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PED-EM-L  February 2018

PED-EM-L February 2018


Re: The shooting in Florida


Robert Flood <[log in to unmask]>


Robert Flood <[log in to unmask]>


Sun, 18 Feb 2018 17:26:11 +0000





text/plain (460 lines)

Dear Colleagues:

This conversation gives me some hope that we can and will address the issue of gun violence through the scientific approach, rather than "beliefs" and "feelings", similar to the way that Dr. Wintemute has done for the past several decades. While I fully support a "re-evaluation/clarification" of the second amendment, a "Children's Rights Amendment", and other legislation to help curb gun violence in the US, we can and and should evaluate potential interventions now in the context of over 350 million guns, with unlimited ammunition, available to the US public.

So, if we are going to use the scientific approach to this huge public health emergency that clearly endangers our children, we really should break up the huge scope of "gun violence" into unique subsets, including but not limited to the following:

1) Mass Shootings: Unfortunately, the US leads the entire world in the number of mass shootings, which may be more properly categorized as "mass suicides" since these shooters usually have no intention of surviving their murderous rampages. Clearly, the evidence shows a direct correlation with the elimination on the band on assault rifles and the increase in the number and deaths in these incidents. So, everyone's comments on the access to better mental health should be just one aspect of the study of all potential interventions. For instance, even pediatricians must admit that if we had armed security in every school, perhaps with the national guard, we would likely decrease the number of gun related deaths/year in our schools. However, we would need to study that model to prove our hypothesis rather than saying "I believe this will work".  Still, Mass Shooting Deaths are only a tiny percentage of gun deaths in the US in any given year. In fact, if we eliminated every single mass shooting gun death and injury in the US, it would have a negligible impact on gun related death and injury rates.

2) Intentional Hand Gun Violence: We continue to have disturbing data regarding intentional handgun injuries, especially in the inner city African American communities. With over 100 K gun related injuries/year, and over 10 k non-suicidal gun related deaths/year, this is a very different problem than "Mass Shootings" and needs to be studied in very different ways. Within this category there are both domestic (ie, in the home) and non-domestic sub-categories, which will likely require very different interventions. For instance, in Saint Louis, MO, we are participating in a 4 hospital (all level 1 trauma centers), 2 university intervention program whereby social worker mentors will be paired with willing participants who present as victims of gun violence with the goal of preventing recidivism as either a victim or a perpetrator.

3) Suicides: The data is consistent and very alarming: over 20 K deaths/year from suicides with a gun. The overwhelming majority of these deaths are due to access to handguns and ammunition in the homes. So, while our limited data allows us to recommend that guns and ammunition be stored and locked separately, we don't know for sure whether this would have significant impact on intentional suicides by teenagers, who often have access to both of these locked items. So, we need to study this in much greater detail, and offer viable solutions to well intentioned individuals who are trying to "protect their families".

4) Accidental Shootings: As we all have friends who own one or more weapons, it is often difficult to convince them that the weapon in the home greatly increases the risk of one of their loved ones being the victim of that weapon. Rather, these often well intentioned families in the suburban and rural areas, who honestly believe that having a loaded gun will protect their families from the very, very unlikely chance of a home invasion, will actually endanger their loved ones simply by bringing guns into the home. On the other hand, in the inner city where gun violence is part of everyday life, families believe having the loaded gun readily available (unlocked, fully loaded) allows them to better protect their loved ones from the reality of their situation. So, when we, as healthcare providers, care for the young children who "accidentally" shoot themselves, we are particularly frustrated and angered by the tragedy of the entire plight of these families. The point is this: these very different groups may require very different approaches with respect to interventions.

I look forward to the continued dialogue, and, more importantly, continued research in these areas.

Bob Flood

Saint Louis University

From: Pediatric Emergency Medicine Discussion List <[log in to unmask]> on behalf of Nathan Kuppermann <[log in to unmask]>
Sent: Sunday, February 18, 2018 8:04:25 AM
To: [log in to unmask]
Subject: Re: The shooting in Florida

Jeffrey and colleagues:

My colleague Garen Wintemute is an EM physician at UC Davis and has been doing seminal work on firearm violence prevention for decades - doggedly and with great impact

He is the director of the Violence Prevention Research Program (VPRP) at UC Davis, and has been named a "hero of medicine" by Time Magazine in the past for his work. He is as smart and accomplished as they come, and there is nobody in the country who has been doing this longer or with greater impact. And he has weathered the political and funding crises for this type of work for years, frequently funding his own work when the political climate for this work was bleak. But he has also received substantial foundation money and federal grants during more supportive political times.

