Trends in firearm production and firearm deaths in U.S. youth.

INTRODUCTION: Firearms are now the leading cause of death for U.S. children and teens ages 0-19. The U.S. Department of Justice Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) reported data in 2022 on firearm production, for specific firearm types and calibers. We hypothesized there would be a correlation between firearm production and firearm deaths and nonfatal injuries in youth. METHODS: All firearm deaths and nonfatal injury rates for youth ages 0-19 were extracted from the Centers for Disease Control and Prevention from 2001 to 2020. Firearm production from 2001 to 2020 was extracted from the 2022 ATF Firearms in Commerce Report for overall firearm production, production by weapon type and pistol caliber. Relationships between firearm death and injury and firearm production were evaluated using correlational analyses. RESULTS: Firearm death and nonfatal injury rates for youth increased from 2001 to 2020 by 48.2% and 69.2%, respectively, and firearm production increased 265% overall and 1298% for 9 mm pistols. There was no correlation between total firearm manufacturing and total firearm deaths or nonfatal injury rates from 2001 to 2020 (all r < 0.28). Pistol caliber (25 and 9 mm) was associated with total firearm deaths and nonfatal injuries (all r > 0.55). CONCLUSION: While total firearm manufacturing was not related to firearm deaths and injuries, except suicides, there were strong relationships between 9 mm pistol production and firearm deaths and injuries in youth. Firearm injuries are preventable; we must invest in stronger information systems that track details of firearms linked with deaths and injuries.

Saving Lives with Tourniquets: A Review of Penetrating Injury Medical Examiner Cases.

Background: After numerous recent mass casualty events, civilian hemorrhage control has taken a militaristic approach with aggressive and early use of tourniquets. While military literature has demonstrated the utility of tourniquets in preventing battlefield deaths from extremity injuries, there is limited understanding of their role in civilian penetrating trauma deaths. The purpose of this study is to review medical examiner (ME) autopsy records in a defined population to determine the incidence of preventable deaths from extremity wounds amenable to tourniquet placement. Methods: This is a retrospective review of ME cases from one urban county with a descriptive analysis of the demographics, mechanisms of injuries, and causes of death of homicide cases from 2003 to 2017. Mechanism of injury and wound patterns were reviewed to determine the overall occurrence of extremity injuries and amenability of tourniquet placement. Results: A total of 1,804 homicide cases were reviewed with 1,521 (84.3%) resulting from penetrating trauma. Isolated extremity injuries were present in 22 (1.45%) of the penetrating cases, all of which were amenable to tourniquet placement. There were 409 (26.9%) concurrent extremity and central penetrating injuries. The vast majority of extremity wounds were amenable to tourniquet placement (92.1%). Extrapolating nationally to 16,187 annual penetrating injury related homicides in 2016, an estimated 235 (1.45%) isolated extremity injury related deaths could be prevented and an additional estimated 4,354 (26.9%) concurrent extremity and central injury related deaths could potentially receive enhanced care with early tourniquet placement. Conclusion: Among urban ME cases, both isolated extremity cases and concurrent extremity-central injuries exist that may be amenable to life-saving tourniquet use. Extrapolating our findings nationwide suggests that many lives could be saved with early tourniquet use. Considering these findings, tourniquet availability and early placement may have a prominent role in reducing injury deaths from penetrating trauma.

Incidence of sports and recreation related injuries resulting in hospitalization in Wisconsin in 2000.

OBJECTIVE: To describe the incidence and patterns of sports and recreation related injuries resulting in inpatient hospitalization in Wisconsin. Although much sports and recreation related injury research has focused on the emergency department setting, little is known about the scope or characteristics of more severe sports injuries resulting in hospitalization. SETTING: The Wisconsin Bureau of Health Information (BHI) maintains hospital inpatient discharge data through a statewide mandatory reporting system. The database contains demographic and health information on all patients hospitalized in acute care non-federal hospitals in Wisconsin. METHODS: The authors developed a classification scheme based on the International Classification of Diseases External cause of injury code (E code) to identify hospitalizations for sports and recreation related injuries from the BHI data files (2000). Due to the uncertainty within E codes in specifying sports and recreation related injuries, the authors used Bayesian analysis to model the incidence of these types of injuries. RESULTS: There were 1714 (95% credible interval 1499 to 2022) sports and recreation-related injury hospitalizations in Wisconsin in 2000 (32.0 per 100,000 population). The most common mechanisms of injury were being struck by/against an object in sports (6.4 per 100,000 population) and pedal cycle riding (6.2 per 100,000). Ten to 19 year olds had the highest rate of sports and recreation related injury hospitalization (65.3 per 100,000 population), and males overall had a rate four times higher than females. CONCLUSIONS: Over 1700 sports and recreation related injuries occurred in Wisconsin in 2000 that were treated during an inpatient hospitalization. Sports and recreation activities result in a substantial number of serious, as well as minor injuries. Prevention efforts aimed at reducing injuries while continuing to promote participation in physical activity for all ages are critical.

