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I think we agree that in addition to this being tragic, this is no longer just a second amendment issue but a PUBLIC SAFETY ISSUE requiring research and public action, starting at the grass roots. 

Maybe the outspoken teens from Parkland will help lead the way with their voices…...

thanks

Meta Carroll

	
> On Feb 19, 2018, at 9:04 AM, Michael Falk <[log in to unmask]> wrote:
> 
> Yes, Chicago has a unique problem with homicide.  But if you actually look
> at the list of the top 10 cities for homicide, and the same holds true for
> states, you will find that the vast majority are in states with lax gun
> laws.  In fact, Chicago ranks 25 as of 2016 for homicide and if you look at
> the full list I get that 4/30 are in states with tougher gun laws.  I maybe
> overreaching here, but that hardly seems like a "media hype" issue to me.
> 
> As for Chicago....they have one of the worst and most entrenched gang
> cultures in the US.  Given that, it's hardly the norm in this country and
> should not be thought of as such.  Finally, it happens to been within an
> hour drive from a number of other states that have incredibly loose gun
> laws and where it's very, very easy to purchase a gun and then transport it
> back to Chicago and sell for a large profit.
> 
> Just my 2 cents....and a few public health facts.
> 
> On Mon, Feb 19, 2018 at 9:25 AM, Mick Work <[log in to unmask]> wrote:
> 
>> http://apps.chicagotribune.com/news/local/young_victims/
>> 
>> 10x the number of kids dying and they have stricter gun laws.   Why do
>> these deaths draw so little attention?  Yet suburban school shootings  and
>> the shooter gets major coverage.
>> 
>> Is the media effectively and wisely moving public opinion around guns or
>> opioids etc or is it about reaction and ratings?
>> 
>> The government can’t solve issues any more than the c-suite can claim to
>> provide better care in hospitals through policy alone.    Just my opinion.
>> 
>> Real solutions won’t come from laws or policy especially from those
>> distant from the problem and solely developed to satisfy media hype or
>> check a regulatory box.
>> 
>> 
>> 
>> Mick Connors
>> 
>> 
>> 
>>> On Feb 19, 2018, at 12:00 AM, PED-EM-L automatic digest system <
>> [log in to unmask]> wrote:
>>> 
>>> There are 17 messages totaling 3381 lines in this issue.
>>> 
>>> Topics of the day:
>>> 
>>> 1. School shootings....... (4)
>>> 2. PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39) (3)
>>> 3. The shooting in Florida (9)
>>> 4. A second, more settled, reflection on the Florida shooting
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ----------------------------------------------------------------------
>>> 
>>> Date:    Sat, 17 Feb 2018 21:57:25 -0500
>>> From:    "Horst D. Weinberg, MD"
>>>        <[log in to unmask]>
>>> Subject: School shootings.......
>>> 
>>> Yes, automatic weapons should be banned by our government, but most of
>> the discussions posted blame the guns, the NRA, the 2nd amendment and our
>> 'laws'.  Nobody gets to the meat of the matter:  If there is a demand (for
>> guns), regardless of the laws passed, someone will fill that demand.  This
>> is no different from Prohibition, where there was no shortage of available
>> booze or the 'war' on drugs, where you can get them at most street corners
>> in any city. What needs to change: There has been a steady decline over the
>> past 20 or so years in our country's moral fiber, personal and work ethic,
>> and yes, child rearing. Cause: unmarried or one parent families, poverty,
>> and absence of any discipline both in the home and in the schools, for
>> 'political correctness'. Parents want to be friends with their children
>> rather than running their homes like 'benevolent dictator ships'.  Nothing
>> is denied the child: the child wants $150.00 sneakers or a new cell-phone:
>> no problem.  So you can blame the gun all you want, but unless there is a
>> real change in the populations personal morality and ethics, these school
>> tragedies will continue.
>>> We pediatricians should look at our own practices in teaching good child
>> rearing ways to the families we serve.     Horst D. Weinberg, MD
>>> 
>>> 
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 06:13:44 -0500
>>> From:    Mick Work <[log in to unmask]>
>>> Subject: Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>>> 
>>> I respect the need for debate around guns.   However, I think we are
>> remiss as pediatric emergency physicians to not raise a deeper discussion
>> around the mental illness crisis.
>>> 
>>> We all see kids who meet this persons profile across the country. We see
>> disturbing mental illness and the many factors (including social media,
>> broken families, child abuse) that lead a child to buy a gun to do harm.
>> Or if not gun an explosive device etc..
>>> 
>>> We see kids who are socially isolated and warning signs ignored.  Anyone
>> else concerned that the kids we see with mental illness are recognized by
>> schools or pediatric visit screening more often than by their own parents,
>> friends or neighbors.
>>> 
>>> This persons desire to be a “school shooter” should raise attention
>> around how the media covers these events.  The fame brought to these
>> shooters should be called into question.  Are we fostering this copycat
>> mentality?
>>> 
>>> The lack of respect for human life should call us to question more than
>> the how but why.
>>> 
>>> A focus only on guns and gun laws is remiss to the bigger picture in my
>> opinion and experience.
>>> 
>>> Mick
>>> 
>>> 
>>> 
>>>> On Feb 17, 2018, at 12:01 AM, PED-EM-L automatic digest system <
>> [log in to unmask]> wrote:
>>>> 
>>>> There are 4 messages totaling 391 lines in this issue.
>>>> 
>>>> Topics of the day:
>>>> 
>>>> 1. Peds EM talk (2)
>>>> 2. Bacterial meningitis
>>>> 3. The shooting in Florida
>>>> 
>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>>               http://listserv.brown.edu/ped-em-l.html
>>>> 
>>>> ----------------------------------------------------------------------
>>>> 
>>>> Date:    Fri, 16 Feb 2018 11:50:44 -0500
>>>> From:    Purva Grover <[log in to unmask]>
>>>> Subject: Re: Peds EM talk
>>>> 
>>>> Thanks all for your help on this.
>>>> Best
>>>> Purva
>>>> 
>>>> Purva Grover , MD
>>>> Medical Director
>>>> Pediatric Emergency Department
>>>> Cleveland Clinic Health System
>>>> Email- [log in to unmask] <[log in to unmask]>g
>>>> 
>>>>> On Thu, Feb 15, 2018 at 2:18 PM, <[log in to unmask]> wrote:
>>>>> 
>>>>> Hi All
>>>>> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
>>>>> cover ALL or even most. Any thoughts / talks / power points- you could
>>>>> share would be appreciated.
>>>>> Thanks
>>>>> Purva
>>>>> 
>>>>> Sent from my mobile device
>>>> 
>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>>               http://listserv.brown.edu/ped-em-l.html
>>>> 
>>>> ------------------------------
>>>> 
>>>> Date:    Fri, 16 Feb 2018 14:34:20 +0000
>>>> From:    "Chamberlain, James" <[log in to unmask]>
>>>> Subject: Re: Peds EM talk
>>>> 
>>>> I would also cover unusual cases that you can't afford to miss, e.g.
>>>> 
>>>> Sternoclavicular dislocation
>>>> Conjunctivitis caused by penetrating FB
>>>> Septic joint presenting with only low-grade fever (we've had several
>> Staph infections where temp was only 37.6 or 37.7 orally)
>>>> Myocarditis presenting as wheezing. Remind them that all
>> "bronchiolitis" patients need a through cardiac exam, including distal
>> pulses
>>>> NAT
>>>> The "sleepy" baby who has hypoglycemia
>>>> The "sleepy" baby who has intussusception
>>>> The appendicitis patient who presents with vomiting and diarrhea (not
>> all that unusual, actually)
>>>> Etc.
>>>> 
>>>> To me, this is the challenge of PEM. Finding the needle in the
>> haystack, that one sick kid who is different than all the usual low acuity
>> illness...
>>>> 
>>>> Jim
>>>> 
>>>> James Chamberlain
>>>> Division Chief, Emergency Medicine
>>>> Children’s National Health System
>>>> (202) 476-4177
>>>> 
>>>> -----Original Message-----
>>>> From: Pediatric Emergency Medicine Discussion List [mailto:
>> [log in to unmask]] On Behalf Of Mojica, Michael
>>>> Sent: Thursday, February 15, 2018 5:29 PM
>>>> To: [log in to unmask]
>>>> Subject: Re: Peds EM talk
>>>> 
>>>> Purva
>>>> 
>>>> 
>>>> 
>>>> I would recommend "the critically ill infant".
>>>> 
>>>> 
>>>> 
>>>> It is the topic that scares the most people and you can cover a lot of
>> causes through cases.
>>>> 
>>>> 
>>>> 
>>>> I like to use cases that include common presenting complaints (e.g.
>> vomiting) that are associated with very bad things (e.g. midgut volvulus).
>>>> 
>>>> 
>>>> 
>>>> I'm attaching a ppt file for a talk I did a few years ago on this topic.
>>>> 
>>>> 
>>>> 
>>>> My goal is for them to develop a mental checklist of potentially
>> life-saving interventions.
>>>> 
>>>> 
>>>> 
>>>> Michael
>>>> 
>>>> 
>>>> 
>>>> Michael Mojica, M.D
>>>> 
>>>> Director of Education, Division of Pediatric Emergency Medicine
>>>> 
>>>> Director, Pediatric Emergency Medicine Fellowship
>>>> 
>>>> Bellevue Hospital Center
>>>> 
>>>> Administration Building Room A528
>>>> 
>>>> New York, N.Y. 10016
>>>> 
>>>> [log in to unmask]
>>>> 
>>>> 212-562-8147
>>>> 
>>>> 
>>>> 
>>>> 
>>>> 
>>>> On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on
>> behalf of Purva Grover" <[log in to unmask] on behalf of
>> [log in to unmask]> wrote:
>>>> 
>>>> 
>>>> 
>>>>  Hi All
>>>> 
>>>>  I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can
>> not cover ALL or even most. Any thoughts / talks / power points- you could
>> share would be appreciated.
>>>> 
>>>>  Thanks
>>>> 
>>>>  Purva
>>>> 
>>>> 
>>>> 
>>>>  Sent from my mobile device
>>>> 
>>>>  For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> 
>>>>  The URL for the PED-EM-L Web Page is:
>>>> 
>>>>                   https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFAg&c=
>> j5oPpO0eBH1iio48DtsedbOBGmuw5jHLjgvtN2r4ehE&r=-
>> uVUSwDIF0s52hEnO0EzoINmOqevlfnirF7YJ_EXiAQ&m=c2wlkkLWVP009LBCXl-
>> k6T4PNiNn1YYHTaSvJRCvGWo&s=7bcGZM66nE4BJGdqQQrjhL6fNRMBTCzuSv96wXa91qc&e=
>>>> 
>>>> 
>>>> 
>>>> 
>>>> 
>>>> 
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>>>> 
>>>> 
>>>> 
>>>> 
>>>> For more information, send mail to [log in to unmask] with
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>>>> 
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>>>> 
>>>> 
>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>>               http://listserv.brown.edu/ped-em-l.html
>>>> 
>>>> ------------------------------
>>>> 
>>>> Date:    Fri, 16 Feb 2018 18:29:38 -0500
>>>> From:    Aline Baghdassarian <[log in to unmask]>
>>>> Subject: Re: Bacterial meningitis
>>>> 
>>>> Scott,
>>>> 
>>>> Would love to hear more about the cases. How did they present? What was
>> the
>>>> decision making process?
>>>> 
>>>> Thank you,
>>>> 
>>>> Aline
>>>> 
>>>> Aline Baghdassarian, MD, MPH, FAAP
>>>> Director, Pediatric Emergency Medicine Fellowship Program
>>>> Assistant Professor, Department of Emergency Medicine
>>>> Virginia Commonwealth University School of Medicine
>>>> 
>>>> Children's Hospital of Richmond at VCU
>>>> Email [log in to unmask]
>>>> 
>>>> 
>>>> On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[log in to unmask]>
>>>> wrote:
>>>> 
>>>>> In a recent case at our institution, there was a present but subtle
>> degree
>>>>> of meningismus — I’ve found over the years there is always some
>> elicitable
>>>>> sign — but as importantly there’s a degree of irritability or altered
>>>>> behavior that has everyone concerned: mom, RN’s, me.
>>>>> If mama ain't happy, I ain't happy. I’ll make liberal use of the term
>>>>> cerebritis or encephalopathic behavior until there’s a consent signed.
>>>>> 
>>>>> I’m not such a good scientist anymore, but I’ve tried to be an
>> attentive
>>>>> clinician.
>>>>> 
>>>>> Julian Orenstein
>>>>> 
>>>>> 
>>>>>> On Feb 14, 2018, at 3:30 PM, JAY FISHER <[log in to unmask]> wrote:
>>>>>> 
>>>>>> Scott - Bacterial meningitis is alive and well here in LV - we have
>> seen
>>>>> it in a variety of age groups. There is good evidence that there has
>> been
>>>>> an increase in pneumococcal serotypes not covered by the polyvalent
>>>>> vaccines since there widespread use, such that the burden of
>> pneumococcal
>>>>> meningitis (as opposed to H. flu type b) has not decreased nearly as
>> much.
