Past research has shown us that improving the safety of motor vehicles led to a drop in children’s car accident deaths. A new study in Pediatrics proposes that preventive policies directed at reducing gun injuries among children could likely lead to fewer deaths as well – and such policies are much needed considering the study’s main findings.

The study found that one third of the children who died from gunshot wounds died before ever reaching the hospital — and that one in every five children who were shot died.

The researchers examined all 9-1-1 calls related to children’s injuries in five geographical areas to assess how firearm injuries compared to other types. More than 29,000 children under age 19 died from gunshots from 2001 to 2010, the authors noted.

Gunshot injuries accounted for only 1% of all children's injuries that were called into EMS -- but they accounted for one fifth of the deaths. Photo by Robert Linder

Gunshot injuries accounted for only 1% of all children’s injuries that were called into EMS — but they accounted for one fifth of the deaths. Photo by Robert Linder

There’s good news:

  • Following a peak in gunshot injuries in 1994, firearm deaths in children dropped by half (55%) by 2003.
  • The study found that firearm injuries accounted for only 1% of all the injuries to children leading to a 9-1-1 call.

But there’s bad news too:

  • Since that decline, firearm-caused death rates for children have stagnated since 2003.
  • 21% of the children in this study who died had been shot — making firearm deaths proportionally the highest death rate of all injuries.

Or, more plainly, kids who were shot were far more likely to die than kids injured in any other way.

Briefly, here’s how the researchers conducted the study: First they looked at all EMS and 9-1-1 calls coming in to 47 EMS agencies that serve more than 2.2 million children. The agencies cover emergency transports to 93 hospitals in the rural, suburban and metropolitan areas of five geographical regions: four counties around Portland/Vancouver on the Oregon/Washington border; King County in Washington; Sacramento, Calif.; Santa Clara, Calif.; and Denver County, Colo.

With this data, the researchers then determined what the injuries were for all children up to age 19 (a total of 49,983 children) calling in to those EMS centers. Then they compared the severity of injuries, major surgeries, blood transfusions, deaths and overall costs per child in each of six injury categories: gunshot, cut/piercing/stabbing, car accidents, getting hit by a car, falls, blunt objects and “other.”

Their main findings were sadly unsurprising: “Gunshot injuries were more severe, requiring more frequent major therapeutic interventions and resulting in higher mortality and per-patient costs than any other injury mechanism.” In fact, a child arriving at the hospital with a gunshot wound was four times more likely to die (8% in-hospital death rate) than a child coming in with the next most deadly injury, piercings and stabbings (2% rate).

Consider some of the specifics:
•    Children with gunshot injuries represented the highest proportion of severe injuries (23% of all the injuries categorized as most severe were due to firearms)
•    Abdominal/pelvic injuries and extremity injuries were proportionally far more common among gunshot victims than among victims of any other injury
•    One third of all the children who required major surgery (of total injuries) had been shot
•    Firearm victims were more likely than those injured any other way to need a blood transfusion

Although the rate averaged across all regions was 7.5 gunshot injuries per 100,000 children, the rates varied dramatically from one region to the next: from 2 cases to 31 cases per 100,000 children. The vast majority of gunshot injuries afflicted older teens, aged 15 to 19, who comprised 83% of all firearm injuries (though this age group only comprised 49% of total injuries of any kind). In addition, 84.5% of the firearm injuries occurred to males, though males were involved in only 59% of total injuries of any kind.

And getting shot is pretty expensive too. The highest per-patient average cost for any of the injuries was $28,510 — the average medical costs for treating children who had been shot. The next highest amount was for car accidents but was almost half as much: $15,566.

“These comparisons illustrate the immense per-patient impact of gunshot injuries in children,” the researchers wrote — yet these costs do not include any costs outside of the hospital. They do not include long-term outcomes, additional medical costs in follow-up or physical therapy, costs related to PTSD or other mental health repercussions, lost productivity in the children’s futures, lost productivity to society for the children’s deaths, lost productivity and related costs to the family, friends and other community members who grieved or were otherwise affected by these injuries and deaths, court costs in any cases that were filed as a result of the cases…

Like any study, this one throws a lot of numbers at us, but the big takeaway is pretty straightforward: firearm injuries may be relatively rare compared to other major injuries among children, but gunshots account for one in five deaths among children and have enormous personal, medical and financial impact.

