What Can Surgeons Do about Gun Violence?

​The American College of Surgeons (ACS) Committee on Trauma (COT) has developed a consensus multilayered strategy aimed at reducing deaths from firearms injuries, published in the October 2017 issue of theBulletin of the American College of Surgeons. Although firearms injuries account for only about 5% of visits to American trauma centers, the authors said, they account for the same amount of deaths as car accidents and falls do. The first goal of the ACS COT strategy is to reduce the incidence of firearm injuries through violence prevention programs. Beyond that, the goals include achieving immediate bleeding control at scenes of injury before emergency services (EMS) arrive by "turning bystanders into immediate responders"; ensuring the delivery of rapid onsite medical care by promoting high-quality EMS care; providing fast and high-quality care at trauma centers; and promoting rehabilitation to minimize disability. ACS COT also addressed the divisiveness of the gun control debate, acknowledging that it has created a "perceived chasm that may seem unbridgeable." Strategies outlined to bridge this gap include promoting professionalism, collegiality, and respect; using objective data; recognizing that everyone constructs narratives and that other people's narratives may differ from one's own; and focusing on doing the right thing for the patient. Other articles in the October 2017 Bulletinalso address strategies to reduce injury and violence, including a primer for trauma centers on how to develop comprehensive violence intervention programs. The authors recommend reducing the incidence of gun violence through the same types of mitigation strategies that reduced heart attack and cancer rates, using a comprehensive approach that takes into account mental health and social determinants of health.