>>>>>> 
>>>>>> Brouwer MC, van de Beek D. Epidemiology of community-acquired
>> bacterial
>>>>> meningitis. Curr Opin Infect Dis. 2018;31(1):78-84.
>>>>>> 
>>>>>> Also, the absence of meningismus in older kids with bacterial
>> meningitis
>>>>> is well described and occurs in a substantial subset.
>>>>>> 
>>>>>> Geiseler J, Nelson, K.E. Bacterial meningitis without clinical signs
>> of
>>>>> meningeal irritation. . Southern Med J 1982;75(4):448-450.
>>>>>> 
>>>>>> Much of the data on the sensitivity of the neck exam is of the
>>>>> retrospective variety. I have only read one really good prospective
>> study
>>>>> on the sensitivity of PE for bacterial meningitis and it was a single
>>>>> center variety as I recall.
>>>>>> 
>>>>>> Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of
>>>>> bacterial versus aseptic meningitis in childhood. Ann Emerg Med.
>>>>> 1992;21(8):910-914.
>>>>>> 
>>>>>> Tough case.
>>>>>> 
>>>>>> 
>>>>>> Jay
>>>>>> 
>>>>>> Jay D. Fisher MD FAAP FACEP
>>>>>> Medical Director, Pediatric EM
>>>>>> Children's Hospital of Nevada at UMC
>>>>>> Clinical Professor of Emergency Medicine and Pediatrics
>>>>>> UNLV School of Medicine
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>>> On February 14, 2018 at 4:18 PM "Conners, Gregory, P" <
>>>>> [log in to unmask]> wrote:
>>>>>>> 
>>>>>>> 
>>>>>>> I shared this with our ID director (Dr. Mary Anne Jackson), who
>> pointed
>>>>> out that bacterial meningitis appears at this time of year as a
>>>>> complication of influenza:
>>>>>>> "Both pneumococcal and meningococcal meningitis can occur post flu as
>>>>> well as GAS and S aureus invasive disease and TSS."
>>>>>>> 
>>>>>>> She also addressed Jim's question:  "We do know that new serotypes
>> [of
>>>>> pneumococcus] have emerged but this is not waning immunity because the
>> teen
>>>>> only got PCV7".
>>>>>>> 
>>>>>>> 
>>>>>>> Greg Conners
>>>>>>> 
>>>>>>> Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP
>>>>>>> 
>>>>>>> Director, Division of Emergency Medicine
>>>>>>> Associate Chair of Pediatrics
>>>>>>> Professor of Pediatrics and Emergency Medicine
>>>>>>> Children’s Mercy Hospital, Kansas City
>>>>>>> University of Missouri, Kansas City
>>>>>>> [log in to unmask]
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>> -----Original Message-----
>>>>>>> From: Pediatric Emergency Medicine Discussion List [mailto:
>>>>> [log in to unmask]] On Behalf Of 000001679b145c30-dmarc-
>>>>> [log in to unmask]
>>>>>>> Sent: Wednesday, February 14, 2018 2:25 PM
>>>>>>> To: [log in to unmask]
>>>>>>> Subject: Re: Bacterial meningitis
>>>>>>> 
>>>>>>> *** This message was sent to you from an External Source. Please do
>> not
>>>>> open untrusted links or attachments. ***
>>>>>>> 
>>>>>>> ________________________________
>>>>>>> 
>>>>>>> 
>>>>>>> Could you share with us the clinical findings and history that
>> prompted
>>>>> the LP?
>>>>>>> 
>>>>>>> 
>>>>>>> Shiu-Lin
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>> Shiu-Lin Tsai, MD
>>>>>>> Division of Pediatric Emergency Medicine
>>>>>>> 
>>>>>>> Department of Emergency Medicine
>>>>>>> Columbia University Medical Center
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>> -----Original Message-----
>>>>>>> From: Scott Freedman <[log in to unmask]>
>>>>>>> To: PED-EM-L <[log in to unmask]>
>>>>>>> Sent: Wed, Feb 14, 2018 2:44 pm
>>>>>>> Subject: Bacterial meningitis
>>>>>>> 
>>>>>>> ALL:
>>>>>>> Since Jan 1st this year, we have seen 3 cases of culture + bacterial
>>>>> meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with
>>>>> *Neisseria meningiditis*.  All 3 were in older children/ teens who
>> received
>>>>> their Prevnar 13  vaccines as well as the Menactra series in the
>> patient
>>>>> with Neisseria.  Anyone else seeing cases of this sort?  I do not
>> recall 3
>>>>> cases of bacterial meningitis in older kids in a community setting
>> such as
>>>>> ours in quite a long time.  Is this random bad luck or do  we all need
>> to
>>>>> be more vigilant?  Incidentally, none had neck pain or meningismus as a
>>>>> clinical finding.
>>>>>>> 
>>>>>>> --
>>>>>>> Kind regards,
>>>>>>> 
>>>>>>> Scott
>>>>>>> Scott Freedman, MD
>>>>>>> Medical Director,  Pediatric Emergency Dept Rockville MD
>>>>>>> 
>>>>>>> For more information, send mail to [log in to unmask] with
>>>>> the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>>>>>>>              http://listserv.brown.edu/ped-em-l.html
>>>>>>> 
>>>>>>> 
>>>>>>> For more information, send mail to [log in to unmask] with
>>>>> the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>>>>>>>              http://listserv.brown.edu/ped-em-l.html
>>>>>>> 
>>>>>>> ________________________________
>>>>>>> 
>>>>>>> Electronic mail from Children's Mercy Kansas City. This communication
>>>>> is intended only for the use of the addressee. It may contain
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>>>>> that is privileged or confidential under applicable law. If you are
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>>>>> intended recipient or the agent of the recipient, you are hereby
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>>>>> Security Officer via return electronic mail at
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>>>>>>> 
>>>>>>> For more information, send mail to [log in to unmask] with
>>>>> the message: info PED-EM-L
>>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>>              http://listserv.brown.edu/ped-em-l.html
>>>>>> 
>>>>>> For more information, send mail to [log in to unmask] with
>> the
>>>>> message: info PED-EM-L
>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>              http://listserv.brown.edu/ped-em-l.html
>>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>> the
>>>>> message: info PED-EM-L
>>>>> The URL for the PED-EM-L Web Page is:
>>>>>               http://listserv.brown.edu/ped-em-l.html
>>>>> 
>>>> 
>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>>               http://listserv.brown.edu/ped-em-l.html
>>>> 
>>>> ------------------------------
>>>> 
>>>> Date:    Fri, 16 Feb 2018 18:29:08 -0500
>>>> From:    Martin Pusic <[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
>> year.
>>>> 
>>>> 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
>>>> 
>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>>               http://listserv.brown.edu/ped-em-l.html
>>>> 
>>>> ------------------------------
>>>> 
>>>> End of PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>>>> **************************************************************
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 12:42:58 +0000
>>> From:    Terence Bergmann <[log in to unmask]>
>>> Subject: Re: The shooting in Florida
>>> 
>>> Hi Joe
>>> 
>>> I disagree about ‘strict gun control laws’ here having anything to do
>> with it .  Either you or I could have a new hunting rifle in a week or two
>> in Canada.  If you look at the school shootings or the Vegas massacre these
>> are not people who acquired their guns and went slaughtering.  These guns
>> were acquired and the armamentarium prepped and the plans made.  Canadian
>> laws would not stop this.
>>> 
>>> We have a different culture here in Canada.  Guns are not toted around
>> in public.  Thankfully the 49th parallel prevented the ‘western’ mentality
>> from flourishing on our side of the border.  I don’t know why.
>>> 
>>> The challenge to end ‘their’ problem is that once the bad guys are armed
>> with illegal guns how do you stop the populace from wanting to have legal
>> guns?
>>> 
>>> Somehow other countries can have legal weapons, such as Swiss adults all
>> keeping their weapons at home after their years of mandatory service, yet
>> they don’t kill each other with them.  Somehow a well armed militia there
>> does not lead to violence.
>>> 
>>> I have lots of questions, but I don’t know the answers.
>>> 
>>> Terence
>>> 
>>> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]
>> <mailto:[log in to unmask]>> wrote:
>>> 
>>> Disclaimer: I live in Canada and  love our very strict gun control laws.
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 14:31:22 +0000
>>> From:    "Habib, David" <[log in to unmask]>
>>> Subject: Re: The shooting in Florida
>>> 
>>> Repeal and replace the second amendment with a clear and contemporary
>> document. Dave Habib
>>> 
>>> ________________________________________
>>> From: Pediatric Emergency Medicine Discussion List [
>> [log in to unmask]] on behalf of Terence Bergmann [
>> [log in to unmask]]
>>> Sent: Sunday, February 18, 2018 7:42 AM
>>> To: [log in to unmask]
>>> Subject: Re: The shooting in Florida
>>> 
>>> 
>>> 
>>> Hi Joe
>>> 
>>> I disagree about ‘strict gun control laws’ here having anything to do
>> with it .  Either you or I could have a new hunting rifle in a week or two
>> in Canada.  If you look at the school shootings or the Vegas massacre these
>> are not people who acquired their guns and went slaughtering.  These guns
>> were acquired and the armamentarium prepped and the plans made.  Canadian
>> laws would not stop this.
>>> 
>>> We have a different culture here in Canada.  Guns are not toted around
>> in public.  Thankfully the 49th parallel prevented the ‘western’ mentality
>> from flourishing on our side of the border.  I don’t know why.
>>> 
>>> The challenge to end ‘their’ problem is that once the bad guys are armed
>> with illegal guns how do you stop the populace from wanting to have legal
>> guns?
>>> 
>>> Somehow other countries can have legal weapons, such as Swiss adults all
>> keeping their weapons at home after their years of mandatory service, yet
>> they don’t kill each other with them.  Somehow a well armed militia there
>> does not lead to violence.
>>> 
>>> I have lots of questions, but I don’t know the answers.
>>> 
>>> Terence
>>> 
>>> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]
>> <mailto:[log in to unmask]>> wrote:
>>> 
>>> Disclaimer: I live in Canada and  love our very strict gun control laws.
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 14:04:25 +0000
>>> From:    Nathan Kuppermann <[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: https://en.wikipedia.org/wiki/
>> Garen_Wintemute
>>> 
>>> If you are interested in his program or donating, here is the link:
>> http://www.ucdmc.ucdavis.edu/vprp/
>>> 
>>> 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 isn’t 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 70’s, 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:
>>> 
>>> Martin,
>>> 
>>> As I sit in my living room on this Saturday morning, I’ve 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 post...as 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
>>> 
>>> 
>>> 
>>> 
>>> 
>>> 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
>>> violence.
>>> 
>>> "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 *
>>> www.aap.org<http://www.aap.org>
>>> <https://linkprotect.cudasvc.com/url?a=http://www.mmsend70.
>> com/link.cfm%3fr%3dP1AWQRX2DH6KpZKp05dazA~~%26pe%3dBH4KXYJXftdV7_
>> OrPTTyUbVAzQsfgoRvleBm2XUVQ6AiEVwuBNacQ0AWbz2OcXguY6Y2i1bNdC
>> MkiPdWG-fHRg~~%26t%3dP2O93UltqkjSP1tT62_PaA~~&c=E,1,
>> EDnzTesKajviC9Rbq687pz7yfFyRgC2WBFw6mF1beQyzL2WYF_
>> fPWMjWxOixG1eagtp40GaUhhxZ8IL4zNcR4weeC1DLvkbbpHQsmMSnszDC&typo=1>*
>>> and
>>> 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
>>> year.
>>> 
>>> 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
>>> 
>>> For more information, send mail to [log in to unmask] with the
>>> message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>>>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
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>> Zoipt4Nmcnjorr_6TBHi1A&r=
>>> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=txqCyZ0Q4Y_
>> a1kDlfTJH0FA02j_
>>> Op8nlDmuc3NLl9Kk&s=LCEbA3j7FkFKvJBa54LAl44ZTpZ431TWXx-0dUvQ7Xo&e=
>>> 
>>> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
>>> Confidentiality Notice: This e-mail message, including any attachments,
>> is
>>> for the sole use of the intended recipient(s) and may contain
>> confidential
>>> and privileged information. Any unauthorized review, use, disclosure or
>>> distribution is prohibited. If you are not the intended recipient, please
>>> contact the sender by reply e-mail and destroy all copies of the original
>>> message.
