July 4, 2022, began as usual. This quickly changed, however, when a shooter opened fire at the Fourth of July parade in Highland Park, Illinois. My family usually attends this parade, but this year went to a different parade five miles away. The attack left numerous people dead and dozens more injured. As the tragedy unfolded, my family and I could not safely reach our home in Highland Park and sought refuge at the nearby Northwestern Medicine Lake Forest Hospital (NMLFH). While sheltering my family, I learned that shooting victims would be arriving at NMLFH. I did as any of us would have and rushed to the emergency room to assist. My training had prepared me for this. I was unprepared, however, for the phone call I was about to receive. A close friend had been shot. Her family asked if I could help.
It has been one month since this tragedy. Although grateful to have been able to help my community, I continue to experience a profound sense of helplessness. The same helplessness, in fact, that accompanies each and every mass shooting (Table 1).1 When is enough, enough?
Table 1.
Deadliest Mass Shootings in the United States Since 19991
| Year | Location | Fatalities |
|---|---|---|
| 2017 | Las Vegas, Nev. (Las Vegas Strip) | 58 |
| 2016 | Orlando, Fla. (Pulse nightclub) | 49 |
| 2007 | Blacksburg, Va. (Virginia Tech) | 32 |
| 2012 | Newtown, Conn. (Sandy Hook Elementary School) | 27 |
| 2017 | Sutherland Springs, Tex. (Texas First Baptist Church) | 26 |
| 2022 | Uvalde, Tex. (Robb Elementary School) | 21 |
| 2019 | El Paso, Tex. (El Paso Walmart) | 20 |
| 2018 | Parkland, Fla. (Marjory Stoneman Douglas High School) | 17 |
| 2015 | San Bernardino, Ca. (San Bernardino) | 14 |
| 2009 | Binghamton, N.Y. (Binghamton) | 14 |
| 2009 | Fort Hood, Tex. (Fort Hood) | 13 |
| 1999 | Littleton, Colo. (Columbine High School) | 13 |
| 2012 | Aurora, Colo. (Aurora movie theater) | 12 |
| 2013 | Washington, D.C. (Washington Navy Yard) | 12 |
| 2018 | Thousand Oaks, Calif. (Thousand Oaks nightclub) | 12 |
| 2019 | Virginia Beach, Va. (Virginia Beach municipal building) | 12 |
| 2018 | Pittsburgh, Pa. (Tree of Life Synagogue) | 11 |
| 2005 | Red Lake, Minn. (Red Lake) | 10 |
| 2018 | Santa Fe, Tex. (Santa Fe High School) | 10 |
| 2021 | Boulder, Colo. (Boulder supermarket) | 10 |
| 2022 | Buffalo, N.Y. (Buffalo supermarket) | 10 |
In the last two decades, mass shootings in the United States have notably increased. There have been more mass shootings in the previous five-year period than in any other half-decade since 1966. In 2022, the United States has already experienced 409 mass shootings, 19 of which were mass murders.2 Although elusive, factors potentially responsible include deficient gun-safety laws, mental health challenges, and inadequate security measures in public places (eg, schools). Although examining gun violence causal factors is essential, it alone will not reduce preventable gun violence. Active steps are also required.
The rise of gun violence is a threat to public health. Plastic surgeons often witness gun-induced destruction and are therefore uniquely positioned to advocate for positive and deliberate change. Conventional wisdom, particularly in the media, is that traumatic gun violence management primarily falls to trauma and orthopedic surgeons. Plastic surgeons, however, are frequently key members of the care team, often required for complex traumatic reconstruction.3 Recently, Robert Pearl smartly suggested that society’s significant trust in healthcare professionals may be leveraged to influence stricter and more intelligent gun-safety legislation.4 Furthermore, incorporating strategies to reduce gun violence during patient encounters (eg, discussing risks of gun ownership) and screening for relevant mental health concerns (eg, violent ideation) is crucial.