Unintentional and undetermined firearm related deaths: a preventable death analysis for three safety devices.

OBJECTIVE: To determine the proportion of unintentional and undetermined firearm related deaths preventable by three safety devices: personalization devices, loaded chamber indicators (LCIs), and magazine safeties. A personalized gun will operate only for an authorized user, a LCI indicates when the gun contains ammunition, and a magazine safety prevents the gun from firing when the ammunition magazine is removed. DESIGN: Information about all unintentional and undetermined firearm deaths from 1991-98 was obtained from the Office of the Chief Medical Examiner for Maryland, and from the Wisconsin Firearm Injury Reporting System for Milwaukee. Data regarding the victim, shooter, weapon, and circumstances were abstracted. Coding rules to classify each death as preventable, possibly preventable, or not preventable by each of the three safety devices were also applied. RESULTS: There were a total of 117 firearm related deaths in our sample, 95 (81%) involving handguns. Forty three deaths (37%) were classified as preventable by a personalized gun, 23 (20%) by a LCI, and five (4%) by a magazine safety. Overall, 52 deaths (44%) were preventable by at least one safety device. Deaths involving children 0-17 (relative risk (RR) 3.3, 95% confidence interval (CI) 2.1 to 5.1) and handguns (RR 8.1, 95% CI 1.2 to 53.5) were more likely to be preventable. Projecting the findings to the entire United States, an estimated 442 deaths might have been prevented in 2000 had all guns been equipped with these safety devices. CONCLUSION: Incorporating safety devices into firearms is an important injury intervention, with the potential to save hundreds of lives each year.

Missing the target: a comparison of buyback and fatality related guns.

OBJECTIVES: To determine whether the firearms recovered in buyback programs in a large urban community are the types most closely associated with firearm fatalities in the same geographic area. METHODS: The type, caliber, and manufacturer of 941 handguns recovered in Milwaukee County 1994-96 buyback programs were compared with 369 homicide related and 125 suicide related handguns used in Milwaukee during 1994-97. RESULTS: Buyback handguns differed substantially from those used in homicide and suicide. One third of buyback handguns were semiautomatic pistols versus two thirds of homicide related handguns (p<0.001) and 40% of suicide related handguns (p=NS). Over 75% of buyback handguns were small caliber compared with 24% of homicide and 32% of suicide handguns (p<0.001). The top two manufacturers of buyback handguns represented 30% of these guns but only 5% of fatality related handguns (p<0.001). Companies currently out of business manufactured 15% of buyback handguns versus 7% of fatality related handguns (p<0.001). CONCLUSIONS: Handguns recovered in buyback programs are not the types most commonly linked to firearm homicides and suicides. Although buyback programs may increase awareness of firearm violence, limited resources for firearm injury prevention may be better spent in other ways.

Preventive care in the emergency department: a systematic literature review on emergency department-based interventions that address smoke detectors in the home.

OBJECTIVES: To assess the effectiveness of an emergency department (ED)-based strategy to identify and counsel selected patients about the importance of an operational smoke detector in the home and to offer a graded recommendation regarding such a strategy. METHODS: A systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. Two Medline combined searches were performed using the following terms: emergency medical services and counseling, protective devices and smoke detectors, accidents, home, burns, fires, and residential fires. A free-text search of indexed and nonindexed citations in Emergency Medical Abstracts from 1977 to 1999 and a search of the Cochrane Library were also performed. In addition, reviewers performed independent Medline searches and suggested four additional studies. Studies selected for inclusion in this systematic review were required to meet the following criteria: 1) report ED-based research and 2) address the topic of fire and burn prevention with some pertinent discussion of ED-based interventions. The initial inclusion criteria had restricted studies to those that reported the results of counseling strategies for smoke detectors. The authors later decided to consider, as indirectly relevant, studies that did not investigate counseling strategies. Data from the selected studies were extracted using the template form, and the validity and applicability of the results to emergency practice were assessed. Recommendations were derived following criteria developed by a systematic review of preventive interventions in the ED. RESULTS: Six articles were closely reviewed. Four of the six studies met the inclusion criteria. One other study that did not meet the inclusion criteria was also considered. No study focused specifically on the counseling of ED patients about smoke detectors. CONCLUSIONS: Following the criteria of the graded recommendations used for the parent project. a recommendation cannot be made either for or against an ED-based strategy to counsel patients on the importance of smoke detectors. No studies located in our review directly assessed the effectiveness of such a strategy. Based on the retrospective case series study of the potential opportunity for a home fire safety intervention during an emergency medical services visit and the Safe Block Project study, it may be worthwhile to consider further research on the effectiveness of systems-level/structural interventions, with a targeted focus on strategies that attempt to overcome barriers associated with active interventions.

Wisconsin needs to support death investigation: here's why.