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>              http://listserv.brown.edu/ped-em-l.html
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>              http://listserv.brown.edu/ped-em-l.html
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>              http://listserv.brown.edu/ped-em-l.html
>>> 
>>> For more information, send mail to [log in to unmask]<mailto:
>> [log in to unmask]> with the message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>               http://listserv.brown.edu/ped-em-l.html
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 10:20:42 -0500
>>> From:    Martin Pusic <[log in to unmask]>
>>> Subject: A second, more settled, reflection on the Florida shooting
>>> 
>>> After my amygdala-based email of Friday, a clarification:
>>> 
>>> It is right and fit and proper that Pediatric Emergency Medicine
>> physicians bring the full force of our research and clinical armementarium
>> to bear on the problems of our patients.  That means sweating thresholds of
>> WBC for their predictive value in infections.  That means mounting massive
>> 10 year PECARN/PERC/PERN level research efforts to understand in detail the
>> mechanisms of our patients' problems in order to benefit them in any way we
>> can.  That's our  laudable job.  We should be proud of taking on the
>> problem of brain tumours 30 years from now.  In no way did I mean to
>> denigrate those efforts.  Instead, the complete opposite  -- I think they
>> provide us with the moral authority to speak out against government
>> policies that harm children.
>>> 
>>> What is neither right nor fit nor proper is the ease with which a gun
>> violence proponent can wreak havoc at a scale that, on a given schoolday,
>> trivializes my efforts and those of my PEM colleagues.  It feels like a
>> personal affront that we live in a nation in which somehow the NRA has
>> better government support than CHIP does.  My point is not to devalue our
>> day/evening/night/weekend job.... we are doing MORE than our part in
>> society.......but rather to express that I, as a PEM physician, am rocked
>> to the core by the moral imbalance that makes it possible to routinely
>> leave 17 children dead.  And that this is some sort of normal.
>>> 
>>> Some notes:
>>>> If you need an example of how routine this has become, one PEM
>> colleague wrote that he is going to his son's elementary school next week
>> to instruct the teachers on external control of hemorrhage
>>>> A Scot described the positive example of the way the Dunblane massacre
>> provoked a re-writing of their laws.  They haven't had another in 22 years
>> since.
>>>> Fahd Ahmad from WashU had already written on this:
>> http://www.roguedadmd.com/2018/02/how-many-people-and-
>> which-people-should-die-for-which-rights/
>>>> I learned of the positive examples of EM physicians taking this on
>> including Garen Wintemute of UC Davis and Eric Fleegler/Lois Lee at Boston
>> Children's.
>>>> thank you posting the AAP statement which properly represents our values
>>>> The majority of people who wrote back are mothers.
>>> 
>>> Finally, I commit to writing back, constructively, every 3 months on
>> this topic until there's nothing to write about
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 16:56:19 +0000
>>> From:    Doc Holiday <[log in to unmask]>
>>> Subject: Re: The shooting in Florida
>>> 
>>> Before I continue, I must say how much more comfortable this on-line
>> debate feels as compared to previous ones on other ListServs. I know it's a
>> generalising comment, but I keep finding that the insertion into the mix of
>> people who work with children makes everything so much more polite and
>> patient. If I recall correctly, there was a lot of anger and short
>> sentences last time I was involved in a debate on this topic on an "adult"
>> list....
>>> 
>>> 
>>> From: Joe Nemeth, Dr <[log in to unmask]>
>>>> As I sit in my living room on this Saturday morning
>>> 
>>> 
>>> --> My living room. Sunday afternoon. What else is there to do on a
>> weekend, eh?
>>> 
>>> 
>>>> I live in Canada and  love our very strict gun control laws
>>> 
>>> 
>>> --> As people know, I live in the UK at this time and I also like the
>> gun laws here (as well as ones on knives, etc). I don't feel as positive
>> about drug laws, but that's a different thread. Still, the point I made
>> before and make again now is that I don't think our gun laws are THE cause
>> of our statistics. I think they are but one (be it major) factor
>> contributing, but on the background of a culture which rejects gun
>> violence! I don't think that any society will change sufficiently merely by
>> their introduction - no matter how strict. I have lived for many years in
>> more than one country in which guns were far more common than they are in
>> the UK and these countries differed markedly in terms of gun violence. One
>> was actually on the same scale as the USA!
>>> 
>>> 
>>>> A troubled young man AND inappropriate access to crazy weapons is what
>> caused this catastrophe... too simplistic and frankly naive to think that
>> stricter gun control would solve all of these gun related deaths
>>> 
>>> 
>>> --> I agree. And I would add that there are factors beyond the two you
>> mentioned. It's not even ONLY two factors. We can probably add to this:
>>> - the lack of major societal backlash to inappropriate comments
>>> - the tolerance of lack of free psychiatric care
>>> - the overwhelming number of similar cases which will "drown" the
>> efforts of law enforcement to identify the cases which eventually go on to
>> this sort of event from among so many others, etc
>>> - there will be more factors identified as this case gets investigated
>>> 
>>> 
>>> One more point, though - a HUGE factor might be, as in past cases, if
>> the outrage dies down! The NRA and those who profit from guns will push
>> their politicians, including some of the more publicly-prominent ones and
>> they will keep things as quiet as possible. Possibly, even the next similar
>> event somehow will be used to make this one "disappear". You can recognise
>> the "silencing tactics" by indicator phrases such as:
>>> - "Now is not the time..."
>>> - "Country/state/city X ... bla-bla-bla ... And they have more/fewer
>> guns and more/fewer gun deaths and this random statistic thus means we
>> should stop looking into gun control"
>>> - "My child just falls a lot" (sorry - had to put that in, as it's on
>> the same level)
>>> - "The USA is a unique country and yet, when it suits me, I will find
>> some other one with which to make comparisons to prove my point"
>>> 
>>> 
>>>> Britain has more violent crime then the US (ban on guns since 1997)
>>> 
>>> 
>>> --> I realise that I am picking up just one of the many points which
>> were listed together. I am only choosing this one because it's one I have
>> been familiar with for a very long time. It has been much "used" in order
>> to "prove" to Americans how the introduction of gun laws in the UK has left
>> it with a higher violent crime rate than the USA and should thus be avoided
>> by the USA. Now, I won't trouble the List by arguments about this. Instead,
>> I would appreciate it if y'all satisfy your own curiosities, each to
>> his/her own level, by going to a favourite search engine and searching for
>> the phrase "Britain has more violent crime then the US". You can read for
>> yourselves and save me from having to type up the actual facts...
>>> 
>>> 
>>> But I can't stop myself from mentioning something which has come up in a
>> past discussion I was accidentally drawn into on a visit to the USA 3-4
>> years ago. This same myth was raised. That, in itself, was no surprise, but
>> it had been raised by someone who had already impressed me with how many
>> "facts" he had absorbed from social media sources and how confidently he
>> spoke of these despite appearing to be far less eloquent whenever
>> questioned in detail about anything. I.e., he appeared to me to have been
>> "brainwashed". Despite knowing better, I challenged him on why he thought
>> the USA was "doing so much better" than the UK in terms of violent crime.
>> He gave me the answer. He then mistook my look of disbelief to indicate I
>> did not believe the facts he had mentioned. He was wrong - what I did not
>> believe is that someone could be that easy to "sell" to. He pulled out his
>> phone and showed me the "evidence". No idea what you're sitting on as you
>> read this, but I hope it has handles for you to hang onto, so that you
>> don't fall to the ground laughing. The reason, according to this "expert"
>> for how the USA got to have what he claimed was 10 times less violent crime
>> than the UK is because the USA has taken the excellent pre-emptive step of
>> imprisoning those who would otherwise have engaged in violent crime! I kid
>> you not - he attributed the high level of violent crime he believed the UK
>> had, not to the fact that the UK records a huge number of offences which
>> the USA does not include in its statistics. What he showed me was:
>> https://en.wikipedia.org/wiki/List_of_countries_by_incarceration_rate
>> (the version which was on line then). He had been "educated" to believe
>> that the fact that the USA had around a 10-time higher number of prisoners
>> than the UK per million of population correlated with how it achieved a
>> 10-time lower rate of violent crime...
>>> 
>>> 
>>> I expect one requires whole armies of people who can be thus educated in
>> order to perpetuate certain "facts"... Such people can be convinced of many
>> things...
>>> 
>>> 
>>> 
>>> 
>>> 
>>> 
>>> 
>>> <http://listserv.brown.edu/ped-em-l.html>
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 12:00:26 -0500
>>> From:    Michael Falk <[log in to unmask]>
>>> Subject: Re: The shooting in Florida
>>> 
>>> While I get the despair and anger given the lose of 17 people in another
>>> senseless mass shooting, I would caution people to not give up hope.
>> When
>>> I first came to New York City in 1989, it was averaging about 2,000
>>> homicides a year.  If take our statistics for nonlethal injuries per
>>> homicide, roughly 7:1, the city was seeing another 10,000 plus
>> penetrating
>>> traumas and I have not even mentioned the assaults with fists or blunt
>>> objects.  Last year in NYC, we had less than 400 homicides and the city
>> is
>>> safer than it has been in years.  Why?  Well, there was a concerted
>> effort
>>> to change the culture of policing and law enforcement in the city, and
>>> there was a massive crackdown on guns and getting them off the streets.
>>> The laws were changed around gun ownership and licensing, and there you
>>> have it....
>>> 
>>> Also, many of you are forgetting that we had an assault weapons law in
>> the
>>> US and Bush/Congress let it lapse in 2003.  Now it's record is a mixed
>> bag
>>> but I think that if we learn from the mistakes we made the last time, and
>>> write a better law, we can actually have a significant impact.
>>> 
>>> Just my two cents..
>>> Mike Falk
>>> NYC.
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 17:09:24 +0000
>>> From:    Robert Finkelstein <[log in to unmask]>
>>> Subject: Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>>> 
>>> Other countries have the same level of mental illness as the United
>> States, but not nearly the number of gun deaths. The mental health issue is
>> important but access to weapons that can kill a large number of people in
>> seconds allows the results we see. In addition, access to guns plays  a
>> huge role in suicides since many who attempt suicide and do not succeed
>> will get help and not attempt again. However, access to a gun makes it much
>> more likely that the first attempt will result in death.
>>> 
>>> Robert Finkelstein
>>> 
>>>> On Feb 18, 2018, at 8:42 AM, Mick Work <[log in to unmask]> wrote:
>>>> 
>>>> I respect the need for debate around guns.   However, I think we are
>> remiss as pediatric emergency physicians to not raise a deeper discussion
>> around the mental illness crisis.
>>>> 
>>>> We all see kids who meet this persons profile across the country. We
>> see disturbing mental illness and the many factors (including social media,
>> broken families, child abuse) that lead a child to buy a gun to do harm.
>> Or if not gun an explosive device etc..
>>>> 
>>>> We see kids who are socially isolated and warning signs ignored.
>> Anyone else concerned that the kids we see with mental illness are
>> recognized by schools or pediatric visit screening more often than by their
>> own parents, friends or neighbors.
>>>> 
>>>> This persons desire to be a “school shooter” should raise attention
>> around how the media covers these events.  The fame brought to these
>> shooters should be called into question.  Are we fostering this copycat
>> mentality?
>>>> 
>>>> The lack of respect for human life should call us to question more than
>> the how but why.
>>>> 
>>>> A focus only on guns and gun laws is remiss to the bigger picture in my
>> opinion and experience.
>>>> 
>>>> Mick
>>>> 
>>>> 
>>>> 
>>>>> On Feb 17, 2018, at 12:01 AM, PED-EM-L automatic digest system <
>> [log in to unmask]> wrote:
>>>>> 
>>>>> There are 4 messages totaling 391 lines in this issue.
>>>>> 
>>>>> Topics of the day:
>>>>> 
>>>>> 1. Peds EM talk (2)
>>>>> 2. Bacterial meningitis
>>>>> 3. The shooting in Florida
>>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>> The URL for the PED-EM-L Web Page is:
>>>>>              http://listserv.brown.edu/ped-em-l.html
>>>>> 
>>>>> ----------------------------------------------------------------------
>>>>> 
>>>>> Date:    Fri, 16 Feb 2018 11:50:44 -0500
>>>>> From:    Purva Grover <[log in to unmask]>
>>>>> Subject: Re: Peds EM talk
>>>>> 
>>>>> Thanks all for your help on this.
>>>>> Best
>>>>> Purva
>>>>> 
>>>>> Purva Grover , MD
>>>>> Medical Director
>>>>> Pediatric Emergency Department
>>>>> Cleveland Clinic Health System
>>>>> Email- [log in to unmask] <[log in to unmask]>g
>>>>> 
>>>>>> On Thu, Feb 15, 2018 at 2:18 PM, <[log in to unmask]> wrote:
>>>>>> 
>>>>>> Hi All
>>>>>> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can
>> not
>>>>>> cover ALL or even most. Any thoughts / talks / power points- you could
>>>>>> share would be appreciated.
>>>>>> Thanks
>>>>>> Purva
>>>>>> 
>>>>>> Sent from my mobile device
>>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>> The URL for the PED-EM-L Web Page is:
>>>>>              http://listserv.brown.edu/ped-em-l.html
>>>>> 
>>>>> ------------------------------
>>>>> 
>>>>> Date:    Fri, 16 Feb 2018 14:34:20 +0000
>>>>> From:    "Chamberlain, James" <[log in to unmask]>
>>>>> Subject: Re: Peds EM talk
>>>>> 
>>>>> I would also cover unusual cases that you can't afford to miss, e.g.
