ridiculed by the National Rifle Association in November, with a Twitter-issued admonishment for internal medicine specialists in ACP to “stay in their lane.”5

This set off a social media firestorm and statements of support from multiple physician groups attesting to one simple truth, captured in the rallying phrase, #ThisIsOurLane.6

Scores of physicians spoke out via social and news media. “Treating gunshot wounds has always been our lane,” wrote Christopher Lee Bennett, MD, an emergency medicine resident at Massachusetts General Hospital and Brigham and Women’s Hospital in Boston.7

We also saw that providers are not immune from the plague of gun violence following a Nov. 20, 2018, shooting at Chicago’s Mercy Hospital, which killed a police officer, a pharmacy resident and an emergency room doctor. “Every shooting in America is a tragedy, and it is especially senseless when a shooting occurs in the healing space of a hospital,” noted a release from the hospital.8

When addressing gun violence as a public health matter, there are clear health initiatives. Dozens of healthcare providers from several St. Louis trauma centers offer training on controlling life-threatening bleeding through the Stop the Bleed STL program, which trained 1,500 people since launching in March 2018.9

During annual checkups, a growing number of physicians are routinely inquiring whether patients or their family members own or use firearms to better understand risks facing the patient.10

Most important, as reporter Eileen Markey spells it out in America magazine, “what if the chain of violence that can change a victim into a new perpetrator could be broken?” Markey cites public health methodologies used by the Cure Violence nonprofit group, founded by Gary Slutkin, MD, as a means to understand why violence spreads in a population, especially among those previously affected by violence. The group’s senior director of science and policy, Charles Ransford, says the work requires “an epidemiological lens.

“There is no justice in waiting for a person who has been heavily traumatized by violence themselves to behave violently and then send them to prison. That is not just or fair for anyone involved,” Ransford asserted. The group instead identifies people affected by crime and works with those victims before they spread violence, whether the driver is retaliation, fear or pride.

An April 2018 Gun Violence Prevention Hack-a-thon hosted by Massachusetts General Hospital yielded a similar result. The community resilience award went to Dream Alive, an app developed to link individuals and families affected by gun violence to mentors and social services.11

There are new and innovative ways to think about the health issue of gun violence. These are just some of them — for the sake of patients and ourselves, it is past time to consider the science and stop the bleeding.

Additional resources

• "Do you need insurance for an active shooter incident?" (MGMA Connection article)
• "Addressing workplace violence in healthcare settings" (MGMA Connection article)
• "Solving emergency department security challenges" (MGMA Connection article)

Notes:

1. “Mass shootings in 2018.” Gun Violence Archive. Accessed Nov. 11, 2018. Available from: bit.ly/2wyjyC1.
2. Lopez G. “The Pittsburgh synagogue shooting is another example of America’s gun problem.” Vox, Oct. 27, 2018. Available from: bit.ly/2Q2nLGy.
3. Murray-Cooper A. “SPH, School of Social Work join forces to talk gun violence prevention.” The Daily Free Press, Oct. 25, 2018. Available from: bit.ly/2CLPLu7.
4. Wintemute GJ. “What you can do to stop firearm violence.” Ann Intern Med. ;167:886–887. doi: 10.7326/M17-2672.
5. Fox M. “NRA tweet warns doctors to ‘stay in their lane’ over gun control.” NBC News, Nov. 8, 2018. Available from: nbcnews.to/2F7gqo2.
6. ACP Internists. Twitter. Nov. 9, 2018. Available from: bit.ly/2AZn4c0.
7. Bennett C. “Hey, NRA: I treat gunshot victims. Advocating about firearms is ‘my lane.’” STAT. Nov. 14, 2018. Available from: bit.ly/2DLBWNT.
8. Charles S., et al. “This tears at the soul of our city.” Chicago Sun-Times. Nov. 19, 2018. Available from: bit.ly/2DvfJTg.
9. Farzan S. “’Stop the Bleed’ effort targets St. Louis neighborhoods affected by gun violence.” St. Louis Public Radio, Oct. 28, 2018. Available from: bit.ly/2SrnKgM.
10. “Should doctors routinely talk to patients about gun use?” The Wall Street Journal, June 24, 2018. Available from: on.wsj.com/2yGAn1R.
11. CAMTech. “Gun violence prevention program report.” June 2018. Available from: bit.ly/2ObOUVS.