Guns Don't Kill People, People Kill People

Before I started researching gun deaths, gun-control policy used to frustrate me. I wished the National Rifle Association would stop blocking common-sense gun-control reforms such as banning assault weapons, restricting silencers, shrinking magazine sizes and all the other measures that could make guns less deadly.

Then, my colleagues and I at FiveThirtyEight spent three months analyzing all 33,000 lives ended by guns each year in the United States, and I wound up frustrated in a whole new way. We looked at what interventions might have saved those people, and the case for the policies I’d lobbied for crumbled when I examined the evidence. The best ideas left standing were narrowly tailored interventions to protect subtypes of potential victims, not broad attempts to limit the lethality of guns.

By the time we published our project, I didn’t believe in many of the interventions I’d heard politicians tout.

Instead, I found the most hope in more narrowly tailored interventions. Potential suicide victims, women menaced by their abusive partners and kids swept up in street vendettas are all in danger from guns, but they each require different protections.

Another day, another school shooting. My thoughts:

I have been reading many appropriately emotional comments from friends and relatives in the aftermath of the Broward County high school shooting. I’ve even discovered I have close friends who’s children attend the school involved. It’s a shocking situation which makes me equally angry. I agree with everyone’s passion on the fact that this ridiculous violence must be stopped. Thoughts and prayers are fine, but I think its past time for some action to be taken.

First off, let me state my belief in our United States Constitution and the Republic our founders created. It’s one of the most impressive documents and efforts ever accomplished. The entire world, even those who’s governments are more socialist in nature, marvel at our representative form of government. The checks and balances, the individual freedoms and liberties and ability to be amended are it’s hallmark.

Some of my friends and relatives are suggesting we scrap our constitution and start anew. I think not. The process’s for change in our country is not to throw away our founding document and start over. The process for change is written right into the document. We have the ability to amend the constitution. We have the ability to fix what’s broken. It starts at the local level. It starts with your vote. It starts with finding politicians who can work together toward solving problems rather than being stagnant - polarized in their far right and far left views. Become politically active. Start with uniform term limits and tighten restrictions on political contributions. Gut the special interests and elect those who want to lead and make change into office. Find and support those independent thinking individuals in your communities who can transform our current polarized 2 party system into a multi-partied approach which actually gets something positive accomplished.

Gun control. The pink elephant. But first, lets have full disclosure: I am not a supporter of the NRA, I am not a republican nor am I a democrat. I am center conservative. I own guns. I do not own anything which could be called an ‘assault rifle.’ I am a retired peace officer, having served over 35 years.

Sadly, post shooting emotional calls to action banning ‘black rifles’ has become the standard. But, in my opinion its the easy way out and is, absolutely not the answer - nor even a ‘good start.’ It’s a misguided, simple approach to a problem with a much more difficult solution. It’s a “feel good’ response to a terrible situation. There are around 300 million guns in America today. Do you honestly think banning one type of gun will solve anything? I hear this...Yes, but if it prevents one shooting it will be worth it. How sadly ridiculous this contention is. Just look at the gun violence in those cities who have the strictest gun laws in the nation. Making a law prevents good folks from committing an act. It doesn't prevent criminals or those mentally ill from doing anything. Again, its a feel good resolution to an extremely complex situation.

I think we need to look at the root cause. The great majority of mass school violence cases has a common denominator - the criminal has mental health issues. It’s high time we realize we have a lack of suitable mental health care in our society. Our health care system needs immediate reform. Historically, We have transformed over the years from one side of the spectrum (insane asylums) to today’s system where most everyone can be outpatient - treated with prescription medications. Over the years, its become a big win for big pharma (Don’t get me started on big pharma) while society has alleviated many beds from in-patient mental health care facilities. As a result there are lots of really DANGEROUS folks running around our communities. I’m not in any way suggesting going back to the asylum days, but we’ve have to rethink and adjust our current line of thought and funding concerning those who really need help.