>>>>> 
>>>>> Sternoclavicular dislocation
>>>>> Conjunctivitis caused by penetrating FB
>>>>> Septic joint presenting with only low-grade fever (we've had several
>> Staph infections where temp was only 37.6 or 37.7 orally)
>>>>> Myocarditis presenting as wheezing. Remind them that all
>> "bronchiolitis" patients need a through cardiac exam, including distal
>> pulses
>>>>> NAT
>>>>> The "sleepy" baby who has hypoglycemia
>>>>> The "sleepy" baby who has intussusception
>>>>> The appendicitis patient who presents with vomiting and diarrhea (not
>> all that unusual, actually)
>>>>> Etc.
>>>>> 
>>>>> To me, this is the challenge of PEM. Finding the needle in the
>> haystack, that one sick kid who is different than all the usual low acuity
>> illness...
>>>>> 
>>>>> Jim
>>>>> 
>>>>> James Chamberlain
>>>>> Division Chief, Emergency Medicine
>>>>> Children’s National Health System
>>>>> (202) 476-4177
>>>>> 
>>>>> -----Original Message-----
>>>>> From: Pediatric Emergency Medicine Discussion List [mailto:
>> [log in to unmask]] On Behalf Of Mojica, Michael
>>>>> Sent: Thursday, February 15, 2018 5:29 PM
>>>>> To: [log in to unmask]
>>>>> Subject: Re: Peds EM talk
>>>>> 
>>>>> Purva
>>>>> 
>>>>> 
>>>>> 
>>>>> I would recommend "the critically ill infant".
>>>>> 
>>>>> 
>>>>> 
>>>>> It is the topic that scares the most people and you can cover a lot of
>> causes through cases.
>>>>> 
>>>>> 
>>>>> 
>>>>> I like to use cases that include common presenting complaints (e.g.
>> vomiting) that are associated with very bad things (e.g. midgut volvulus).
>>>>> 
>>>>> 
>>>>> 
>>>>> I'm attaching a ppt file for a talk I did a few years ago on this
>> topic.
>>>>> 
>>>>> 
>>>>> 
>>>>> My goal is for them to develop a mental checklist of potentially
>> life-saving interventions.
>>>>> 
>>>>> 
>>>>> 
>>>>> Michael
>>>>> 
>>>>> 
>>>>> 
>>>>> Michael Mojica, M.D
>>>>> 
>>>>> Director of Education, Division of Pediatric Emergency Medicine
>>>>> 
>>>>> Director, Pediatric Emergency Medicine Fellowship
>>>>> 
>>>>> Bellevue Hospital Center
>>>>> 
>>>>> Administration Building Room A528
>>>>> 
>>>>> New York, N.Y. 10016
>>>>> 
>>>>> [log in to unmask]
>>>>> 
>>>>> 212-562-8147
>>>>> 
>>>>> 
>>>>> 
>>>>> 
>>>>> 
>>>>> On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on
>> behalf of Purva Grover" <[log in to unmask] on behalf of
>> [log in to unmask]> wrote:
>>>>> 
>>>>> 
>>>>> 
>>>>> Hi All
>>>>> 
>>>>> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can
>> not cover ALL or even most. Any thoughts / talks / power points- you could
>> share would be appreciated.
>>>>> 
>>>>> Thanks
>>>>> 
>>>>> Purva
>>>>> 
>>>>> 
>>>>> 
>>>>> Sent from my mobile device
>>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>> 
>>>>> The URL for the PED-EM-L Web Page is:
>>>>> 
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>>>>> For more information, send mail to [log in to unmask] with
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>>>>> The URL for the PED-EM-L Web Page is:
>>>>>              http://listserv.brown.edu/ped-em-l.html
>>>>> 
>>>>> ------------------------------
>>>>> 
>>>>> Date:    Fri, 16 Feb 2018 18:29:38 -0500
>>>>> From:    Aline Baghdassarian <[log in to unmask]>
>>>>> Subject: Re: Bacterial meningitis
>>>>> 
>>>>> Scott,
>>>>> 
>>>>> Would love to hear more about the cases. How did they present? What
>> was the
>>>>> decision making process?
>>>>> 
>>>>> Thank you,
>>>>> 
>>>>> Aline
>>>>> 
>>>>> Aline Baghdassarian, MD, MPH, FAAP
>>>>> Director, Pediatric Emergency Medicine Fellowship Program
>>>>> Assistant Professor, Department of Emergency Medicine
>>>>> Virginia Commonwealth University School of Medicine
>>>>> 
>>>>> Children's Hospital of Richmond at VCU
>>>>> Email [log in to unmask]
>>>>> 
>>>>> 
>>>>> On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[log in to unmask]>
>>>>> wrote:
>>>>> 
>>>>>> In a recent case at our institution, there was a present but subtle
>> degree
>>>>>> of meningismus — I’ve found over the years there is always some
>> elicitable
>>>>>> sign — but as importantly there’s a degree of irritability or altered
>>>>>> behavior that has everyone concerned: mom, RN’s, me.
>>>>>> If mama ain't happy, I ain't happy. I’ll make liberal use of the term
>>>>>> cerebritis or encephalopathic behavior until there’s a consent signed.
>>>>>> 
>>>>>> I’m not such a good scientist anymore, but I’ve tried to be an
>> attentive
>>>>>> clinician.
>>>>>> 
>>>>>> Julian Orenstein
>>>>>> 
>>>>>> 
>>>>>>> On Feb 14, 2018, at 3:30 PM, JAY FISHER <[log in to unmask]> wrote:
>>>>>>> 
>>>>>>> Scott - Bacterial meningitis is alive and well here in LV - we have
>> seen
>>>>>> it in a variety of age groups. There is good evidence that there has
>> been
>>>>>> an increase in pneumococcal serotypes not covered by the polyvalent
>>>>>> vaccines since there widespread use, such that the burden of
>> pneumococcal
>>>>>> meningitis (as opposed to H. flu type b) has not decreased nearly as
>> much.
>>>>>>> 
>>>>>>> Brouwer MC, van de Beek D. Epidemiology of community-acquired
>> bacterial
>>>>>> meningitis. Curr Opin Infect Dis. 2018;31(1):78-84.
>>>>>>> 
>>>>>>> Also, the absence of meningismus in older kids with bacterial
>> meningitis
>>>>>> is well described and occurs in a substantial subset.
>>>>>>> 
>>>>>>> Geiseler J, Nelson, K.E. Bacterial meningitis without clinical signs
>> of
>>>>>> meningeal irritation. . Southern Med J 1982;75(4):448-450.
>>>>>>> 
>>>>>>> Much of the data on the sensitivity of the neck exam is of the
>>>>>> retrospective variety. I have only read one really good prospective
>> study
>>>>>> on the sensitivity of PE for bacterial meningitis and it was a single
>>>>>> center variety as I recall.
>>>>>>> 
>>>>>>> Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of
>>>>>> bacterial versus aseptic meningitis in childhood. Ann Emerg Med.
>>>>>> 1992;21(8):910-914.
>>>>>>> 
>>>>>>> Tough case.
>>>>>>> 
>>>>>>> 
>>>>>>> Jay
>>>>>>> 
>>>>>>> Jay D. Fisher MD FAAP FACEP
>>>>>>> Medical Director, Pediatric EM
>>>>>>> Children's Hospital of Nevada at UMC
>>>>>>> Clinical Professor of Emergency Medicine and Pediatrics
>>>>>>> UNLV School of Medicine
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>> 
>>>>>>>> On February 14, 2018 at 4:18 PM "Conners, Gregory, P" <
>>>>>> [log in to unmask]> wrote:
>>>>>>>> 
>>>>>>>> 
>>>>>>>> I shared this with our ID director (Dr. Mary Anne Jackson), who
>> pointed
>>>>>> out that bacterial meningitis appears at this time of year as a
>>>>>> complication of influenza:
>>>>>>>> "Both pneumococcal and meningococcal meningitis can occur post flu
>> as
>>>>>> well as GAS and S aureus invasive disease and TSS."
>>>>>>>> 
>>>>>>>> She also addressed Jim's question:  "We do know that new serotypes
>> [of
>>>>>> pneumococcus] have emerged but this is not waning immunity because
>> the teen
>>>>>> only got PCV7".
>>>>>>>> 
>>>>>>>> 
>>>>>>>> Greg Conners
>>>>>>>> 
>>>>>>>> Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP
>>>>>>>> 
>>>>>>>> Director, Division of Emergency Medicine
>>>>>>>> Associate Chair of Pediatrics
>>>>>>>> Professor of Pediatrics and Emergency Medicine
>>>>>>>> Children’s Mercy Hospital, Kansas City
>>>>>>>> University of Missouri, Kansas City
>>>>>>>> [log in to unmask]
>>>>>>>> 
>>>>>>>> 
>>>>>>>> 
>>>>>>>> 
>>>>>>>> -----Original Message-----
>>>>>>>> From: Pediatric Emergency Medicine Discussion List [mailto:
>>>>>> [log in to unmask]] On Behalf Of 000001679b145c30-dmarc-
>>>>>> [log in to unmask]
>>>>>>>> Sent: Wednesday, February 14, 2018 2:25 PM
>>>>>>>> To: [log in to unmask]
>>>>>>>> Subject: Re: Bacterial meningitis
>>>>>>>> 
>>>>>>>> *** This message was sent to you from an External Source. Please do
>> not
>>>>>> open untrusted links or attachments. ***
>>>>>>>> 
>>>>>>>> ________________________________
>>>>>>>> 
>>>>>>>> 
>>>>>>>> Could you share with us the clinical findings and history that
>> prompted
>>>>>> the LP?
>>>>>>>> 
>>>>>>>> 
>>>>>>>> Shiu-Lin
>>>>>>>> 
>>>>>>>> 
>>>>>>>> 
>>>>>>>> 
>>>>>>>> Shiu-Lin Tsai, MD
>>>>>>>> Division of Pediatric Emergency Medicine
>>>>>>>> 
>>>>>>>> Department of Emergency Medicine
>>>>>>>> Columbia University Medical Center
>>>>>>>> 
>>>>>>>> 
>>>>>>>> 
>>>>>>>> -----Original Message-----
>>>>>>>> From: Scott Freedman <[log in to unmask]>
>>>>>>>> To: PED-EM-L <[log in to unmask]>
>>>>>>>> Sent: Wed, Feb 14, 2018 2:44 pm
>>>>>>>> Subject: Bacterial meningitis
>>>>>>>> 
>>>>>>>> ALL:
>>>>>>>> Since Jan 1st this year, we have seen 3 cases of culture + bacterial
>>>>>> meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with
>>>>>> *Neisseria meningiditis*.  All 3 were in older children/ teens who
>> received
>>>>>> their Prevnar 13  vaccines as well as the Menactra series in the
>> patient
>>>>>> with Neisseria.  Anyone else seeing cases of this sort?  I do not
>> recall 3
>>>>>> cases of bacterial meningitis in older kids in a community setting
>> such as
>>>>>> ours in quite a long time.  Is this random bad luck or do  we all
>> need to
>>>>>> be more vigilant?  Incidentally, none had neck pain or meningismus as
>> a
>>>>>> clinical finding.
>>>>>>>> 
>>>>>>>> --
>>>>>>>> Kind regards,
>>>>>>>> 
>>>>>>>> Scott
>>>>>>>> Scott Freedman, MD
>>>>>>>> Medical Director,  Pediatric Emergency Dept Rockville MD
>>>>>>>> 
>>>>>>>> For more information, send mail to [log in to unmask] with
>>>>>> the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>>>>>>>>             http://listserv.brown.edu/ped-em-l.html
>>>>>>>> 
>>>>>>>> 
>>>>>>>> For more information, send mail to [log in to unmask] with
>>>>>> the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>>>>>>>>             http://listserv.brown.edu/ped-em-l.html
>>>>>>>> 
>>>>>>>> ________________________________
>>>>>>>> 
>>>>>>>> Electronic mail from Children's Mercy Kansas City. This
>> communication
>>>>>> is intended only for the use of the addressee. It may contain
>> information
>>>>>> that is privileged or confidential under applicable law. If you are
>> not the
>>>>>> intended recipient or the agent of the recipient, you are hereby
>> notified
>>>>>> that any dissemination, copy or disclosure of this communication is
>>>>>> strictly prohibited. If you have received this communication in error,
>>>>>> please immediately forward the message to the Children's Mercy
>> Information
>>>>>> Security Officer via return electronic mail at
>> informationsecurityofficer@
>>>>>> cmh.edu and expunge this communication without making any copies.
>> Thank
>>>>>> you for your cooperation.