But that does not mean the situation is hopeless. “Lessons in improving car motor vehicle safety (eg, booster seats, age-appropriate restraint systems and seat position, air bags) and the associated reductions in pediatric motor vehicle mortality provide important examples of the potential impact of injury prevention efforts,” the authors wrote.

If we can make it less likely for a car accident to kill children through smart, evidence-based policies, then we should also be able to develop smart, evidence-based policies that reduce children’s likelihood of dying from guns as well.

 

This study was funded by the National Institutes of Health, the Robert Wood Johnson Foundation, California Wellness Foundation, the Oregon Clinical and Translational Research Institute, the University of California Davis Clinical and Translational Science Center, the Stanford Center for Clinical and Translational Education and Research, the University of Utah Center for Clinical and Translational Science, and the University of California San Francisco Clinical and Translational Science Institute.

This is the key question so many of us involved in the gun debate face. On a personal level, answering it has big implications for our families’ safety. As Amy discussed in a recent post, having a gun in the household increases the chances that someone in the household will die by gunshot, though even in households with guns there are many things you can do to keep your kids safer.

US and Japanese Flags With GunBut what about across the country? At the national level, the question has big implications for our country’s laws. Many people carry concealed or unconcealed weapons in public places out of fear of crime. Some people argue (see, for instance, here) that laws that allow easy access to guns and that allow guns to be carried in public places in the United States help to keep crime rates down. A recent study in The American Journal of Medicine – one of our country’s most prestigious sources of cutting-edge research in medicine and public health – concludes that that the answer is decidedly “No.”

The authors of this study examine rates of firearm ownership in 27 developed countries: from culturally relatively similar ones like Australia and New Zealand, to culturally quite different ones such as Japan. They also consider rates of major depressive disorder in those countries. Then they ask how firearm ownership and mental health problems in each country are related to the crime rate and the number of firearm deaths per person.

What they find is striking: the more guns in a country, the higher its rate of firearm deaths. The relationship is very strong, and holds up even when you don’t consider the countries at the extremes, such as the United States (high gun ownership, high firearm death rate) and Japan (low gun ownership, low firearm death rate). No matter how you slice the data, the more guns a country has, the more likely the average citizen is to die by gunshot. By contrast, there is a small, statistically significant relationship between mental illness and rates of gun deaths, but the association is very weak.

But some people might say that even if more guns means more gun deaths, criminals will be less likely to strike in countries where they fear that their potential victims could have a concealed weapon. In other words, maybe crime rates go down at the same time that would-be criminals are more likely to get killed. Unfortunately, once again the authors find that the answer is “No.” They find that there is no relationship between the number of guns per person in a country and the country’s crime rate. The U.S. happens to have a lot of guns and, in recent years, pretty low crime rates. But Japan has very few guns and even lower crime rates. And the UK and Israel have fewer guns than the U.S., but more crime.

Surely there must be some cases in which the presence of guns helps to prevent a crime, or in which potential victims kill would-be attackers. Still, this study has a very clear conclusion: on average and across the developed world, having more guns does NOT make countries safer.

Exactly nine months after the Sandy Hook shootings in Newtown, schools across the country countinue to face problems with guns on campus.

 

Week4

 

 

By Amy, mom to A (1 year 3 months) and O (3 years 9 months)

Over the Labor Day weekend, I stopped my one-year-old from pulling all the books off the bottom two shelves of the living room bookcase three times. He managed to chew up two twigs and a walnut that had fallen off the tree in our yard, and he ingested unknown quantities of dirt. In a split second in which I turned my attention elsewhere, my three-year-old pushed his little brother down the stairs.

Boy and Girl Running in Tall Grass

Luckily, everyone’s okay, and I think we’ll safely avoid a visit from Child Protective Services. We have carpeted stairs, the books are easily replaced, and the baby won’t die from any bugs he might possibly have ingested with the dirt.

In recent months Americans have been shocked by a number of incidents involving young children and guns – incidents that didn’t end nearly as happily as my children’s little mishaps over Labor Day. In Kentucky in early May, a five-year-old boy shot and killed his two-year-old sister. A couple of months later in the same state, a four-year-old boy shot and killed his six-year-old sister. And in New Orleans in July, a five-year-old girl killed herself with a weapon she found in a bedroom. Last month, a California SWAT officer was shot in the thigh at a children’s reading event when an eight-year-old boy somehow managed to pull the trigger on the officer’s holstered gun. Just this Saturday, an 11-year-old girl accidentally shot and killed her stepfather while he was showing off his new gun.

