Five years ago, we did not think that any shooting could be worse than the one that killed 20 children, only 6 and 7 years old, and 7 adults, at Sandy Hook School in Newtown, Connecticut. But again, the unimaginable has occurred, and the numbers are staggering. Fifty-nine lives lost and 500+ injured, by a lone shooter armed with a cache of powerful and deadly guns, modified to serve as automatic weapons. How is it that one man can accumulate more than 40 firearms and plan such an attack?

After Sandy Hook, I wrote an editorial acknowledging that critical-care nurses see the effects of gun violence every day. Moreover, we know that much of what we have seen is preventable. This is clearly a public health issue. We know that the purpose of a gun is to kill, perhaps wild game, but often humans, who become our patients. The images of Sandy Hook, Orlando, San Bernardino, Aurora, and now Las Vegas bring me back to so many patients that I have cared for and families I have grieved with.1

The editorial was a call for unity, wrapped in certainty, that the events in Newtown would cause us to right the ship. As the nation grieved and banned together to address the complex issues related to gun violence, I, too, believed that we would come together as a nation so this would never happen again.2

But the shootings continue, and the statistics are staggering. Every day, 315 people in America are shot in murders, assaults, suicides and suicide attempts, unintentional shootings, and police intervention. Every day, 93 people die of gun violence.3

We are not safe when individuals can legally purchase firearms and large amounts of ammunition. Often, these individuals choose automatic weapons and/or other firearms and reengineer them to kill many people at once. This could not be what the second amendment inferred. Yet, by upholding the law, without common-sense regulation, we are all complicit in each mass shooting; our silence empowers individuals to kill and injure hundreds of our citizens.

We know that the core of health care is prevention, and prevention of gun-related injury is an ongoing challenge. As providers, we must raise our voices and use our expertise and research findings toward evidence that may lead to some solutions. In this spirit, I wrote again in 2016, as my heart was heavy and angered by a senseless shooting of a physician at my local hospital. I realized that there is not enough research to inform us about guns, their effects on society, ways to control injury, and so many important questions that remain unanswered. As professionals, we know that data inform us, and we cannot expect to make change unless the data are given to the people who make change. Perhaps better data can help keep people safe and guide changes policy and law.4

Doctors for America, an organization of physicians and medical students, continues to challenge Congress to end a ban (#EndTheBan) on the Centers for Disease Control and the National Institutes for Health from conducting federally funded scientific research on gun violence. The call to congress is to appropriate funds to the Centers for Disease Control and the National Institutes for Health to conduct this lifesaving research, as we do for other preventable injuries in the United States.5

Gun violence prevention groups remind us that as health care professionals and public health researchers we use well-funded evidence-based research to save lives from car accidents and other traffic fatalities, reduce smoking-related illnesses, and prevent heart disease, diabetes, cancer, and other major health challenges. We should be able to replicate this model to prevent gun violence. In a recent JAMA article, Green and colleagues6 report on firearm violence in Chicago, Illinois, from 2006 to 2014. The report illustrates how violence is transmitted by social interaction through networks of people. The study establishes that the spread of firearm violence relates closely to the spread of infectious diseases. This important finding helps put aside the mistaken idea that epidemiology, medicine, and public health somehow have no place in the prevention of firearm violence, a disease process that affects roughly 100 000 people in the United States each year.6

Congressional lawmakers control the policy, and perhaps the purse strings, to research funds allocated to examine gun violence and gun ownership. They could change this today, yet many of our elected leaders seem to consistently side with legislation that favors a robust gun economy over personal safety.

Solutions appear simple: limit the sale of personal weapons and regulate ownership. The Las Vegas shooter had more than 40 weapons, perhaps an indication of our lax gun laws, which allow these tragedies to occur, over and over again. National and local media reports indicate that since Sandy Hook there has been an average of 1 mass shooting almost every day, defined by 4 or more people killed or wounded. It makes no sense that someone is allowed to own more than 40 weapons. Can you even own that many pets without special permits and oversight?

Mass shootings are complex, and so are people. They don't fit perfectly into our narratives. This is not an easy fix, yet one we must address from many perspectives. Physicians and nurses have a unique perspective and must add our voice to the public outcry.

One thing seems clear; the United States has a problem with gun violence. John Cassidy, a writer for The New Yorker, tackles this topic eloquently. He is acutely aware of the political issues, stating, "Of all the ways in which American democracy is showing symptoms of dysfunction, the inability to face down the gun lobby is one of the most egregious."7,8

He adds, "To break the gun lobby's grip, it may take the creation of a mass movement capable of acting as a countervailing force." Cassidy quotes a democratic senator from Connecticut, Chris Murphy, when he was asked why the opinion-poll findings do not translate into legislation, "The answer is pretty simple. The gun lobby is much stronger now than the anti-gun-violence movement."

Murphy added some advice: "We are not going to win this inside of Washington. We are going to win this outside of Washington."7

The media calls this a persistent American tragedy. In the developed world, these levels of gun violence are a uniquely American problem.9 Adam Gopnik tells us, "We have a fixation about the right to own guns that seems to go beyond the second amendment. Military style weapons are not good for sport - and they may not be useful to protect us against an unlikely government rebellion. Yet, Americans have a fixation about it, practically religious in its intensity." Gopnik10 reminds us that facts remain facts, but he creates a metaphor we can relate to: "Gun control acts on gun violence the way antibiotics act on infections-imperfectly but with massive efficacy."

So, as we consider the events of October 1, 2017, when the deadliest mass shooting occurred in US history, let us speak out for these friends, neighbors, patients, and colleagues who were senselessly massacred. Salute our colleagues at Las Vegas hospitals who worked through tears and anger[horizontal ellipsis] and pledge to do something to make it stop.

References