An additional measure that plastic surgeons could take is encouraging our professional societies and governing bodies to advocate for gun safety. There is precedence for this by other groups. The American College of Physicians recently recommended explicit measures to reduce gun violence, including physicians taking an active role in gun violence prevention (ie, by addressing attendant risks with patients) and advocating for improved gun-safety legislation.5 Additional leading professional organizations (eg, American College of Surgeons) have endorsed a call-to-action to reduce the public health threat of gun violence (Table 2).5 Plastic surgeons, and our societies, should similarly follow suit and encourage measures to reduce gun violence. Almost certainly, there will be challenges. These may include societal hesitance to political discourse, patient reticence, and lack of physician familiarity in discussing these topics. Thus, additional education on gun violence, and how to address it appropriately in clinical encounters, will be important. Collective action by many, even if incremental, is crucial to effecting change. And what change is more important than the change aimed at protecting our patients, families, communities, and the public? Indeed, the time to take action to prevent senseless gun violence is far past due.
Table 2.
Notable Professional Health Organizations Endorsing Call-to-Action for Gun Violence Reduction5
| Organization | Abbreviation | Website |
|---|---|---|
| American College of Physicians | ACP | https://www.acponline.org/ |
| American Academy of Family Physicians | AAFP | https://www.aafp.org/home.html |
| American Academy of Pediatrics | AAP | https://www.aap.org/ |
| American College of Surgeons | ACS | https://www.facs.org/ |
| American Medical Association | AMA | https://www.ama-assn.org/ |
| American Psychiatric Association | APA | https://www.psychiatry.org/ |
| American Public Health Association | APHA | https://www.apha.org/ |
| American Academy of Neurology | AAN | https://www.aan.com/ |
| American Academy of Ophthalmology | AAO | https://www.aao.org/ |
| American Academy of Physical Medicine and Rehab | AAPM&R | https://www.aapmr.org/ |
| American Psychological Association | APA | https://www.apa.org/ |
| American Association of Clinical Endocrinologists | AACE | https://www.aace.com/ |
| American College of Cardiology | ACC | https://www.acc.org/ |
| American College of Chest Physicians | ACCP | https://www.chestnet.org/ |
| American College of Obstetricians & Gynecologists | ACOG | https://www.acog.org/ |
| American College of Preventive Medicine | ACPM | https://www.acpm.org/ |
| American Geriatrics Society | AGS | https://www.americangeriatrics.org/ |
| American Medical Women’s Association | AMWA | https://www.amwa-doc.org/ |
| American Society of Hematology | ASH | https://www.hematology.org/ |
| American Society of Nephrology | ASN | https://www.asn-online.org/ |
| American Thoracic Society | ATS | https://www.thoracic.org/ |
| Society for Adolescent Health and Medicine | SAHM | https://www.adolescenthealth.org/ |
| Society of Critical Care Medicine | SCCM | https://www.sccm.org/Home |
| Society of Interventional Radiology | SIR | https://www.sirweb.org/ |
Footnotes
Disclosure: The author has no financial interest to declare in relation to the content of this article.
REFERENCES
- 1.Mother Jones. Number of victims of the worst mass shootings in the United States between 1982 and May 2022. Statista; 2022. Available at https://www-statista-com.proxy.lib.umich.edu/statistics/476101/worst-mass-shootings-in-the-us/. Accessed August 12, 2022.
- 2.Gun Violence Archive. 2022. Available at https://www.gunviolencearchive.org/. Accessed July 31, 2022.
- 3.Kaufman Y, Cole P, Hollier LH. Facial gunshot wounds: trends in management. Craniomaxillofac Trauma Reconstr. 2009;2:85–90. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Pearl R. Gun violence is a chronic disease. Health professionals must help prevent it. The Fulcrum. 2022. Available at https://thefulcrum.us/big-picture/Leveraging-big-ideas/gun-violence-2657414435. Accessed July 31, 2022.
- 5.McLean RM, Harris P, Cullen J, et al. Firearm-related injury and death in the United States: a call to action from the nation’s leading physician and public health professional organizations. Ann Intern Med. 2019;171:573–577. [DOI] [PubMed] [Google Scholar]