Anyone with a young child knows that the moment the kid starts really walking, all bets are off – kids are little and squirrely and can get into trouble in the blink of an eye. You’re stirring a pot of oatmeal and turn away from the stove to answer the phone. Your husband interrupts you, and for a split second you forget that you were about to tell your child to climb off that table, NOW! When you have several young children, or you need to get other things done around the house, or – God forbid – you are sleep deprived and sick, it all gets that much harder. It’s easy to second-guess the parents whose children fired the guns. In hindsight, maybe a parent shouldn’t have stepped into the backyard for a second. Maybe the eight-year-old California boy’s mom or dad shouldn’t have let him get that close to the officer’s gun. As a parent of two young boys, though, I tend to think this is asking parents to be superhuman. The only thing that’s kept my kids from shooting themselves or someone else is that there’s no gun around.

Even ammunition by itself can be dangerous. Young children may think bullets, like walnuts and twigs, look interesting to put in their mouths. Kids have died trying to tamper with bullets, or bang them on rocks, or hit them with hammer and nail.

It would be nice to think that gun safety would get easier once the kids get a little older and better at following directions. The Eddie Eagle rules are targeted at kids pre-K to third grade. They’re simple, clear, and easy to memorize: “If you see a gun, 1.STOP! 2. Don’t Touch. 3. Leave the Area. 4. Call an Adult.” The rules are great, one of the things for which the NRA should really be commended. The trick is to get your kids to follow the rules when you’re not around. Research shows that just telling kids the rules isn’t enough (also see here). You need to reinforce the message frequently, using active-learning and role-playing. It’s best if you practice the skills in the same kind of place where your child will encounter the gun.

Unfortunately, a study has found that even pre-teen boys whose parents talk with them about gun safety – and even ones whose parents think they’re not at all interested in guns – can’t really be trusted alone in a room with a gun. In a study that should send shivers down the spines of parents everywhere, medical researchers observed pairs of boys waiting in a room for 15 minutes. In a drawer in that room, the researchers had planted a handgun with a sensor on the trigger. Of the 29 groups of boys they studied, 72% found the gun. Among the kids who found the gun, three-quarters of the groups picked it up and touched it, and in half of the groups one or both kids actually pulled the trigger. The kids’ behavior was totally unrelated to their parents’ perceptions of how interested their kids were in guns, or to whether the kids had had gun safety instruction.

So the pre-teen years are obviously a problem. Maybe by the time my boys are teenagers they’ll be better at self-control and following gun safety rules? Unfortunately, right at this point adolescent hormones spike. Surely my boys will understand the rules by this point. But this is exactly when peer pressure is worst. In fact, peer influence is, I would guess, a big part of the reason the pre-teen boys in the study I discussed above behaved in ways their parents didn’t expect, and in contradiction of the gun safety rules they’d been taught.

Adolescent depression might be even worse than peer influence. Having a firearm in the home increases the risk of a teenager committing suicide – if firearms are removed from the home, some youth will commit suicide by other means, but many won’t. Studies of suicide attempts show that suicide is, despite its finality, usually impulsive. Tragically, however, impulsive suicide attempt are likely to be deadly when the weapon is a gun – between 78 and 90% of gun suicide attempts are fatal.

Many parents strongly believe that having a gun in the home is the safest way to protect their kids from danger. Unfortunately, though, evidence suggests the opposite – kids who live in homes with guns are actually more likely to die by gunshot than are kids living in homes without guns. As a result of this evidence, the American Academy of Pediatrics has taken a strong position on guns and kids: “The safest home for children and teens is one without guns. If there are guns in the home, scientific evidence shows the risk of injury or death is greatly reduced when they are stored unloaded and locked, with the ammunition locked in a separate place.”

So how can we keep our kids safe from themselves when it comes to guns? In a world where guns are plentiful it may be almost impossible to completely protect our children. Still, here are some general guidelines that I’ve picked up.