>>>>>>>> 
>>>>>>>> For more information, send mail to [log in to unmask] with
>>>>>> the message: info PED-EM-L
>>>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>>>             http://listserv.brown.edu/ped-em-l.html
>>>>>>> 
>>>>>>> For more information, send mail to [log in to unmask] with
>> the
>>>>>> message: info PED-EM-L
>>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>>             http://listserv.brown.edu/ped-em-l.html
>>>>>> 
>>>>>> For more information, send mail to [log in to unmask] with
>> the
>>>>>> message: info PED-EM-L
>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>              http://listserv.brown.edu/ped-em-l.html
>>>>>> 
>>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>> The URL for the PED-EM-L Web Page is:
>>>>>              http://listserv.brown.edu/ped-em-l.html
>>>>> 
>>>>> ------------------------------
>>>>> 
>>>>> Date:    Fri, 16 Feb 2018 18:29:08 -0500
>>>>> From:    Martin Pusic <[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
>> year.
>>>>> 
>>>>> 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
>>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>> The URL for the PED-EM-L Web Page is:
>>>>>              http://listserv.brown.edu/ped-em-l.html
>>>>> 
>>>>> ------------------------------
>>>>> 
>>>>> End of PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>>>>> **************************************************************
>>>> 
>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>>               http://listserv.brown.edu/ped-em-l.html
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 10:17:05 -0500
>>> From:    Deepti Thomas-Paulose <[log in to unmask]>
>>> Subject: Re: The shooting in Florida
>>> 
>>> The year speed limit laws went into effect-->traffic deaths down 17%.
>>> Mothers against Drunk Driving, stricter DUI enforcement  laws-->cut
>> deaths
>>> due to drunk driving by half every year since 1980. Seat belt safety
>> laws,
>>> traffic laws-all created to protect the public.  As a public health
>> trained
>>> physician, it seems so illogical to me that we would not create stricter
>>> gun laws especially against military style guns for the civilian
>>> population.  Let's start there.
>>> 
>>> Problem- Mass shootings
>>> Prevention- Ban assault rifles
>>> 
>>> 
>>> On Sun, Feb 18, 2018 at 7:42 AM, Terence Bergmann <
>>> [log in to unmask]> wrote:
>>> 
>>>> Hi Joe
>>>> 
>>>> I disagree about ‘strict gun control laws’ here having anything to do
>> with
>>>> it .  Either you or I could have a new hunting rifle in a week or two in
>>>> Canada.  If you look at the school shootings or the Vegas massacre these
>>>> are not people who acquired their guns and went slaughtering.  These
>> guns
>>>> were acquired and the armamentarium prepped and the plans made.
>> Canadian
>>>> laws would not stop this.
>>>> 
>>>> We have a different culture here in Canada.  Guns are not toted around
>> in
>>>> public.  Thankfully the 49th parallel prevented the ‘western’ mentality
>>>> from flourishing on our side of the border.  I don’t know why.
>>>> 
>>>> The challenge to end ‘their’ problem is that once the bad guys are armed
>>>> with illegal guns how do you stop the populace from wanting to have
>> legal
>>>> guns?
>>>> 
>>>> Somehow other countries can have legal weapons, such as Swiss adults all
>>>> keeping their weapons at home after their years of mandatory service,
>> yet
>>>> they don’t kill each other with them.  Somehow a well armed militia
>> there
>>>> does not lead to violence.
>>>> 
>>>> I have lots of questions, but I don’t know the answers.
>>>> 
>>>> Terence
>>>> 
>>>> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]
>> <mailto:j
>>>> [log in to unmask]>> wrote:
>>>> 
>>>> Disclaimer: I live in Canada and  love our very strict gun control laws.
>>>> 
>>>> 
>>>> For more information, send mail to [log in to unmask] with the
>>>> message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>>                http://listserv.brown.edu/ped-em-l.html
>>>> 
>>> 
>>> 
>>> 
>>> --
>>> Deepti Thomas-Paulose, MD, MPH
>>> Fellowship Director
>>> Global Health Division
>>> Mt. Sinai St.Luke's Roosevelt Hospital Center
>>> http://www.slredglobalhealth.org
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 17:15:53 +0000
>>> From:    Robert Finkelstein <[log in to unmask]>
>>> Subject: Re: School shootings.......
>>> 
>>> Just because people will find a way to break laws does not mean that we
>> shouldn’t have them.   By that logic, we expect that all of us who are
>> currently law abiding don’t need any laws to make us so.  Human nature
>> being what it is, we all need laws and structure.  Yes, gun regulation
>> would not stop all gun violence, but it could reduce it. Also, I don’t
>> think the majority want prohibition of guns, just regulation; the same way
>> alcohol is regulated by age and penalties for driving under the influence.
>> Or, the way cars are regulated with licensing, registration, having to pass
>> a driving test and citations for violations.
>>> 
>>>> On Feb 18, 2018, at 8:42 AM, Horst D. Weinberg, MD <
>> [log in to unmask]> wrote:
>>>> 
>>>> Yes, automatic weapons should be banned by our government, but most of
>> the discussions posted blame the guns, the NRA, the 2nd amendment and our
>> 'laws'.  Nobody gets to the meat of the matter:  If there is a demand (for
>> guns), regardless of the laws passed, someone will fill that demand.  This
>> is no different from Prohibition, where there was no shortage of available
>> booze or the 'war' on drugs, where you can get them at most street corners
>> in any city. What needs to change: There has been a steady decline over the
>> past 20 or so years in our country's moral fiber, personal and work ethic,
>> and yes, child rearing. Cause: unmarried or one parent families, poverty,
>> and absence of any discipline both in the home and in the schools, for
>> 'political correctness'. Parents want to be friends with their children
>> rather than running their homes like 'benevolent dictator ships'.  Nothing
>> is denied the child: the child wants $150.00 sneakers or a new cell-phone:
>> no problem.  So you can blame the gun all you want, but unless there is a
>> real change in the populations personal morality and ethics, these school
>> tragedies will continue.
>>>> We pediatricians should look at our own practices in teaching good
>> child rearing ways to the families we serve.     Horst D. Weinberg, MD
>>>> 
>>>> 
>>>> 
>>>> 
>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>>               http://listserv.brown.edu/ped-em-l.html
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 17:26:11 +0000
>>> From:    Robert Flood <[log in to unmask]>
>>> Subject: Re: The shooting in Florida
>>> 
>>> 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: https://urldefense.proofpoint.
>> com/v2/url?u=https-3A__en.wikipedia.org_wiki_Garen-
>> 5FWintemute&d=DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
>> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2
>> TVpCIOAggcCW0&s=MwtCq_L-kQIs3_poo8ESXJUfQXyAfM2mv3_BCZ2sBPo&e=
>>> 
>>> 
>>> 
>>> If you are interested in his program or donating, here is the link:
>> https://urldefense.proofpoint.com/v2/url?u=http-3A__www.
>> ucdmc.ucdavis.edu_vprp_&d=DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
>> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2
>> TVpCIOAggcCW0&s=km0yMXq80C4DGUQlje9yL-_xAQ5OiKQNooiyry9xUC0&e=
>>> 
>>> 
>>> 
>>> 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 isn’t 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 70’s, 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:
>>> 
>>> 
>>> 
>>> Martin,
>>> 
>>> 
>>> 
>>> As I sit in my living room on this Saturday morning, I’ve 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 post...as 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
>>> 
>>> 
>>> 
>>> 
>>> 
>>> 
>>> 
>>> 
>>> 
>>> 
>>> 
>>> 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
>>> 
>>> violence.
>>> 
>>> 
>>> 
>>> "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 *
>>> 
>>> www.aap.org<https://urldefense.proofpoint.com/v2/
>> url?u=http-3A__www.aap.org&d=DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
>> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2
>> TVpCIOAggcCW0&s=3Oc_7pCeJFj4KZ9QlF0MpVKwh-Xixr5f2-x4dFOOgHk&e=>
>>> 
>>> <https://urldefense.proofpoint.com/v2/url?u=https-
>> 3A__linkprotect.cudasvc.com_url-3Fa-3Dhttp-3A__www.
>> mmsend70.com_link.cfm-253fr-253dP1AWQRX2DH6KpZKp05dazA-7E-
>> 7E-2526pe-253dBH4KXYJXftdV7-5FOrPTTyUbVAzQsfgoRvleBm2XUVQ6
>> AiEVwuBNacQ0AWbz2OcXguY6Y2i1bNdCMkiPdWG-2DfHRg-7E-7E-2526t-
>> 253dP2O93UltqkjSP1tT62-5FPaA-7E-7E-26c-3DE-2C1-
>> 2CEDnzTesKajviC9Rbq687pz7yfFyRgC2WBFw6mF1beQyzL2WYF-
>> 5FfPWMjWxOixG1eagtp40GaUhhxZ8IL4zNcR4weeC1DLvkbbpHQsmMSnszDC
>> -26typo-3D1&d=DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
>> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2
>> TVpCIOAggcCW0&s=IjSKeAbtNO1UyfAxfonG3YrPW35X2WKiPCyGj3YfSnQ&e=>*
>>> 
>>> and
>>> 
>>> 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
>>> 
>>> year.
>>> 
>>> 
>>> 
>>> 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
>>> 
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>>> 
>>> message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>>> 
>>>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
>>> 
>>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=
>> Zoipt4Nmcnjorr_6TBHi1A&r=
>>> 
>>> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=txqCyZ0Q4Y_
>> a1kDlfTJH0FA02j_
>>> 
>>> Op8nlDmuc3NLl9Kk&s=LCEbA3j7FkFKvJBa54LAl44ZTpZ431TWXx-0dUvQ7Xo&e=
>>> 
>>> 
>>> 
>>> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
>>> 
>>> Confidentiality Notice: This e-mail message, including any attachments,
>> is
>>> 
>>> for the sole use of the intended recipient(s) and may contain
>> confidential
>>> 
>>> and privileged information. Any unauthorized review, use, disclosure or
>>> 
>>> distribution is prohibited. If you are not the intended recipient, please
>>> 
>>> contact the sender by reply e-mail and destroy all copies of the original
>>> 
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>>> 
>>> 
>>> 
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>>> 
>>> message: info PED-EM-L
>>> 
>>> The URL for the PED-EM-L Web Page is:
>>> 
>>>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Pk_HpaIpE_
>> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
>> kjmFQ1KpfStKxhcvfi4QpgjqumdRH2TVpCIOAggcCW0&s=Ow11-
>> rbJQjUhFQeEocHhTmlmSYtinw81eMl15NzZwq8&e=
>>> 
>>> 
>>> 
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> 
>>> The URL for the PED-EM-L Web Page is:
>>> 
>>>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Pk_HpaIpE_
>> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
>> kjmFQ1KpfStKxhcvfi4QpgjqumdRH2TVpCIOAggcCW0&s=Ow11-
>> rbJQjUhFQeEocHhTmlmSYtinw81eMl15NzZwq8&e=
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> 
>>> The URL for the PED-EM-L Web Page is:
>>> 
>>>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Pk_HpaIpE_
>> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
>> kjmFQ1KpfStKxhcvfi4QpgjqumdRH2TVpCIOAggcCW0&s=Ow11-
>> rbJQjUhFQeEocHhTmlmSYtinw81eMl15NzZwq8&e=
>>> 
>>> 
>>> 
>>> For more information, send mail to [log in to unmask]<mailto:
>> [log in to unmask]> with the message: info PED-EM-L
>>> 
>>> The URL for the PED-EM-L Web Page is:
>>> 
>>>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Pk_HpaIpE_
>> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
>> kjmFQ1KpfStKxhcvfi4QpgjqumdRH2TVpCIOAggcCW0&s=Ow11-
>> rbJQjUhFQeEocHhTmlmSYtinw81eMl15NzZwq8&e=
>>> 
>>> 
>>> 
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> 
>>> The URL for the PED-EM-L Web Page is:
>>> 
>>>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Pk_HpaIpE_
>> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
>> kjmFQ1KpfStKxhcvfi4QpgjqumdRH2TVpCIOAggcCW0&s=Ow11-
>> rbJQjUhFQeEocHhTmlmSYtinw81eMl15NzZwq8&e=
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 12:18:07 -0500
>>> From:    Jeff Pender <[log in to unmask]>
>>> Subject: Re: The shooting in Florida
>>> 
>>> I have a desire to put in my 2 cents as well, considering this is
>> perhaps one of the issues I feel most passionately about.   This is a
>> multi-factorial problem, obviously.   Not only is it a problem with
>> “quality and quantity”, but also with “culture".
>>> 
>>> By quality and quantity, I am speaking about what people own, and how
>> much they own.  Does anyone outside the military need a semi automatic
>> weapon for anything?  No.  Does anyone need a bump stock?  No.  Does anyone
>> need an extended magazine?  No.  If you require any of these things for the
>> lame ass excuse of “home defense”, you either need to move, or take some
>> classes and become a far better shot with a handgun.    Further, do people
>> need the insane quantity of weapons and ammunition they tend to
>> accumulate?  No, but this is a secondary problem to the types of weapons
>> they own.    We can’t own a bazooka, so “we” understand that limits can
>> exist, so we need to extend those limits to the things listed above.