He recently received $5 million from the California state legislature to lead the University of California Firearm Violence Research Center, the first state-funded gun violence research center in the country.

Here is his entry in Wikipedia:

If you are interested in his program or donating, here is the link:

Full disclosure: I serve as the Chair of EM at UC Davis where Garen works, but the only benefit to me for getting Garen more exposure or money to the VPRP program that he oversees is my children and family whom I desperately want to protect, my many friends throughout this great country about whom I deeply care, and a country about which I am deeply concerned.

Nate Kuppermann

UC Davis

On Feb 17, 2018, at 3:03 PM, Jeffrey Oestreicher <[log in to unmask]<mailto:[log in to unmask]>> wrote:

Thanks for this cathartic thread, Dr. Pusic and others. Hope fellows are allowed to chime in. Like many on here my gut reaction is to focus on politics, ie an assault weapons ban, the 2nd amendment etc. If Americans were being killed by the same type of airplane that kept crashing, congress would act. Why the same isnít done with the AR-15 given that it keeps being used to murder kids (in Sandy Hook, Aurora, Orlando, Las Vegas and now Parkland) is maddening. But I wonder if we could do more by taking the lead on another key gun violence issue on which physicians are experts. The problem was encapsulated by the first few hours after the parkland shooting when media outlets were literally arguing over how many school shootings there have been in 2018. We don't even know! We don't know because there are very little data on firearm injury/death in this country on account of Congress blocking gun violence research funding since 1996. And this funding block (the "Dickey amendment," named for the NRA point person in Congress at the time) has created a political chill on research that has trickled down even to academic medical centers. When I tried to examine NY EMS data to look at pre-hospital intervention in pediatric firearm injury, the city blocked it on account of the study being "too political." Where is the research? When SIDs reached epidemic numbers in the 70ís, Congress allocated funds for aggressive research leading to Back to Sleep campaign and SIDS rates plummeted. Similar research campaigns produced life-saving interventions for lead poisoning and car crashes. Yet no research crusade has been directed at the epidemic of pediatric firearm death because Congress essentially prohibits it. The hard part is trying to figure out what to do about it. In my state of New York, A.2977/S.4363, sponsored by New York State Assemblymember Jo Anne Simon and Senator Roxanne Persaud, would create a Firearm Violence Research Institute in New York and I along with some colleagues are trying to support this in a few different ways; if others on here want to discuss or have other ideas pls be in touch. This is not meant to discourage us from yelling from rooftops and writing senators about background checks, assault weapons ban etc. That is so important. But we have a unique vantage point with regard to public health research and we're allowed to do it for every other public health problem except this one.  Thanks so much for allowing me to add my 2 cents

Sent from my iPhone

On Feb 17, 2018, at 3:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:[log in to unmask]>> wrote:


As I sit in my living room on this Saturday morning, Iíve also gotten my self in a state about how we tend to focus in on the small picture and neglect an exponentially bigger one.

Spoiler Alert: this will NOT be a politically laced nor personally biased opposed to some of the previous posts on this issue - I'm actually quite disappointed that politics had to rear its ugly head.

Disclaimer: I live in Canada and  love our very strict gun control laws.

                 Don't claim to be a gun control policy expert

Now, allow me to expound:

1. A troubled young man AND inappropriate access to crazy weapons is what caused this catastrophe.

Colleagues, I think we all agree that it would be too simplistic and frankly naive to think that stricter gun control would solve all of these gun related deaths...many examples of this false and misleading association of tighter gun control means safer society here are just a few below...many more:

-explore New Hampshire and Illinois...NH has very liberal gun control, Chicago instead has very strict ones...look up who has more gun related violent crime per capita...

-the Swiss gov't actually encourages gun ownership.. has one of the highest rates of gun ownership in the world, but little gun-related street crime

-Britain has more violent crime then the US (ban on guns since 1997)

From my viewpoint, attention is being focused in the wrong direction. I think we as powerful respected advocates of "public health" should focus at the root causes of the problem, starting with the breakdown of the family (young males who are deprived of an active father figure are far more likely to commit violent crimes), the relentless stream of violent promoting behaviour from Hollywood, the exponential increase in mental illness in youth to start with.

How come we don't lambast the horrendous violence coming out of Hollywood which our youth are imbibing with negative consequences?

2. As per the CDC, in 2016, ~900 000 legal induced abortions were reported from 49 reporting areas...likely a significant underestimate since CA among other states does not report its numbers  (BTW ~ 1.5% for rape/incest, 3% for fetal health issues).