  1. Follow the advice of this country’s flagship association of pediatricians. If possible, taking into account your family’s lifestyle and needs, keep guns out of the house entirely. If that’s not possible, follow their advice and keep your gun(s) stored unloaded and locked. Keep the ammunition in a different place, also locked up.
  2. To the extent possible, try to keep guns out of your child’s environment when he or she is away from home. If your child is at a home daycare center, ask the provider if she has a gun in her house. If your child goes over to a friend’s house on a play date, ask if the friend’s parents have a gun in the home. At your child’s public school, talk with the PTA about devising a plan to keep children from bringing guns into the school.
  3. You need to exercise special caution if you have a teen in the house who develops symptoms of depression. Teens are watchful and resourceful and they often know much more about how to get access to supposedly secured weapons than their parents realize. Even if the teen is well trained with firearms, intelligent and responsible, the best idea is to get the guns out of the house altogether – sell them or ask a responsible relative to store them (locked up) in another house to which your depressed teen doesn’t have access.
  4. Build in redundancies. Well-meaning, caring adults sometimes forget and, despite the best intentions (as well as penalties for negligence in a few states), they leave weapons in places where children can find them. As your child gets older, he or she will spend less time with you and in places you can monitor. You need to think about what your child will do if or when he or she encounters a gun.

- Drill the Eddie Eagle rules: “If you see a gun, 1.STOP! 2. Don’t Touch. 3. Leave the Area. 4. Call an Adult.” Talk about them. Repeat them regularly. Make sure your children understand them. Check for comprehension. Practice them by role-playing scenarios in which you find a gun.

- Always assume that any gun around is loaded, and treat it accordingly. Even if you yourself emptied the chambers, still assume it’s loaded. Mistakes happen, and people are human – tired, forgetful, rushed. Almost daily, we hear stories of accidents, often tragic ones, explained by someone who says, “I didn’t know it was loaded.” This rule should mostly apply to grown-ups, since kids should NOT be touching guns without adults around. Still, if there are guns in your household, it’s an important rule for EVERYONE to keep in mind.

- Some people recommend teaching your child to shoot. They argue that doing so will help your child learn to handle a gun safely, and will make her less curious about touching a gun if she encounters one. This might be logical, but I can’t find any research that shows whether such a strategy is effective. One study, however, did find that kids with guns in their homes were more likely to touch a gun in a risky, unsupervised situation. Gun researchers all endorse the Eddie Eagle rules as the single most important way to keep your kids safe around a gun. If you do teach your child to shoot, make sure you emphasize guidelines for gun safety – and most importantly, that you still rehearse the Eddie Eagle rules regularly. 

Week3

There were too many shootings over the holiday weekend to include in a single graphic. Even after leaving out multiple-victim shootings that occurred on Monday, there were an additional seven shootings left off this graphic that occurred Saturday and Sunday: two were shot in Camden, NJ, three in Buffalo, NY, two in Hartford, CT, two in Bergenfield, NJ, two in Hamilton, OH and two in Palo Alto, CA. This post will be updated later with links to all the incidents referred to in the graphic.
multiplevictims5LaborDay

GunsinSchool-Wk2B

Mass shootings are so common now that many aren’t even mentioned in national news media. We decided to keep a watchful eye one weekend, not to note every shooting (that would be an enormous undertaking), but every shooting involving multiple victims. Surely we’ve missed some. In addition to the 13 incidents on this infographic, we found several more, all from this weekend: two people were shot in Brooklyn NY; two in Lackawanna, NY; two in Buena Vista, MI; two in Union City, CA; two in Syracuse, NY; two in Jacksonville, FL; three in Rochester, NY; three in Asbury Park, NJ; three in Portland, OR.

multiplevictims5

5Days2

We recently posted an infographic about murder rates in Chicago as compared to other U.S. cities. Some skeptics thought we must be distorting the data. They complained that, while we did use an apples-to-apples comparison of Metropolitan areas, what they would have preferred was a comparison only of murders within the city limits. They also complained that we were comparing all murders, not just gun-related murders. Well, here are three different ways of comparing murder rates. As you can see, the point we were making (that Chicago is not uniquely murderous) bears out in each case. (And to reiterate, that’s the only point we’re making in this post–violence has many factors, of which gun laws are only one. We can’t point to any one factor and say “that’s why this city is more violent than that city.” But we can provide real data to combat factually inaccurate assertions.)

 

Chicago-all

 

And here are some supporting links:

Data table from the Federal Bureau of Investigation

Data table from the Centers for Disease Control

Article in PoliticusUSA on the most dangerous cities in the U.S. as of 2013

Article on Yahoo about the most dangerous cities in America

Article in the Chicago Tribune about murder rates

Article in the Wall Street Journal about the ten most dangerous American cities

Article in US News and World Report about the 11 most dangerous American cities