>>> 
>>> The culture issue, to me, is even worse.  In the spirit of full
>> disclosure, I despise guns. I don’t own one, and have no plans on ever
>> owning one.  I won’t allow one in my home, period.  I feel pretty damn safe
>> with my 3 large dogs, thank you. I will admit that I pull away socially
>> from people once I learn they are big time gun enthusiasts.  I won’t spend
>> time with people that I know are carrying a gun on their person, or in
>> their car.  I can’t help it, and I don’t feel bad about it for even 1
>> second.  We just see the world too differently, although I don’t think it
>> makes them a bad person.  In my anecdotal experience, these serious
>> “enthusiasts” share some similar traits - they own a shit ton of guns,
>> ridiculous ammunition that no target shooter or home defense person really
>> needs, but most importantly perhaps, a “macho” response to their guns.
>> This is the thing that needs to change.
>>> 
>>> Guns are celebrated in our country as both cool and macho.  Decide where
>> to place the blame - video games, movies, athletes, musicians, etc.   But,
>> our politicians are part of this problem, and perhaps the largest part.
>> Since they are the ones that make the laws (and take the
>> bribes…err…donations), we need them to stop believing this more than anyone
>> else. They will never change the gun laws until the culture of how we view
>> guns changes.  Think back to that insane video Ted Cruz made where he
>> wrapped bacon around the muzzle of an AR-15, and after shooting for a
>> while, ate the bacon that the hot muzzle cooked.  It was horrifying how he
>> celebrated that AR-15….just so he could get another donation from gun
>> lovers.  Change the culture of how they are viewed (and then campaign
>> finance laws) and the needle can be moved on this issue.
>>> 
>>> Israel and Swiss citizens own guns at incredibly high rates, but they
>> are viewed as a fact of life, not as a point of pride or machismo.
>> Culture changes are very slow to occur, but that is what is needed first,
>> I think.  Without it, laws won’t change, and neither will the desire to own
>> these weapons and accessories.   Think of other social
>> changes/regulations….they were slow — seat belt laws, speed limits, voting
>> rights, marriage equality, marijuana legalization, etc etc.   They take
>> decades, sadly. We are a country that seems to have extreme difficulty
>> doing the right thing without it taking insanely long. It drives me crazy.
>>> 
>>> I truly hope that this school shooting has occurred around student’s
>> ages that can possibly make a difference in that these students are at an
>> age to become true activists, unlike when it happens to younger children.
>> A wave has to start, and I think it is most likely to start with these
>> young people, as long as we “older” people support them…both financially
>> and vocally…and in our voting patterns.
>>> 
>>> Jeff
>>> 
>>> 
>>> 
>>> 
>>> 
>>>> On Feb 18, 2018, at 7:42 AM, Terence Bergmann <
>> [log in to unmask]> wrote:
>>>> 
>>>> Hi Joe
>>>> 
>>>> I disagree about ‘strict gun control laws’ here having anything to do
>> with it .  Either you or I could have a new hunting rifle in a week or two
>> in Canada.  If you look at the school shootings or the Vegas massacre these
>> are not people who acquired their guns and went slaughtering.  These guns
>> were acquired and the armamentarium prepped and the plans made.  Canadian
>> laws would not stop this.
>>>> 
>>>> We have a different culture here in Canada.  Guns are not toted around
>> in public.  Thankfully the 49th parallel prevented the ‘western’ mentality
>> from flourishing on our side of the border.  I don’t know why.
>>>> 
>>>> The challenge to end ‘their’ problem is that once the bad guys are
>> armed with illegal guns how do you stop the populace from wanting to have
>> legal guns?
>>>> 
>>>> Somehow other countries can have legal weapons, such as Swiss adults
>> all keeping their weapons at home after their years of mandatory service,
>> yet they don’t kill each other with them.  Somehow a well armed militia
>> there does not lead to violence.
>>>> 
>>>> I have lots of questions, but I don’t know the answers.
>>>> 
>>>> Terence
>>>> 
>>>> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]
>> <mailto:[log in to unmask]>> wrote:
>>>> 
>>>> Disclaimer: I live in Canada and  love our very strict gun control laws.
>>>> 
>>>> 
>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>>               http://listserv.brown.edu/ped-em-l.html
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 12:34:05 -0500
>>> From:    Michael Falk <[log in to unmask]>
>>> Subject: Re: The shooting in Florida
>>> 
>>> Friend just posted this interesting rebuttal to the "mental illness"
>>> response whenever there is a mass shooting:
>>> 
>>> "Believing that mental illness causes mass shootings can feel reassuring.
>>> It helps to believe that only a mentally ill person could do something so
>>> horrific. We also think that if someone is mentally ill, they can be
>>> identified. But the evidence suggests that mental illness only causes a
>>> small fraction of gun violence. And even if some shooters have
>> undiagnosed
>>> mental illness, there is no evidence to suggest that they could have been
>>> diagnosed prior to their gun violence or that such a diagnosis would
>>> increase the predictive validity of a diagnosis on gun violence."
>>> 
>>> http://behavioralscientist.org/myth-mental-illness-
>> causes-mass-shootings/
>>> 
>>> I will add few links of my own:
>>> 
>>> https://www.theatlantic.com/health/archive/2017/10/why-
>> better-mental-health-care-wont-stop-mass-shootings/541965/
>>> 
>>> https://www.vox.com/policy-and-politics/2017/11/9/
>> 16618472/mental-illness-gun-homicide-mass-shootings
>>> 
>>> The mentally ill are stigmatized enough, blaming them for these killings
>>> seems unfair.
>>> 
>>> Mike Falk
>>> 
>>>> On Sun, Feb 18, 2018 at 12:18 PM, Jeff Pender <[log in to unmask]>
>> wrote:
>>>> 
>>>> I have a desire to put in my 2 cents as well, considering this is
>> perhaps
>>>> one of the issues I feel most passionately about.   This is a
>>>> multi-factorial problem, obviously.   Not only is it a problem with
>>>> “quality and quantity”, but also with “culture".
>>>> 
>>>> By quality and quantity, I am speaking about what people own, and how
>> much
>>>> they own.  Does anyone outside the military need a semi automatic weapon
>>>> for anything?  No.  Does anyone need a bump stock?  No.  Does anyone
>> need
>>>> an extended magazine?  No.  If you require any of these things for the
>> lame
>>>> ass excuse of “home defense”, you either need to move, or take some
>> classes
>>>> and become a far better shot with a handgun.    Further, do people need
>> the
>>>> insane quantity of weapons and ammunition they tend to accumulate?  No,
>> but
>>>> this is a secondary problem to the types of weapons they own.    We
>> can’t
>>>> own a bazooka, so “we” understand that limits can exist, so we need to
>>>> extend those limits to the things listed above.
>>>> 
>>>> The culture issue, to me, is even worse.  In the spirit of full
>>>> disclosure, I despise guns. I don’t own one, and have no plans on ever
>>>> owning one.  I won’t allow one in my home, period.  I feel pretty damn
>> safe
>>>> with my 3 large dogs, thank you. I will admit that I pull away socially
>>>> from people once I learn they are big time gun enthusiasts.  I won’t
>> spend
>>>> time with people that I know are carrying a gun on their person, or in
>>>> their car.  I can’t help it, and I don’t feel bad about it for even 1
>>>> second.  We just see the world too differently, although I don’t think
>> it
>>>> makes them a bad person.  In my anecdotal experience, these serious
>>>> “enthusiasts” share some similar traits - they own a shit ton of guns,
>>>> ridiculous ammunition that no target shooter or home defense person
>> really
>>>> needs, but most importantly perhaps, a “macho” response to their guns.
>>>> This is the thing that needs to change.
>>>> 
>>>> Guns are celebrated in our country as both cool and macho.  Decide where
>>>> to place the blame - video games, movies, athletes, musicians, etc.
>> But,
>>>> our politicians are part of this problem, and perhaps the largest part.
>>>> Since they are the ones that make the laws (and take the
>>>> bribes…err…donations), we need them to stop believing this more than
>> anyone
>>>> else. They will never change the gun laws until the culture of how we
>> view
>>>> guns changes.  Think back to that insane video Ted Cruz made where he
>>>> wrapped bacon around the muzzle of an AR-15, and after shooting for a
>>>> while, ate the bacon that the hot muzzle cooked.  It was horrifying how
>> he
>>>> celebrated that AR-15….just so he could get another donation from gun
>>>> lovers.  Change the culture of how they are viewed (and then campaign
>>>> finance laws) and the needle can be moved on this issue.
>>>> 
>>>> Israel and Swiss citizens own guns at incredibly high rates, but they
>> are
>>>> viewed as a fact of life, not as a point of pride or machismo.   Culture
>>>> changes are very slow to occur, but that is what is needed first, I
>> think.
>>>> Without it, laws won’t change, and neither will the desire to own these
>>>> weapons and accessories.   Think of other social
>> changes/regulations….they
>>>> were slow — seat belt laws, speed limits, voting rights, marriage
>> equality,
>>>> marijuana legalization, etc etc.   They take decades, sadly. We are a
>>>> country that seems to have extreme difficulty doing the right thing
>> without
>>>> it taking insanely long. It drives me crazy.
>>>> 
>>>> I truly hope that this school shooting has occurred around student’s
>> ages
>>>> that can possibly make a difference in that these students are at an
>> age to
>>>> become true activists, unlike when it happens to younger children.  A
>> wave
>>>> has to start, and I think it is most likely to start with these young
>>>> people, as long as we “older” people support them…both financially and
>>>> vocally…and in our voting patterns.
>>>> 
>>>> Jeff
>>>> 
>>>> 
>>>> 
>>>> 
>>>> 
>>>>> On Feb 18, 2018, at 7:42 AM, Terence Bergmann <
>>>> [log in to unmask]> wrote:
>>>>> 
>>>>> Hi Joe
>>>>> 
>>>>> I disagree about ‘strict gun control laws’ here having anything to do
>>>> with it .  Either you or I could have a new hunting rifle in a week or
>> two
>>>> in Canada.  If you look at the school shootings or the Vegas massacre
>> these
>>>> are not people who acquired their guns and went slaughtering.  These
>> guns
>>>> were acquired and the armamentarium prepped and the plans made.
>> Canadian
>>>> laws would not stop this.
>>>>> 
>>>>> We have a different culture here in Canada.  Guns are not toted around
>>>> in public.  Thankfully the 49th parallel prevented the ‘western’
>> mentality
>>>> from flourishing on our side of the border.  I don’t know why.
>>>>> 
>>>>> The challenge to end ‘their’ problem is that once the bad guys are
>> armed
>>>> with illegal guns how do you stop the populace from wanting to have
>> legal
>>>> guns?
>>>>> 
>>>>> Somehow other countries can have legal weapons, such as Swiss adults
>> all
>>>> keeping their weapons at home after their years of mandatory service,
>> yet
>>>> they don’t kill each other with them.  Somehow a well armed militia
>> there
>>>> does not lead to violence.
>>>>> 
>>>>> I have lots of questions, but I don’t know the answers.
>>>>> 
>>>>> Terence
>>>>> 
>>>>> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]
>>>> <mailto:[log in to unmask]>> wrote:
>>>>> 
>>>>> Disclaimer: I live in Canada and  love our very strict gun control
>> laws.
>>>>> 
>>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>> the
>>>> message: info PED-EM-L
>>>>> The URL for the PED-EM-L Web Page is:
>>>>>               http://listserv.brown.edu/ped-em-l.html
>>>> 
>>>> 
>>>> For more information, send mail to [log in to unmask] with the
>>>> message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>>                http://listserv.brown.edu/ped-em-l.html
>>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 12:52:28 -0500
>>> From:    Mick Work <[log in to unmask]>
>>> Subject: Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>>> 
>>> I appreciate the passion around gun legislation and not opposed.  I
>> don’t think laws will end this countries obsession with guns or limit
>> access to those who want to perform unlawful acts.  But again I am not
>> arguing against reasonable legislation.
>>> 
>>> I have heard proposed that we need to arm principals and add more
>> security in schools.   I just wonder if we added mental health counselors
>> instead if we wouldn’t make a greater impact.
>>> 
>>> My point is our prevention should be multi-modal like all effective
>> strategies.
>>> 
>>> 
>>> Mick
>>> 
>>> 
>>> 
>>>> On Feb 18, 2018, at 12:09 PM, Robert Finkelstein <
>> [log in to unmask]> wrote:
>>>> 
>>>> Other countries have the same level of mental illness as the United
>> States, but not nearly the number of gun deaths. The mental health issue is
>> important but access to weapons that can kill a large number of people in
>> seconds allows the results we see. In addition, access to guns plays  a
>> huge role in suicides since many who attempt suicide and do not succeed
>> will get help and not attempt again. However, access to a gun makes it much
>> more likely that the first attempt will result in death.
>>>> 
>>>> Robert Finkelstein
>>>> 
>>>>> On Feb 18, 2018, at 8:42 AM, Mick Work <[log in to unmask]> wrote:
>>>>> 
>>>>> I respect the need for debate around guns.   However, I think we are
>> remiss as pediatric emergency physicians to not raise a deeper discussion
>> around the mental illness crisis.
>>>>> 
>>>>> We all see kids who meet this persons profile across the country. We
>> see disturbing mental illness and the many factors (including social media,
>> broken families, child abuse) that lead a child to buy a gun to do harm.