Our current standard of mental health commitment is: ‘A documentable danger to themselves or others.’ This is fine however, there are not enough bed spaces in our states mental health facilities to effectively hold, evaluate and treat those those individuals who need evaluation. In most instances, those picked up by cops who are exhibiting dangerous behavior are released back to the community before officers can complete the required M-1 paperwork. Many of these dangerous individuals need a lock up facility for treatment. Most are released for lack of bed space.

Additional funding is obviously needed to build regional treatment facilities and staff them with competent professionals. Those who are a legitimate danger need to be held and treated until they are deemed to no longer be a danger to society. How about a starting a nationwide effort, much like the space program in the 60’s, to resolve our mental health issues. Look for funding from alternative means...open up all doors and ideas - why not legalize marijuana nationwide and fund mental health and opioid addiction through pot taxation. How about less highway funding and more dollars directed to care for those who need help.

In any event, I agree with everyone -we must do something. Just think about the root causation vs. a feel good, short term resolution.

Mark Fisher

As I opened the CT scan last week to read the next case, I was baffled.

I was looking at a CT scan of one of the victims of the shooting at Marjory Stoneman Douglas High School, who had been brought to the trauma center during my call shift. The organ looked like an overripe melon smashed by a sledgehammer, with extensive bleeding. How could a gunshot wound have caused this much damage?

The injury along the path of the bullet from an AR-15 is vastly different from a low-velocity handgun injury. The bullet from an AR-15 passes through the body like a cigarette boat travelling at maximum speed through a tiny canal. The tissue next to the bullet is elastic—moving away from the bullet like waves of water displaced by the boat—and then returns and settles back. This process is called cavitation; it leaves the displaced tissue damaged or killed. The high-velocity bullet causes a swath of tissue damage that extends several inches from its path. It does not have to actually hit an artery to damage it and cause catastrophic bleeding. Exit wounds can be the size of an orange.

With an AR-15, the shooter does not have to be particularly accurate. The victim does not have to be unlucky. If a victim takes a direct hit to the liver from an AR-15, the damage is far graver than that of a simple handgun shot injury. Handgun injuries to the liver are generally survivable unless the bullet hits the main blood supply to the liver. An AR-15 bullet wound to the middle of the liver would cause so much bleeding that the patient would likely never make it to a trauma center to receive our care.

One of my ER colleagues was waiting nervously for his own children outside the school. Even as a physician trained in trauma situations, though, there was nothing he could do at the scene to help to save the victims who had been shot with an AR-15. Most of them died on the spot, with no fighting chance at life.

As a doctor, I feel I have a duty to inform the public of what I have learned as I have observed these wounds and cared for these patients. It’s clear to me that AR-15 or other high-velocity weapons, especially when outfitted with a high-capacity magazine, have no place in a civilian’s gun cabinet.

The CDC is the appropriate agency to review the potential impact of banning AR-15 style rifles and high-capacity magazines on the incidence of mass shootings. The agency was effectively barred from studying gun violence as a public-health issue in 1996 by a statutory provision known as the Dickey amendment. This provision needs to be repealed so that the CDC can study this issue and make sensible gun-policy recommendations to Congress.

Defending children is a must, but putting a firearm in the hands of even the most trained teacher isn’t the answer. Anyone suggesting this solution has clearly never experienced a situation like the one seen in Parkland because it oversimplifies the complexity of an active shooter situation, especially in close-quarters. It is not as easy as a “good guy with a gun stopping a bad guy with a gun.”

I ask that you take a few minutes to understand my perspective and why I feel strongly about this matter. Before recently moving to Charlotte, I served for three and half years as an Army infantryman, stationed at Fort Wainwright in Fairbanks, Alaska, and I deployed to Afghanistan’s Kandahar Province in 2011. By the time my tour was over, I left a place that claimed two members from my company, cost six others at least one limb, wounded over 25 percent of our total force, and left me with shrapnel in my face and a bullet hole in my left thigh. When I saw the news flash of another school shooting I couldn’t help but think of the firefights I had been involved in and how these students and teachers just encountered their own version of Afghanistan.