Medical examiners and coroners (ME/CO) can provide essential data for injury reporting and prevention, but often lack the resources, support and training to supply this important information. With increased interest in injury data, questions surrounding data collection and reporting are being raised. This article describes the experience of the Wisconsin Firearm Injury Reporting System, discusses results of a survey completed by Wisconsin ME/CO and offers recommendations for improved injury reporting and support for death investigation.

Evaluation of error in medicine: application of a public health model.

A case of a chest tube placed on the wrong side during a trauma resuscitation in the emergency department is presented as an example of medical injury. Two traditional models, the legal model and the managerial model, are described and their application to medical injury discussed. A new public health model is then applied to the case example as a more effective way to address medical injury. The public health model addresses the injury event rather than the error itself using Haddon's matrix as a framework. Pre-event, event, and post-event phases are examined to find the weakest link, where intervention has the highest likelihood of successfully preventing future injuries.

Public health strategies to reduce and prevent alcohol-related illness, injury and death in Wisconsin and Milwaukee County.

This paper illustrates the application of a Public Health Model toward understanding the nature and extent of alcohol-related problems and, in turn, provides examples of strategies targeted at reducing or preventing alcohol-related illness, injury and death in Wisconsin and Milwaukee County. More specifically, data are provided detailing the widespread use and misuse of alcohol as well as the medical, behavioral and social problems associated with its use. Alcohol use and misuse is the third leading cause of preventable death behind only tobacco use and diet/activity patterns, and therefore, warrants the implementation of prevention strategies from a public health perspective. In sum, the public health model specifies three interrelated factors--the host, the agent or vehicle, and the environment--that focus strategies to reduce and/or prevent illness, injury and death. The paper concludes with specific examples of alcohol-related public health strategies targeting the host (e.g., youth and families, minority groups), the agent/vehicle (e.g., alcohol content, labeling of containers, large containers), and the environment (e.g., motor vehicle operation BAC limits, zero tolerance laws, alcohol advertising).

National estimates of non-fatal firearm related injuries other than gunshot wounds.

OBJECTIVE: To characterize non-fatal firearm related injuries other than gunshot wounds (non-GSWs) treated in hospital emergency departments in the United States that occur during routine gun handling and recreational use as well as violence related use of a firearm. METHODS: Cases were identified through the National Electronic Injury Surveillance System (NEISS). During the study period, 1 January 1993 through 31 December 1996, NEISS consisted of a nationally representative sample of 91 hospitals in the United States having at least six beds and providing 24 hour emergency services. RESULTS: An estimated 65 374, or an average of 16,300 per year, non-fatal, non-GSWs were treated in American hospital emergency departments during the four year study period. Fifty seven per cent of all the non-fatal, non-GSWs were violence related, most of which involved being struck by a firearm. The majority of unintentional non-fatal, non-GSWs were self inflicted and occurred during routine gun handling or recreational use of a firearm; 43% of these injuries resulted from gun recoils. CONCLUSIONS: Non-fatal, non-GSWs make a notable contribution to the public health burden of firearm related injuries. Firearm related injury prevention programs should focus on not only the reduction of gunshot wounds but also the reduction of unintentional and violence related non-GSWs.

Public health: a successful paradigm applied to firearm injuries.

Firearm injuries are a major contributor to injury mortality and morbidity in the United States and account for substantial loss of productive years of life. A public health approach to injury reduction, and particularly firearm injury prevention, has promise because it emphasizes prevention rather than reaction, it utilizes a scientific approach to policies and programs, it brings an integrative, multi-disciplinary approach to the effort, and it emphasizes the role of communities in solving health problems. The new Firearm Injury Center at the Medical College of Wisconsin exemplifies the public health approach to this vexing problem.

Handgun safety features: a review for physicians.

OBJECTIVE: Handguns are a ubiquitous consumer product in the United States, which annually cause significant morbidity and mortality. Handgun safety devices are often proposed as potential solutions to this problem. Their effectiveness at reducing handgun injuries and deaths is intensely debated. However, to effectively analyze the potential utility of handgun safety devices, physicians need to be aware of the safety devices available in the consumer market and how they operate. METHODS: A wide variety of safety devices are available in the consumer market, which vary in terms of their ease of operation, cost, and the types of injuries they may prevent. We reviewed several types of handgun safety devices, including loaded chamber indicators, manual thumb safeties, grip safeties, magazine disconnectors, drop safeties, built-in locks, trigger locks, lockboxes, and personalized handguns. Each device is described within the context of reducing unintended discharge and unauthorized use. RESULTS: This review is not exhaustive. There are other types of safety devices that limit access to handguns. Many of these devices, such as barrel locks and chamber locks, work in a similar manner as trigger locks and have the same limitations. The user of any type of safety device should think about the types of injuries the device is designed to prevent and be aware of its limitations. CONCLUSION: Physicians have the potential to reduce the risk of firearm injuries with their patients and communities. Providing accurate information on firearm safety devices and their limitations is important, just as it is for other aspects of health care advice. Armed with accurate information, physicians can hopefully be effective in firearm injury prevention.