>> Or if not gun an explosive device etc..
>>>>> 
>>>>> We see kids who are socially isolated and warning signs ignored.
>> Anyone else concerned that the kids we see with mental illness are
>> recognized by schools or pediatric visit screening more often than by their
>> own parents, friends or neighbors.
>>>>> 
>>>>> This persons desire to be a “school shooter” should raise attention
>> around how the media covers these events.  The fame brought to these
>> shooters should be called into question.  Are we fostering this copycat
>> mentality?
>>>>> 
>>>>> The lack of respect for human life should call us to question more
>> than the how but why.
>>>>> 
>>>>> A focus only on guns and gun laws is remiss to the bigger picture in
>> my opinion and experience.
>>>>> 
>>>>> Mick
>>>>> 
>>>>> 
>>>>> 
>>>>>> On Feb 17, 2018, at 12:01 AM, PED-EM-L automatic digest system <
>> [log in to unmask]> wrote:
>>>>>> 
>>>>>> There are 4 messages totaling 391 lines in this issue.
>>>>>> 
>>>>>> Topics of the day:
>>>>>> 
>>>>>> 1. Peds EM talk (2)
>>>>>> 2. Bacterial meningitis
>>>>>> 3. The shooting in Florida
>>>>>> 
>>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>             http://listserv.brown.edu/ped-em-l.html
>>>>>> 
>>>>>> ------------------------------------------------------------
>> ----------
>>>>>> 
>>>>>> Date:    Fri, 16 Feb 2018 11:50:44 -0500
>>>>>> From:    Purva Grover <[log in to unmask]>
>>>>>> Subject: Re: Peds EM talk
>>>>>> 
>>>>>> Thanks all for your help on this.
>>>>>> Best
>>>>>> Purva
>>>>>> 
>>>>>> Purva Grover , MD
>>>>>> Medical Director
>>>>>> Pediatric Emergency Department
>>>>>> Cleveland Clinic Health System
>>>>>> Email- [log in to unmask] <[log in to unmask]>g
>>>>>> 
>>>>>>> On Thu, Feb 15, 2018 at 2:18 PM, <[log in to unmask]> wrote:
>>>>>>> 
>>>>>>> Hi All
>>>>>>> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can
>> not
>>>>>>> cover ALL or even most. Any thoughts / talks / power points- you
>> could
>>>>>>> share would be appreciated.
>>>>>>> Thanks
>>>>>>> Purva
>>>>>>> 
>>>>>>> Sent from my mobile device
>>>>>> 
>>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>             http://listserv.brown.edu/ped-em-l.html
>>>>>> 
>>>>>> ------------------------------
>>>>>> 
>>>>>> Date:    Fri, 16 Feb 2018 14:34:20 +0000
>>>>>> From:    "Chamberlain, James" <[log in to unmask]>
>>>>>> Subject: Re: Peds EM talk
>>>>>> 
>>>>>> I would also cover unusual cases that you can't afford to miss, e.g.
>>>>>> 
>>>>>> Sternoclavicular dislocation
>>>>>> Conjunctivitis caused by penetrating FB
>>>>>> Septic joint presenting with only low-grade fever (we've had several
>> Staph infections where temp was only 37.6 or 37.7 orally)
>>>>>> Myocarditis presenting as wheezing. Remind them that all
>> "bronchiolitis" patients need a through cardiac exam, including distal
>> pulses
>>>>>> NAT
>>>>>> The "sleepy" baby who has hypoglycemia
>>>>>> The "sleepy" baby who has intussusception
>>>>>> The appendicitis patient who presents with vomiting and diarrhea (not
>> all that unusual, actually)
>>>>>> Etc.
>>>>>> 
>>>>>> To me, this is the challenge of PEM. Finding the needle in the
>> haystack, that one sick kid who is different than all the usual low acuity
>> illness...
>>>>>> 
>>>>>> Jim
>>>>>> 
>>>>>> James Chamberlain
>>>>>> Division Chief, Emergency Medicine
>>>>>> Children’s National Health System
>>>>>> (202) 476-4177
>>>>>> 
>>>>>> -----Original Message-----
>>>>>> From: Pediatric Emergency Medicine Discussion List [mailto:
>> [log in to unmask]] On Behalf Of Mojica, Michael
>>>>>> Sent: Thursday, February 15, 2018 5:29 PM
>>>>>> To: [log in to unmask]
>>>>>> Subject: Re: Peds EM talk
>>>>>> 
>>>>>> Purva
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> I would recommend "the critically ill infant".
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> It is the topic that scares the most people and you can cover a lot
>> of causes through cases.
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> I like to use cases that include common presenting complaints (e.g.
>> vomiting) that are associated with very bad things (e.g. midgut volvulus).
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> I'm attaching a ppt file for a talk I did a few years ago on this
>> topic.
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> My goal is for them to develop a mental checklist of potentially
>> life-saving interventions.
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> Michael
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> Michael Mojica, M.D
>>>>>> 
>>>>>> Director of Education, Division of Pediatric Emergency Medicine
>>>>>> 
>>>>>> Director, Pediatric Emergency Medicine Fellowship
>>>>>> 
>>>>>> Bellevue Hospital Center
>>>>>> 
>>>>>> Administration Building Room A528
>>>>>> 
>>>>>> New York, N.Y. 10016
>>>>>> 
>>>>>> [log in to unmask]
>>>>>> 
>>>>>> 212-562-8147
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List
>> on behalf of Purva Grover" <[log in to unmask] on behalf of
>> [log in to unmask]> wrote:
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> Hi All
>>>>>> 
>>>>>> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can
>> not cover ALL or even most. Any thoughts / talks / power points- you could
>> share would be appreciated.
>>>>>> 
>>>>>> Thanks
>>>>>> 
>>>>>> Purva
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> Sent from my mobile device
>>>>>> 
>>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>>> 
>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>> 
>>>>>>                 https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFAg&c=
>> j5oPpO0eBH1iio48DtsedbOBGmuw5jHLjgvtN2r4ehE&r=-
>> uVUSwDIF0s52hEnO0EzoINmOqevlfnirF7YJ_EXiAQ&m=c2wlkkLWVP009LBCXl-
>> k6T4PNiNn1YYHTaSvJRCvGWo&s=7bcGZM66nE4BJGdqQQrjhL6fNRMBTCzuSv96wXa91qc&e=
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> ------------------------------------------------------------
>>>>>> This email message, including any attachments, is for the sole use of
>> the intended recipient(s) and may contain information that is proprietary,
>> confidential, and exempt from disclosure under applicable law. Any
>> unauthorized review, use, disclosure, or distribution is prohibited. If you
>> have received this email in error please notify the sender by return email
>> and delete the original message. Please note, the recipient should check
>> this email and any attachments for the presence of viruses. The
>> organization accepts no liability for any damage caused by any virus
>> transmitted by this email.
>>>>>> =================================
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> 
>>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>>> 
>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>> 
>>>>>>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
>> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=ZQaRUYHlbNuSLlAi-
>> YuD0cY4QPsIIUqjaql9agkSHH8&s=jLXcVKFGHNLAQ-y3T0bMic8mmMkKMtSnWoO5UdsCqvM&
>> e=
>>>>>> 
>>>>>> 
>>>>>> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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>>>>>> Confidentiality Notice: This e-mail message, including any
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>> contain confidential and privileged information. Any unauthorized review,
>> use, disclosure or distribution is prohibited. If you are not the intended
>> recipient, please contact the sender by reply e-mail and destroy all copies
>> of the original message.
>>>>>> 
>>>>>> 
>>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>             http://listserv.brown.edu/ped-em-l.html
>>>>>> 
>>>>>> ------------------------------
>>>>>> 
>>>>>> Date:    Fri, 16 Feb 2018 18:29:38 -0500
>>>>>> From:    Aline Baghdassarian <[log in to unmask]>
>>>>>> Subject: Re: Bacterial meningitis
>>>>>> 
>>>>>> Scott,
>>>>>> 
>>>>>> Would love to hear more about the cases. How did they present? What
>> was the
>>>>>> decision making process?
>>>>>> 
>>>>>> Thank you,
>>>>>> 
>>>>>> Aline
>>>>>> 
>>>>>> Aline Baghdassarian, MD, MPH, FAAP
>>>>>> Director, Pediatric Emergency Medicine Fellowship Program
>>>>>> Assistant Professor, Department of Emergency Medicine
>>>>>> Virginia Commonwealth University School of Medicine
>>>>>> 
>>>>>> Children's Hospital of Richmond at VCU
>>>>>> Email [log in to unmask]
>>>>>> 
>>>>>> 
>>>>>> On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[log in to unmask]
>>> 
>>>>>> wrote:
>>>>>> 
>>>>>>> In a recent case at our institution, there was a present but subtle
>> degree
>>>>>>> of meningismus — I’ve found over the years there is always some
>> elicitable
>>>>>>> sign — but as importantly there’s a degree of irritability or altered
>>>>>>> behavior that has everyone concerned: mom, RN’s, me.
>>>>>>> If mama ain't happy, I ain't happy. I’ll make liberal use of the term
>>>>>>> cerebritis or encephalopathic behavior until there’s a consent
>> signed.
>>>>>>> 
>>>>>>> I’m not such a good scientist anymore, but I’ve tried to be an
>> attentive
>>>>>>> clinician.
>>>>>>> 
>>>>>>> Julian Orenstein
>>>>>>> 
>>>>>>> 
>>>>>>>> On Feb 14, 2018, at 3:30 PM, JAY FISHER <[log in to unmask]> wrote:
>>>>>>>> 
>>>>>>>> Scott - Bacterial meningitis is alive and well here in LV - we have
>> seen
>>>>>>> it in a variety of age groups. There is good evidence that there has
>> been
>>>>>>> an increase in pneumococcal serotypes not covered by the polyvalent
>>>>>>> vaccines since there widespread use, such that the burden of
>> pneumococcal
>>>>>>> meningitis (as opposed to H. flu type b) has not decreased nearly as
>> much.
>>>>>>>> 
>>>>>>>> Brouwer MC, van de Beek D. Epidemiology of community-acquired
>> bacterial
>>>>>>> meningitis. Curr Opin Infect Dis. 2018;31(1):78-84.
>>>>>>>> 
>>>>>>>> Also, the absence of meningismus in older kids with bacterial
>> meningitis
>>>>>>> is well described and occurs in a substantial subset.
>>>>>>>> 
>>>>>>>> Geiseler J, Nelson, K.E. Bacterial meningitis without clinical
>> signs of
>>>>>>> meningeal irritation. . Southern Med J 1982;75(4):448-450.
>>>>>>>> 
>>>>>>>> Much of the data on the sensitivity of the neck exam is of the
>>>>>>> retrospective variety. I have only read one really good prospective
>> study
>>>>>>> on the sensitivity of PE for bacterial meningitis and it was a single
>>>>>>> center variety as I recall.
>>>>>>>> 
>>>>>>>> Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of
>>>>>>> bacterial versus aseptic meningitis in childhood. Ann Emerg Med.
>>>>>>> 1992;21(8):910-914.
>>>>>>>> 
>>>>>>>> Tough case.
>>>>>>>> 
>>>>>>>> 
>>>>>>>> Jay
>>>>>>>> 
>>>>>>>> Jay D. Fisher MD FAAP FACEP
>>>>>>>> Medical Director, Pediatric EM
>>>>>>>> Children's Hospital of Nevada at UMC
>>>>>>>> Clinical Professor of Emergency Medicine and Pediatrics
>>>>>>>> UNLV School of Medicine
>>>>>>>> 
>>>>>>>> 
>>>>>>>> 
>>>>>>>> 
>>>>>>>> 
>>>>>>>> 
>>>>>>>> 
>>>>>>>> 
>>>>>>>>> On February 14, 2018 at 4:18 PM "Conners, Gregory, P" <
>>>>>>> [log in to unmask]> wrote:
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> I shared this with our ID director (Dr. Mary Anne Jackson), who
>> pointed
>>>>>>> out that bacterial meningitis appears at this time of year as a
>>>>>>> complication of influenza:
>>>>>>>>> "Both pneumococcal and meningococcal meningitis can occur post flu
>> as
>>>>>>> well as GAS and S aureus invasive disease and TSS."
>>>>>>>>> 
>>>>>>>>> She also addressed Jim's question:  "We do know that new serotypes
>> [of
>>>>>>> pneumococcus] have emerged but this is not waning immunity because
>> the teen
>>>>>>> only got PCV7".
