I was walking past the radio in the Emergency Department when the nurse took the call from the paramedic on the incoming ambulance.

“He was so shaken I could hardly make out what he was saying.” This about an experienced paramedic, well-used to seeing tragedy and trauma in inner-city Denver.

When my patient arrived, CPR was in progress. I had to intubate her: put a tube down her throat into her lungs to best support all efforts to try to save her life.

By the time I made my attempt, things went smoothly, as the life force that would normally make anyone fight with all her strength against getting a piece of plastic placed deep into her throat, had slipped away. I got the tube in, but all of our efforts couldn’t save this patient, and she died.

She was 5.

She had been shot in the head by another child in her home.

Her brother and cousin, ages 8 and 11, and she were playing. Maybe her brother got mad about something she did and said “I’m going to shoot you!” and pulled the trigger, not realizing the gun was loaded. Or maybe he didn’t understand that unlike his video games, this was real, with permanent consequences. Or maybe it was a complete accident.

When my supervising doctor and I (I was early in my career, training to be an emergency physician) notified the patient’s family that the girl had died, we spoke with her aunt and cousin. The father, who owned the gun, was not there. The aunt told us she had repeatedly told the father to keep his guns locked up. But they weren’t locked up on this day.

In spite of the research that has shown that guns kept in homes are more likely to cause injury or death to those who live there than to a potential assailant,5,6 people often own guns for the purpose of protection. Whether gun ownership is for protection or for other reasons, it seems reasonable (both to people I know who own guns and to others who don’t) that some basic concepts such as Safe Storage should be in place to keep gun owners and others safe. Various devices and storage techniques have been shown to be effective,1,2,3,4,7 yet they are not universally adopted.8,9,10,11

The incident above happened about 20 years ago. Since then I have seen the results of a lot of gun violence. I feel like all of us, gun owners and non-owners, agree that we want our guns to be used safely, but we clash when we try to figure out how to do that. It seems that research and education based on what works, would make a big difference. My frustration is not only for victims like the girl and her family. I hope to prevent more situations in which people like me hover inches above the face of a girl with thick black hair and a hole in her forehead.

References

  1. Cummings P, Grossman DC, Rivara FP, Koepsell TD. State gun safe storage laws and child mortality due to firearms. JAMA 1997; 278:1084-1086.
  2. David C. Grossman, et al., “Gun Storage Practices and Risk of Youth Suicide and Unintentional Firearm Injuries,” JAMA 293, no. 6 (2005): 707–714. 
  3. Hepburn L, Azrael D, Miller M, Hemenway D. The effect of child access prevention laws on unintentional child firearm fatalities, 1979-2000. J Trauma 2006; 61(2):423-8.
  4. Howard PK. Parents’ Beliefs About Children and Gun Safety. Pediatric Nursing. 2005;31(5):374-379.
  5. Kellermann AL, Rivara FP, Rushforth NB, Banton JG, Reay DT, Francisco JT, Locci AB, Prodzinski J, Hackman BB, Somes G. Gun ownership as a risk factor for homicide in the home. N Engl J Med 1993; 329(15):1084-1091.
  6. Kellermann AL, Somes G, Rivara FP, Lee RK, Banton JG. Injuries and deaths due to firearms in the home. J Trauma 1998; 45:263-267.
  7. Lee LK, Fleegler EW, Farrell C, Avakame E, Srinivasan S, Hemenway D, Monuteaux MC. Firearm Laws and Firearm Homicides: A Systematic Review. JAMA Intern Med. 2017 Jan 1;177(1):106-119. doi: 10.1001/jamainternmed.2016.7051.
  8. Miller M, Azrael D, Hemenway D. Firearm availability and unintentional firearm deaths, suicide and homicide among 5-14 year olds. J of Trauma 2002; 52:267-275.
  9. Miller M, Azrael D, Vriniotis M, Hemenway D. Firearm storage practices and rates of unintentional firearm deaths in the United States. Accid Anal Prev 2005; 37:661-667.
  10. Michael C. Monuteaux, Deborah Azrael, and Matthew Miller, “Association of Increased Safe Household Firearm Storage With Firearm Suicide and Unintentional Death Among US Youths,” JAMA Pediatrics (2019). 
  11. Rowhani-Rahbar A, Simonetti JA, Rivara FP. Effectiveness of Interventions to Promote Safe Firearm Storage. Epidemiol Rev. 2016;38(1):111-24
  12. Stewart RM, Kuhls DA, Rotondo MF, Bulger EM. Freedom with responsibility: A consensus strategy for preventing injury, death, and disability from firearm violence. Journal of the American College of Surgeons. 2018: 227(2):281-283. doi:10.1016/j.jamcollsurg.2018.04.006
  13. Vernick JS, Meisel ZF, Teret SP, Milne JS, Hargarten SW: “I didn’t know the gun was loaded”: an examination of two safety devices that can reduce the risk of unintentional firearm injuries. Journal of Public Health Policy 20(4):427-440, 1999
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