The following essay provides an argument for the implementation of evidence-based gun control policies in Massachusetts. This argument is based on the disturbing trauma witnessed in the emergency room at Brigham & Women's Hospital, as well as the stagnant gun control rate over the last decade in our state. The argument is further supported by Dr. Hemenway's gun policy research and international policies that highlight the effectiveness of laws that strengthen background checks and limit gun ownership.
Our pagers rang "Code Trauma" when paramedics rushed a 15-year-old boy with a gunshot wound (GSW) to the chest into our emergency department. We urgently responded by running through the systematic algorithms of trauma care, but with each passing minute, his blood pressure dropped until his heart beat slowly gave way to the sound of silence. He hadn't graduated from high school or passed driving school yet, and now he laid in the bloody gurney of Trauma Bay 1. Time of death: 10:50 PM.
The amount of GSW victims we triaged that year felt surprising. Second to none in the United States, the state of Massachusetts is regularly noted as the nation's leader in gun violence prevention policy while boasting one of the lowest gun-related death rates per 100,000 people (1). Over the last two decades, the Commonwealth has passed the Gun Control Act of 1998 (2) focusing on gun licenses and firearm identification cards (FID), an assault weapons ban in 2004, and a comprehensive gun control bill in 2014 (3) touching on FID regulations, gun trafficking, mental health data sharing, suicide prevention, and broadened police discretion. More recently, Massachusetts became the first state to ban rapid-firing bump stocks in light of the 2017 Las Vegas shooting (4). These laws and regulations combined with low gun ownership rates are significantly responsible for the state's success.
However, coming face-to-face with a dying teenager afflicted by gun violence told us one thing: we can do better.
Well over the last decade, our state's progress in reducing the firearm mortality rate has stalled. The rate measured 3.4 deaths per 100,000 people in both 2005 and 2017 (5). These figures are relatively low when compared to other states, but they are distinctly high when compared to traditionally gun-avid countries like Australia (0.2 deaths per 100,000) and the United Kingdom (0.0 per 100,000) (6).
This impasse is partly a result of the Dickey amendment in 1996 that prevented the Centers for Disease Control & Prevention from advocating or promoting gun control, resulting in poor federal funding addressing the effectiveness of certain gun laws (7). But public outcry as a result of recent mass shootings has prompted universities and private institutions to allocate funds towards studying the effectiveness of gun policies—and it is working.
In 2017, David Hemenway and his group of researchers studied the association between U.S. firearm laws and firearm homicides. They analyzed gun control laws from varying cities, including all 50 U.S. states, and investigated the effects of firearm laws that curb firearm trafficking, strengthen background checks, improve child safety, ban military-style assault weapons, and restrict firearms in public places. Of these categories, the laws which strengthen background checks and permit-to-purchase regulations significantly decreased firearm homicide rates. The Task Force on Community Preventive Services and the National Academy of Sciences reached similar conclusions in the mid 2000s (6). It is clear from these studies that establishing effective gun laws that strengthen background checks and permit-to-purchase regulations could be the answer to advancing our gun violence prevention strategy.
Luckily, Massachusetts recently passed the "Red Flag" bill (8) in 2018, becoming the 4th state to enact a strong Extreme Risk Protection Order (ERPO). The Red Flag law provides an avenue for family and household members to petition the court to temporarily remove guns from people who pose a risk to themselves or others. The law works under the same premise as laws that strengthen background checks or regulate gun permits—that is, it helps remove firearms from the wrong hands. From Professor Hemenway's research and other studies (9), we know that the law's fundamental structure is likely to be an effective means of improving gun violence in Massachusetts.
Australia and the United Kingdom's remarkably low firearm mortality rates provide us with a similar message.
Since the 1980s, Australia has passed a series of laws to combat gun violence, including the National Firearms Agreement that banned semiautomatic rifles and shotguns, instituted a buyback of banned weapons, and more. Nevertheless, Australia's precipitous decline in firearm mortality rate is mostly attributed not to this agreement, but instead, to the country's earlier policies that regulated who has access to guns (10). In the United Kingdom, only police officers, members of the armed forces, or individuals with written permission from the Home Secretary are allowed to own a handgun (11). The general public in both countries have responded to heinous crimes through political group action, thereby significantly reducing firearm mortality through effective gun policies with the support of their legislative body—a feat the U.S. has yet to accomplish.
Although the Red-Flag law is poised to ignite a reduction in the gun death rate, public support mirroring that of countries like the United Kingdom, and more recently, New Zealand, is required to continue instituting effective gun control policy. Robustly supporting legislation that implements what we already know works—laws that strengthen background checks and limit gun ownership from people at high risk of committing a crime—will help Massachusetts further decrease its firearm mortality rate. Both successful international policies and recent gun research call for such a system. Massachusetts is leading the U.S. in firearm rules and regulations, but it can do better by centering conversations around research-based gun policy. An approach like so could ultimately prevent unnecessary deaths and allow more children to live out their dreams.
Harvard Medical Student Review Issue 5 | January 2020