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> Greg Conners
>>>>>>>>> 
>>>>>>>>> Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP
>>>>>>>>> 
>>>>>>>>> Director, Division of Emergency Medicine
>>>>>>>>> Associate Chair of Pediatrics
>>>>>>>>> Professor of Pediatrics and Emergency Medicine
>>>>>>>>> Children’s Mercy Hospital, Kansas City
>>>>>>>>> University of Missouri, Kansas City
>>>>>>>>> [log in to unmask]
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> -----Original Message-----
>>>>>>>>> From: Pediatric Emergency Medicine Discussion List [mailto:
>>>>>>> [log in to unmask]] On Behalf Of 000001679b145c30-dmarc-
>>>>>>> [log in to unmask]
>>>>>>>>> Sent: Wednesday, February 14, 2018 2:25 PM
>>>>>>>>> To: [log in to unmask]
>>>>>>>>> Subject: Re: Bacterial meningitis
>>>>>>>>> 
>>>>>>>>> *** This message was sent to you from an External Source. Please
>> do not
>>>>>>> open untrusted links or attachments. ***
>>>>>>>>> 
>>>>>>>>> ________________________________
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> Could you share with us the clinical findings and history that
>> prompted
>>>>>>> the LP?
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> Shiu-Lin
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> Shiu-Lin Tsai, MD
>>>>>>>>> Division of Pediatric Emergency Medicine
>>>>>>>>> 
>>>>>>>>> Department of Emergency Medicine
>>>>>>>>> Columbia University Medical Center
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> -----Original Message-----
>>>>>>>>> From: Scott Freedman <[log in to unmask]>
>>>>>>>>> To: PED-EM-L <[log in to unmask]>
>>>>>>>>> Sent: Wed, Feb 14, 2018 2:44 pm
>>>>>>>>> Subject: Bacterial meningitis
>>>>>>>>> 
>>>>>>>>> ALL:
>>>>>>>>> Since Jan 1st this year, we have seen 3 cases of culture +
>> bacterial
>>>>>>> meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with
>>>>>>> *Neisseria meningiditis*.  All 3 were in older children/ teens who
>> received
>>>>>>> their Prevnar 13  vaccines as well as the Menactra series in the
>> patient
>>>>>>> with Neisseria.  Anyone else seeing cases of this sort?  I do not
>> recall 3
>>>>>>> cases of bacterial meningitis in older kids in a community setting
>> such as
>>>>>>> ours in quite a long time.  Is this random bad luck or do  we all
>> need to
>>>>>>> be more vigilant?  Incidentally, none had neck pain or meningismus
>> as a
>>>>>>> clinical finding.
>>>>>>>>> 
>>>>>>>>> --
>>>>>>>>> Kind regards,
>>>>>>>>> 
>>>>>>>>> Scott
>>>>>>>>> Scott Freedman, MD
>>>>>>>>> Medical Director,  Pediatric Emergency Dept Rockville MD
>>>>>>>>> 
>>>>>>>>> For more information, send mail to [log in to unmask]
>> with
>>>>>>> the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>>>>>>>>>            http://listserv.brown.edu/ped-em-l.html
>>>>>>>>> 
>>>>>>>>> 
>>>>>>>>> For more information, send mail to [log in to unmask]
>> with
>>>>>>> the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>>>>>>>>>            http://listserv.brown.edu/ped-em-l.html
>>>>>>>>> 
>>>>>>>>> ________________________________
>>>>>>>>> 
>>>>>>>>> Electronic mail from Children's Mercy Kansas City. This
>> communication
>>>>>>> is intended only for the use of the addressee. It may contain
>> information
>>>>>>> that is privileged or confidential under applicable law. If you are
>> not the
>>>>>>> intended recipient or the agent of the recipient, you are hereby
>> notified
>>>>>>> that any dissemination, copy or disclosure of this communication is
>>>>>>> strictly prohibited. If you have received this communication in
>> error,
>>>>>>> please immediately forward the message to the Children's Mercy
>> Information
>>>>>>> Security Officer via return electronic mail at
>> informationsecurityofficer@
>>>>>>> cmh.edu and expunge this communication without making any copies.
>> Thank
>>>>>>> you for your cooperation.
>>>>>>>>> 
>>>>>>>>> For more information, send mail to [log in to unmask]
>> with
>>>>>>> the message: info PED-EM-L
>>>>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>>>>            http://listserv.brown.edu/ped-em-l.html
>>>>>>>> 
>>>>>>>> For more information, send mail to [log in to unmask]
>> with the
>>>>>>> message: info PED-EM-L
>>>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>>>            http://listserv.brown.edu/ped-em-l.html
>>>>>>> 
>>>>>>> For more information, send mail to [log in to unmask] with
>> the
>>>>>>> message: info PED-EM-L
>>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>>             http://listserv.brown.edu/ped-em-l.html
>>>>>>> 
>>>>>> 
>>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>             http://listserv.brown.edu/ped-em-l.html
>>>>>> 
>>>>>> ------------------------------
>>>>>> 
>>>>>> Date:    Fri, 16 Feb 2018 18:29:08 -0500
>>>>>> From:    Martin Pusic <[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
>> year.
>>>>>> 
>>>>>> 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
>>>>>> 
>>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>>> The URL for the PED-EM-L Web Page is:
>>>>>>             http://listserv.brown.edu/ped-em-l.html
>>>>>> 
>>>>>> ------------------------------
>>>>>> 
>>>>>> End of PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>>>>>> **************************************************************
>>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>>> The URL for the PED-EM-L Web Page is:
>>>>>              http://listserv.brown.edu/ped-em-l.html
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 23:05:03 +0000
>>> From:    "Chamberlain, James" <[log in to unmask]>
>>> Subject: Re: School shootings.......
>>> 
>>> I'd be happy with sensible regulations, required training, and licensure
>> so that guns don't get into the hands of criminals and people with mental
>> illness.
>>> 
>>> But the NRA is against sensible regulations.
>>> 
>>> 
>>> 
>>> Sent from my Verizon, Samsung Galaxy smartphone
>>> 
>>> 
>>> -------- Original message --------
>>> From: Robert Finkelstein <[log in to unmask]>
>>> Date: 2/18/18 12:17 (GMT-05:00)
>>> To: [log in to unmask]
>>> Subject: Re: School shootings.......
>>> 
>>> Just because people will find a way to break laws does not mean that we
>> shouldn’t have them.   By that logic, we expect that all of us who are
>> currently law abiding don’t need any laws to make us so.  Human nature
>> being what it is, we all need laws and structure.  Yes, gun regulation
>> would not stop all gun violence, but it could reduce it. Also, I don’t
>> think the majority want prohibition of guns, just regulation; the same way
>> alcohol is regulated by age and penalties for driving under the influence.
>> Or, the way cars are regulated with licensing, registration, having to pass
>> a driving test and citations for violations.
>>> 
>>> 
>>> 
>>>>> On Feb 18, 2018, at 8:42 AM, Horst D. Weinberg, MD <
>> [log in to unmask]> wrote:
>>>> 
>>>> 
>>> 
>>>> Yes, automatic weapons should be banned by our government, but most of
>> the discussions posted blame the guns, the NRA, the 2nd amendment and our
>> 'laws'.  Nobody gets to the meat of the matter:  If there is a demand (for
>> guns), regardless of the laws passed, someone will fill that demand.  This
>> is no different from Prohibition, where there was no shortage of available
>> booze or the 'war' on drugs, where you can get them at most street corners
>> in any city. What needs to change: There has been a steady decline over the
>> past 20 or so years in our country's moral fiber, personal and work ethic,
>> and yes, child rearing. Cause: unmarried or one parent families, poverty,
>> and absence of any discipline both in the home and in the schools, for
>> 'political correctness'. Parents want to be friends with their children
>> rather than running their homes like 'benevolent dictator ships'.  Nothing
>> is denied the child: the child wants $150.00 sneakers or a new cell-phone:
>> no problem.  So you can blame the gun all you want, but unless there is a
>> real change in the populations personal morality and ethics, these school
>> tragedies will continue.
>>> 
>>>> We pediatricians should look at our own practices in teaching good
>> child rearing ways to the families we serve.     Horst D. Weinberg, MD
>>> 
>>>> 
>>> 
>>>> 
>>> 
>>>> 
>>> 
>>>> 
>>> 
>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>> 
>>>> The URL for the PED-EM-L Web Page is:
>>> 
>>>>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
>> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
>> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
>> PA30um4cACI1FYE&e=
>>> 
>>> 
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> 
>>> The URL for the PED-EM-L Web Page is:
>>> 
>>>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
>> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
>> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
>> PA30um4cACI1FYE&e=
>>> 
>>> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
>>> Confidentiality Notice: This e-mail message, including any attachments,
>> is for the sole use of the intended recipient(s) and may contain
>> confidential and privileged information. Any unauthorized review, use,
>> disclosure or distribution is prohibited. If you are not the intended
>> recipient, please contact the sender by reply e-mail and destroy all copies
>> of the original message.
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> Date:    Sun, 18 Feb 2018 19:03:20 -0600
>>> From:    Jill C Obremskey <[log in to unmask]>
>>> Subject: Re: School shootings.......
>>> 
>>> Great discussion but what are WE going to do about it as an organization?
>>> How do we become relentless about the need for gun control, the need for
>> mental health services, and for preventing toxic stress in children.
>>> 
>>> We need to ask leaders in the AAP and AAEM to organize us into a
>> uniified voice that will not quit.
>>> 
>>>> On February 18, 2018 at 5:05 PM "Chamberlain, James" <
>> [log in to unmask]> wrote:
>>>> 
>>>> 
>>>> I'd be happy with sensible regulations, required training, and
>> licensure so that guns don't get into the hands of criminals and people
>> with mental illness.
>>>> 
>>>> But the NRA is against sensible regulations.
>>>> 
>>>> 
>>>> 
>>>> Sent from my Verizon, Samsung Galaxy smartphone
>>>> 
>>>> 
>>>> -------- Original message --------
>>>> From: Robert Finkelstein <[log in to unmask]>
>>>> Date: 2/18/18 12:17 (GMT-05:00)
>>>> To: [log in to unmask]
>>>> Subject: Re: School shootings.......
>>>> 
>>>> Just because people will find a way to break laws does not mean that we
>> shouldn’t have them. By that logic, we expect that all of us who are
>> currently law abiding don’t need any laws to make us so. Human nature being
>> what it is, we all need laws and structure. Yes, gun regulation would not
>> stop all gun violence, but it could reduce it. Also, I don’t think the
>> majority want prohibition of guns, just regulation; the same way alcohol is
>> regulated by age and penalties for driving under the influence. Or, the way
>> cars are regulated with licensing, registration, having to pass a driving
>> test and citations for violations.
>>>> 
>>>> 
>>>> 
>>>>>> On Feb 18, 2018, at 8:42 AM, Horst D. Weinberg, MD <
>> [log in to unmask]> wrote:
>>>>> 
>>>>> 
>>>> 
>>>>> Yes, automatic weapons should be banned by our government, but most of
>> the discussions posted blame the guns, the NRA, the 2nd amendment and our
>> 'laws'. Nobody gets to the meat of the matter: If there is a demand (for
>> guns), regardless of the laws passed, someone will fill that demand. This
>> is no different from Prohibition, where there was no shortage of available
>> booze or the 'war' on drugs, where you can get them at most street corners
>> in any city. What needs to change: There has been a steady decline over the
>> past 20 or so years in our country's moral fiber, personal and work ethic,
>> and yes, child rearing. Cause: unmarried or one parent families, poverty,
>> and absence of any discipline both in the home and in the schools, for
>> 'political correctness'. Parents want to be friends with their children
>> rather than running their homes like 'benevolent dictator ships'. Nothing
>> is denied the child: the child wants $150.00 sneakers or a new cell-phone:
>> no problem. So you can blame the gun all you want, but unless there is a
>> real change in the populations personal morality and ethics, these school
>> tragedies will continue.
>>>> 
>>>>> We pediatricians should look at our own practices in teaching good
>> child rearing ways to the families we serve. Horst D. Weinberg, MD
>>>> 
>>>>> 
>>>> 
>>>>> 
>>>> 
>>>>> 
>>>> 
>>>>> 
>>>> 
>>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> 
>>>>> The URL for the PED-EM-L Web Page is:
>>>> 
>>>>> https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
>> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
>> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
>> PA30um4cACI1FYE&e=
>>>> 
>>>> 
>>>> 
>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> 
>>>> The URL for the PED-EM-L Web Page is:
>>>> 
>>>> https://urldefense.proofpoint.com/v2/url?u=http-3A__
>> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
>> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
>> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
>> PA30um4cACI1FYE&e=
>>>> 
>>>> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
>>>> Confidentiality Notice: This e-mail message, including any attachments,
>> is for the sole use of the intended recipient(s) and may contain
>> confidential and privileged information. Any unauthorized review, use,
>> disclosure or distribution is prohibited. If you are not the intended
>> recipient, please contact the sender by reply e-mail and destroy all copies
>> of the original message.
>>>> 
>>>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>>>> The URL for the PED-EM-L Web Page is:
>>>> http://listserv.brown.edu/ped-em-l.html
>>> 
>>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
>>>                http://listserv.brown.edu/ped-em-l.html
>>> 
>>> ------------------------------
>>> 
>>> End of PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41)
>>> **************************************************************
>> 
>> For more information, send mail to [log in to unmask] with the
>> message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
>>                 http://listserv.brown.edu/ped-em-l.html
>> 
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html


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