There have been many resources created to help those in crisis who may cause harm. There is a large amount of public health messaging surrounding suicide and a plethora of suicide-specific resources that include easily accessible counseling, support services, and prevention hotlines. However, there have not been similar amounts of investment in homicide prevention resources. Most of our nation’s investment in homicide prevention resides in the form of safe gun usage and storage, stricter gun ownership laws, and heavy sentencing for those who commit interpersonal harm. Despite these efforts, gun-related shootings have spiked in the last two years with the U.S. seeing a 33 percent increase in gun violence between 2019 and 2020, and a further seven percent increase from 2020 to 2021.⁴ Harm reduction interventions are necessary, but the commonly used avenues miss the mark on addressing the root causes.

The root causes of gun-related homicide have been thoroughly investigated. Gun violence has been attributed to social inequity and intentional disinvestment of our marginalized communities. Specifically, the structural drivers are income inequality, poverty, underfunded public housing, underfunded public services, underperforming schools, easy gun access by high-risk individuals, and a sense of hopelessness.³ A lack of upward social mobility has also been found to have a strong relationship to interpersonal violence.

Gun-related homicide is a public-health epidemic that deserves a robust public health response. As emergency physicians, we are trained very well to treat the wounds of injured patients, but what can be done to prevent the injury? Active investment in the root causes of this epidemic are just as important as treating the downstream effects.

Tackling root causes can seem daunting, but there are some feasible ways that everyday emergency physicians can impact the upstream causes of gun-related injuries without overstretching. Emergency physicians can utilize a trauma-informed approach to patient care, actively work to mitigate bias toward those affected by gun violence, invest in violence-recovery support staff in our emergency departments (EDs), advocate for hospital partnerships with local community violence prevention programs and when able, increase physician support for community programming that addresses the root causes of interpersonal violence.

Trauma-Informed Care

It can be argued that every emergency physician should be trained in trauma-informed care and utilize this approach with every patient interaction. Taking a trauma-informed approach means to not only treat the patient’s chief complaint, but to acknowledge the adverse events that have occurred to our patients that led them to their behavior and health outcomes. As physicians, it’s important to realize how trauma affects our patient’s presentation. With trauma-informed care training, we are better equipped to recognize the signs of trauma and utilize tools to respondappropriately without re-traumatizing the patient. Taking this perspective and adding empathy to the visit has been found to improve patient engagement, adoption of treatment plans, and patient health outcomes. It can also boost staff wellness.