Firearm Violence and Kids: A Policy Statement

Michael Nance, MD


April 14, 2014

Editorial Collaboration

Medscape &

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My name is Mike Nance. I'm the Trauma Director at The Children's Hospital of Philadelphia. I would like to talk about firearm violence in children.

Those who care for children are quite aware that trauma is the leading cause of death, far surpassing all other causes combined. Firearms themselves are the second leading cause of injury death, second only to motor vehicle collisions.

While Columbine, Virginia Tech, and Sandy Hook all serve as grim reminders of the firearm violence epidemic, it is the injuries and deaths that occur every single day in our hospitals that really take their toll.

In response to the Sandy Hook mass shooting, the American Pediatric Surgical Association (APSA) tasked the trauma committee with revising the policy statement on firearms and children. We came up with 9 recommendations, based on data where they were available, and provided a rationale for those recommendations.[1]

The Association also took the unique step of seeking endorsement from the membership for the policy statement. The policy statement was made available for public review and comment and then, at the business session at the annual meeting, was put up for discussion.

The policy statement was overwhelmingly endorsed by the membership. The 9 recommendations made in the policy statement include several common-sense measures. These include improving the universal background check system, which currently has a large loophole excluding sales that occur at gun shows. In addition, we believe it is important to improve mental health services and access to those services.

We also included several measures that would seem intuitive to a healthcare provider, such as treating the violence epidemic as a public health problem. This strategy has been remarkably successful in reducing the toll of motor vehicle collisions. We think it would be equally efficacious in reducing firearm violence.

In addition, there have been several laws recently, both on the federal level as well as the state level, that have sought to limit the physician-family relationship, specifically as it pertains to discussions about firearms. We believe the physician-family relationship needs to be inviolate, and we strongly oppose such measures.

We also think it is important to limit the access to firearms by children -- an issue with both technological and legislative solutions. Technological solutions might include strategies such as gun safes and gun locks, and legislative solutions would include things such as child access protection laws.

We all practice evidence-based medicine, as we treat our patients every single day, that is founded in data. Data are what we need to address the firearm violence issue as well. We don't have those data, in many cases, because of an existing moratorium on funding that was imposed by Congress. That moratorium needs to be lifted.

We believe it is important to limit high-capacity magazines and assault-style rifles. While somewhat controversial, we feel that both increase lethality when used in shootings.

Finally, we cannot support the routine use of armed personnel in schools. We feel that the potential benefits, which have been touted, would be overshadowed by continued exposure of children at all schools to firearms. Thus, routine use cannot be supported.

The details of these recommendations can be found in the policy statement itself, which is available at the APSA Website. It can also be found in the November 2013 issue of the Journal of the American College of Surgeons.[1]

As healthcare providers, we have a unique and powerful insight into the problem. It is an insight that we should share with our legislators. If you feel passionate about this problem, I encourage you to share your thoughts, both as a healthcare provider and a constituent.


The Center for Injury Research and Prevention at The Children's Hospital of Philadelphia provides information, research, and resources for the prevention of gun violence as part of their Violence Prevention Initiative.