The loss of so much life in the Orlando shootings is exceptional, but the kind of bullet wounds and the extreme nature of the physical trauma that people suffered in this incident is not as uncommon as it was even a decade ago, according to new study. And it is time for this “hidden public health issue” to come out of the shadows, the authors argue.
The research letter in the Journal of the American Medical Association on Tuesday takes a closer look at the nature of gunshot wounds in patients at Denver’s largest trauma center. What it finds is that based on the increasing severity of gunshot wounds and the increasing number of patients shot multiple times, patients are now more likely to die from a gunshot wound than they were even 10 years ago. That’s not the case for other trauma such as falls, accidents and stabbings.
The data came from Denver Health Medical Center between 2000 and 2013, during which time death rates from gunshot wounds increased by about 6% on average every couple of years, according to the research. The authors are careful to say it is hard to extrapolate these data without having more of it from other trauma centers.
But Denver doctors haven’t forgotten how to treat trauma patients. The survivability rates from those other kinds of trauma show that the technology and the communication among the trauma teams, and the kind of care you can get, is “some of the best in the country,” according to study author Dr. Angela Sauaia. What’s changed, she said, is the nature of the gunshot injuries.
“To be blunt, instead of a 2-centimeter hole, you are seeing a 3-centimeter hole with more damage. And there are more wounds, so the team has to repair more damage,” Sauaia said.
The data do not get at why the injuries are more severe. Those records were unavailable to the team, Sauaia said, but co-author and world-renowned trauma surgeon Dr. Ernest Moore said he knows exactly what has changed. He blames the kinds of weapons used and the high capacity magazines.
“The handguns people use now have more of an ability to create severe tissue injury than the typical .38 Special injuries we used to see 15 or 20 years ago,” Moore said. “And if you have weapons that deliver a multitude of bullets, allowing the shooter to continue shooting, (that) is far more damaging than the amount of energy delivered by a single bullet.”
On call last week, Moore treated a patient shot six times. “It’s not uncommon anymore. Not at all,” he said. And he hears that from trauma teams across the country.
“A key difference today in these mass shootings, and even in your bank robberies and assaults, is that now, individuals have these weapons that shoot multiple bullets without delay,” Moore said. “It can be a challenge with that many bullets in that many body parts, and the damage is extensive.”
That is consistent with what gun experts say is the weapon of choice among American criminals.
“Go back to the 1980s, when you see a rise in drug crime,” said Robert Spitzer, who has written five books on gun control and is a professor of political science at SUNY Cortland. “Back in the ’80s, there were fewer guns around, and more often, the gun of choice was a Saturday night special: a cheap handgun with smaller-caliber bullets with firepower that didn’t travel as far.”
With a flood of drug money into the country since then, gangs and gangsters are now more able to buy semiautomatic weapons that had been “more exotic and rare.”
In 2004, a law known as the Federal Assault Weapons Ban expired. It had restricted the number of bullets that a magazine could legally carry to 10. Since then, more criminals have carried weapons that can shoot continuously and inflict even more damage, Spitzer said.
“That would go with what the Denver study is showing, that you would likely see more people with more gunshot wounds that were more severe,” Spitzer said.
Studies have shown similar trends at other hospitals. A study in 2013 found that gunshot injuries in children were more severe and deadly. But data on the nature of gunshot wounds are limited.
Co-author Sauaia said she initially wanted the study to look at the entire state of Colorado, but the team couldn’t get at that data. Gun research funding is extremely limited, even if the desire for more data is there.
In 1996, Congress enacted a provision in the law that essentially barred the Centers for Disease Control and Prevention from funding studies related to gun violence. President Obama signed an executive order lifting the ban in 2013, after the Sandy Hook massacre, but Congress has since blocked funding. And other sources of funding have dried up.
On Tuesday, the American Medical Association reaffirmed its statement that gun violence is “a very public health crisis.”
“We need to advocate for dropping the congressional ban on gun-related research,” Sauaia said. Moore agrees and said he would like to “get the science to begin to attack the problem in a comprehensive manner.” He thinks he’d see fewer patients with less extensive injuries.
“We are right near perfection with the way we work with EMS and with what teams in trauma centers can do these days,” Moore said. “I know people will say that guns don’t kill people, people kill people, but if we provide people regular access to assault weapons and guns with these high capacities, which both are so ubiquitous, we are going to see more of these mass casualties like Orlando, and see more people with severe injuries who will be permanently disabled or paralyzed.
“It should be unacceptable.”