Without going into the classic arguments re pro/con, how can we not, how do we not stand up for these children? I agree with the AAP's stance on gun control but what I have trouble understanding is how the AAP does not weigh in on the abortion issue (~10% of abortions are reported in females <19)?

17 children violently, meaninglessly murdered. An incredible tragedy. How is this different then close to 1 million kids per year mentioned above.

I agree with the AAP's stance on gun control but what I have trouble understanding is how the AAP does not weigh in on the abortion issue?


Joe Nemeth MD FCFP EM

Associate Professor

McGill University


From: Pediatric Emergency Medicine Discussion List <[log in to unmask]<mailto:[log in to unmask]>> on behalf of Barry Nathan <[log in to unmask]<mailto:[log in to unmask]>>

Sent: February 17, 2018 7:23:57 AM

To: [log in to unmask]<mailto:[log in to unmask]>

Subject: Re: The shooting in Florida

In case you don't get emails from the AAP:

[image: AAP_400_61.jpg]

*Statement on School Shooting in Parkland, Florida*

from *Colleen A. Kraft, MD, FAAP, President, American Academy of Pediatrics*

"Yesterday just before the dismissal bell rang, 17 children and adults were

shot and killed and 15 were injured inside Marjory Stoneman Douglas High

School in Parkland, Fla. We find ourselves once again filled with grief and

horror, and we mourn alongside all those impacted by the shooting. As our

hearts are in Parkland, our eyes are on Congress.

"This is the eighteenth school shooting in 2018, the equivalent of one

every two and a half days so far this year. Shootings have an indelible

impact on entire communities, on the families who lost children and loved

ones, and on the children who survived. Columbine. Virginia Tech. Newtown.

Orlando. Las Vegas. And now, Parkland. Children are dying from gun violence

and Congress is failing to act. Every one of our 100 U.S. senators, and all

435 U.S. representatives bear a responsibility to take meaningful action to

protect our children, our families, and our communities. Our elected

leaders cannot continue to fail at this most essential task.

"We can start by working to advance meaningful legislation that keeps

children safe. The American Academy of Pediatrics advocates for stronger

state and federal gun laws that protect children, including a ban on

assault weapons like the one used in yesterday's school shooting. We also

call for stronger background checks, solutions addressing firearm

trafficking, and encouraging safe firearm storage. We will also continue to

work to ensure that children and their families have access to appropriate

mental health services, particularly to address the effects of exposure to


"Although these mass shootings command our attention, our children remain

at risk daily for suicide, homicide, and unintentional injury because of

the current policy regarding access to guns in the United States. Gun

violence is a public health threat to children, and one the American

Academy of Pediatrics will continue to take on, in state capitals across

the country and in the halls of Congress. Parents across the United States

send their children to school every day, and hope and trust they will be

safe. As long as children continue to be injured and killed by guns in this

country, pediatricians will not rest in our pursuit to keep them safe."

*The American Academy of Pediatrics is an organization of 66,000 primary

care pediatricians, pediatric medical subspecialists and pediatric surgical

specialists dedicated to the health, safety and well-being of infants,

children, adolescents and young adults. For more information, visit *<>



follow us on Twitter @AmerAcadPeds.*

On Fri, Feb 16, 2018 at 9:22 PM, Chamberlain, James <

[log in to unmask]> wrote:

I think we need to move to repeal the second amendment. It's the only way

the NRA can be stopped. They resist all reasonable attempts to limit the

carnage and then hide behind a misinterpretation of the second amendment.

Very well, let's repeal it. I know many people agree that we don't need

militias any longer.

Jim Chamberlain

-----Original Message-----

From: Pediatric Emergency Medicine Discussion List [mailto:

[log in to unmask]] On Behalf Of Martin Pusic

Sent: Friday, February 16, 2018 6:29 PM

To: [log in to unmask]

Subject: The shooting in Florida

Hi colleagues,

As I sit in my office late on a Friday, I've gotten myself into a state

about the 17 children gunned down in a school.  For the umpteenth time.

I think the thing that has me so upset, is that this state of gun

complaisance is an affront to everything a pediatric emergency physician

stands for.  We sweat whether it's too risky when the WBC is 15.1 and not

14.9.  We study 40,000 children in order sort out who deserves the x-ray

risk of a maybe brain tumor 30 years from now.  We work in difficult,

burnout inducing conditions so that we can personally save, say, one life a


Today it feels to me like someone with an AK-whatever just wiped out 17

years of my work.  In minutes.  I want to cry.  We SHOULD cry.  Try and

watch that Parkland mother on CNN.  I dare you.

Today is not a day like all the others.  It's just not.

--Martin Pusic

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