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Featured image: ‘GSW to left hip, shotgun, point blank.’ See the original case on Figure 1.

Healthcare professionals have a unique perspective on gun violence. Over the weekend of January 8-10, 2016, we asked the more than 500,000 healthcare professionals on our global case-sharing platform if they had seen the effects of gun violence in their practice. We received 3,161 responses, of which 2,067 were from U.S. healthcare professionals. Globally, 29% of users said they had seen the effects of gun violence. In the U.S., this was significantly higher — 35% said they had seen the effects of gun violence. All respondents had the option to describe their experiences. Here are some of the responses from U.S. users, edited for spelling and clarity and organized by general subject.

Unforgettable patients

I am a pediatric ICU nurse with specialty in neuro. I’ve treated several pediatric patients with GSW [gunshot wound] to the head. One patient that stands out in my mind had double bone flaps out and lots of frontal lobe damage. He had to live in the hospital because it wasn’t safe to send him home. The gang was trying to finish him off. He was 12.

– Neuro ICU nurse

I’m an ER doc. Seeing a teenager’s heart liquefied by bullets is not something I could forget.

– ER resident

Unused to working trauma. There’s nothing worse than a 14-year-old GSW to the head because the child wasn’t taught how to properly use the gun. I will never forget that child.

– Nurse

I’m a RN at a level-one trauma center in the inner city of a major metropolitan. I’ve seen innocent toddlers mowed down, soldiers overcome with PTSD who’ve blown their brains out, gangbangers paralyzed, country boys with toes shot off while cleaning their guns, convenience store clerks with their guts spilling out, and I’ve seen countless dudes that were walking down the street minding their own business with through and throughs [a bullet wound that passes through the body]. It has hardened me. It has cast serious doubts on my faith in humanity.

– RN-BSN Multiple trauma patients ranging in age from small children to the elderly and varying in severity from superficial abrasions to death. The worst experience was during residency. Having to deliver the news to a terrified mother that three of her children had died after being shot by her scorned ex-boyfriend was an experience I wouldn’t wish on anyone.

– Surgeon

gunshot removal

'.40 cal full metal jacket retrieved from the right flank under local anesthetic'. Click the image to see the original case.

For some, it’s an argument for gun control

Definitely changed my opinion on the 2nd amendment. If people could see what I have seen, they would work on changing laws.

– Registered nurse

Saw a 13-year-old girl with a bullet wound. She was a bystander. Never did anything wrong, but got shot in the thigh for walking. Of course the gun was unregistered, and the shooter was a repeat felon. But hey, 2nd amendment, right? I support gun restrictions.

– Medical student

My first job as a new grad respiratory therapist was at the Presley Trauma Center in Memphis in the early ’90s during the crack wars. Stunning level of violence. More recently I took care of victims of the Aurora Colorado theater shootings. 25 years of broken lives and broken bodies. Such a waste.

– Respiratory therapist

Working as an internist at county hospital in large urban metropolitan area with 4 million people, I have observed countless morbidity and mortality secondary to handguns. Most of it was preventable, and sadly, now irreversible. Strict regulation of guns and gun owners should not be a political issue, but a public health one.

– Internal medicine physician

I am a former ER nurse. Cared for numerous GSW victims. Later in my career, I did pediatrics in Connecticut and had a handful of patients from Newtown. Now later in my career I am a family nurse practitioner in Seattle and gun safety is always a topic of conversation when discussing prevention. A fundamental shift in gun policy MUST be a top priority for health care workers. It is a public health issue, first and foremost. It’s embarrassing we haven’t all done more…

– Family nurse practitioner

I’ve seen accidental and intentional shootings. I’ve seen flesh wounds and fatalities. There are no easy answers to gun legislation but I believe background checks are a necessity and a common sense precaution. (From a gun owner in Texas)

– Paramedic / RN

Petty arguments turn deadly. Gun violence begets more gun violence. The cycle goes on forever. The ripples are felt throughout so many communities. Gun restrictions work. Just ask Australia.

– Registered nurse

Several shootings both intentional and accidental. Some gang violence, some domestic violence and some suicide. All of it is terribly horrific and senseless. I am a proponent of proactive community policing, education, and gun control. Speaking as a first responder one is too many and they all have a cumulative effect on the community as a whole. Common sense gun control, education, and proactive policing combined can work.

– Paramedic


'3D CT of Gunshot Wound'. Click the image to see the original case.

For others, it doesn’t shake their faith in the Second Amendment

I work in a New Jersey hospital in the most dangerous city in the U.S. I support the constitutional right to bear arms. But I wish these kids didn’t use such dangerous and permanent means to handle otherwise temporary problems.

– Nurse

I work in an ER that isn’t a trauma facility but we get GSWs [gunshot wounds] dropped by our doors. These cases instantly take all our resources till we can get them stable enough to transfer. I would venture to say that most of these cases have a criminal element involved or someone was in the wrong place at the wrong time. None of this has changed my opinion of gun ownership. I believe we have a right to that ownership. Guns are not the problem. Human nature is and you are not going to change that by passing laws or restricting ownership.

– Nurse

I’ve worked in the emergency room in Memphis and, as a result, have seen many gunshot wounds. However, I am of the opinion that the government should not be permitted to infringe upon our individual freedoms.

