November 6, 1996

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A detailed picture of firearm injuries suffered in three American cities appears in this week's New England Journal of Medicine.

In addition to tabulating firearm deaths, study investigators evaluated the amount, nature and outcome of firearm injuries, says first author Arthur L. Kellermann, M.D., director, Center for Injury Control, Rollins School of Public Health, Emory University. The researchers pieced together data from police departments, medical examiners, ambulance services and hospitals to better understand the firearm deaths and injuries that occurred in Memphis, Tenn.; Seattle, Wash.; and Galveston, Texas, between mid-November 1992 and mid-May 1994.

During that time, 1,915 persons sustained gunshot wounds. Three hundred and sixty-five (19 percent) died. The injury rate in Memphis was twice that in Galveston and four times the rate in Seattle, the authors report.

"Approximately 88 percent of the injuries were incurred during confirmed or probable assaults, seven percent were sustained in the course of suicide or attempted suicides; unintentional injuries accounted for four percent of the cases," the authors report. "Handguns were used in 88 percent of the cases in which the type of weapon was recorded...Emergency department and inpatient charges exceeded $16.5 million."

Streets or parking lots were the sites for nearly half of the assaultive shootings; nearly one third took place in a private residence (of either the victim, shooter or a third party). Forty-two percent of assault victims were shot by strangers and 38 percent by nonintimate acquaintances. Thirteen people (1 percent) were shot by police in line of duty. Twenty-one (1.4 percent) were shot by private citizens in self defense.

The authors draw the following conclusions from their results:

  • "... Firearm-related injuries are a major cause of morbidity and mortality in urban areas. Young black men (ages 15-29) are being shot and killed at a particularly alarming rate (1,708.4 per 100,000 person-years or approximately two per 100 per year) . The reasons for this (high rate of injury) are complex. There is no evidence that one population group is inherently more prone to violence (or victimization) than any (an)other.
  • "... Assaults are the predominant cause of nonfatal gunshot wounds... Almost 90 percent of the injuries we identified were due to a confirmed or probable assault.

  • "... Fatality rates vary markedly according to the intent of the shooter. The ratio of nonfatal injuries to deaths ranged from roughly 16 to 1 for unintentional injury to 0.16 to 1 for suicide attempts. Most of this difference appears to be due to different anatomical patterns of injury. The overall ratio of nonfatal cases to deaths was 4.2 to 1.

  • "... Handguns are disproportionately involved. Although handguns account for roughly half the new guns sold in the United States, they were involved in almost 90 percent of the shootings in the three study communities. The ability of handguns to be concealed readily and their ease of use are the most likely explanations for this observation.

  • "... Greater emphasis must be placed on prevention. In cities like Memphis, Seattle, and Galveston, the benefits of timely access to emergency medical services have already been realized. Further refinements in trauma care are unlikely to produce substantial increases in survival. Ninety-seven percent of deaths occurred within 24 hours of the injury. Future efforts should focus on the primary prevention of gunshot wounds."

The following researchers collaborated on the paper: Frederick P. Rivara, M.D., and Peter Cummings, M.D., Harborview Injury Prevention and Research Center, University of Washington, Seattle; Roberta K. Lee, Dr. P.H., University of Texas Medical Branch, Galveston; and Joyce G. Banton, M.S., Bela B. Hackman, M.D., and Grant Somes, Ph.D., Department of Preventive Medicine, University of Tennessee, Memphis.

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Copyright ©Emory University, 1996. All Rights Reserved.
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