– Medical student

I practice in the Baltimore region so this is unfortunately a regular occurrence. Providers in the area have become “numb” per se to shootings of rival gang members and so forth. What really affects most of us are the innocent bystanders who are affected, such as kids. With that being said, I myself am still pro-2nd amendment.

– Paramedic, paramedic instructor

I have treated patients with gunshot wounds. This did not change my practice in any way, other than this is a violent world we live in today. My right to bear arms for the protection of my family is my earned right. My father was a WWII veteran who fought for our freedom. Let’s not let our rights get taken from us!

– Registered nurse

Many young people (<30 years old) are brought in as Level 1 traumas due to the accidental discharge of a firearm, street violence, or armed robbery. While these are all deeply unfortunate to encounter, my personal stance on gun possession is that anyone over 18 without any obvious criminal history should be allowed to purchase a firearm if they choose.

– General surgery/trauma nurse

The gun violence/gunshot wounds I’ve cared for were all directly involved in illegal activity (most commonly drugs/dealing), and all had prior gun or drug convictions. One man shot himself (not suicide attempt), and one was from accidental discharge, but was on his way to commit a crime. I believe guns are not the problem. I wish I could carry in the hospital where I currently work.

– Registered nurse

Seen in trauma. Only self-inflicted or criminally inflicted on another. Does not change my opinion, I still support gun ownership by responsible people.

– Internal medicine resident


'Comminuted tibia and fibula fracture s/p GSW with assault rifle'. Click the image to see the original case.

How it affects care

Our blood bank is heavily affected by gun violence as many of these patients need massive transfusions of uncrossmatched blood. If there are numerous patients at a single time from this, the blood bank stock can be depleted quickly. To add to that, those who survive will likely have a transfusion reaction that will need a full workup. One single standoff can lead to hundreds of technologist hours and the depletion of the entire O-positive and O-negative blood inventory of a trauma center. I worked in downtown Detroit while in my clinicals and our blood bank saw numerous MTP’s [massive transfusion protocols] called each week for police, gang members, and civilians who had been shot. Our ER had metal detectors and heavy security to get in. Our security guards were heavily armed at the hospital and were able to stop further incidents numerous times.

– Medical technologist

We are sometimes delayed in our response, because we are requesting PD [police department] prior to arrival on unknown medical calls. The world is changing everyday. It seems that as a first responder, we have to keep the idea of being ambushed in the front of our minds when we take calls for unknown medical. It will come to a point when we will need to start legally carrying a firearm for our protection.

– Paramedic

Gun violence has increased and typically increases time to patient contact due to having to await the police to secure the scene.

– Paramedic


'#GSW to the right foot.' Click the image to see the original case.

Unsafe workplaces

We are extremely cautious in our approach on all calls. With the increase in gun-related injuries, once we notify the ER, they will go into a lockdown mode to prevent retaliation at the hospital. There have been far too many deaths by guns this year and it’s only the 8th day [of January]. Our city has laid to rest a mere 14-year-old last week. When treating GSWs [gunshot wounds], our crew is alert and tries to get on and off scene immediately for safety concerns. We wear vests at our discretion. I realize the solution is not just in banning all guns. I also realize that having more guns is not any safer. I feel that many people feel that guns are like accessories and have lost the respect these weapons hold. For yes, they are weapons. People seem to forget the objective of the gun is to injure, maim or kill. There is no reason to open carry, in my opinion. I feel if you have to show off that you have a gun, then you don’t have enough respect for the weapon.

– Paramedic

Nurses are scared to take care of gunshot victims out of fear that the shooter will come to finish the job.

– Nurse

I see patients after surgery to repair damage from GSW. Sometimes patients are in police custody or have police presence waiting to question them. Have to put some under alias, others under watch for gang violence — have had rival gang members on same floor and had to block off sections so the visitors don’t attack each other.

– Nurse

All of our medics are issued ballistic vests, and recently we had an ambulance shot into. There are certain districts that we can expect to run at least one shooting a shift.

– Paramedic

We get mostly young adults, sometimes bystanders. Either way, it devastates the family. I’m in the neuro ICU, so typically prognosis is grim. Large crowds of families, friends, and gangs come to the hospital angry and untrusting. It makes for a tense workplace. You feel unsafe because many times the suspect isn’t caught and the witnesses won’t come forward.

– Registered nurse, neurological ICU

Used to treat gunshot wounds to the head working in neuro ICU. Mostly poor outcomes. This was in Baltimore, and gun violence also caused concern for my own safety when coming into the hospital late at night. Having lived in the UK as well, there is a big difference living in a country where guns are more regulated. Although when it does happen, providers obviously aren’t as experienced at dealing with the wounds!

– Family nurse practitioner

I work in an ED [emergency department] so I’ve seen patients with GSWs and we’ve had a mass-casualty incident involving a shotgun in a workplace. Safety in the department is always a priority too and we are constantly worried about people bringing guns. We have found guns on mental health patients hours after they’ve arrived. Sitting at triage – where we are very exposed – makes me have thoughts of an active shooter where I work. I am not a worrier and it takes a lot to stress me out, but gun violence is one of the few things I’ve always got in the back of my mind.

– Registered nurse

[I have seen] Caregivers having to put themselves in the middle of a gun fight to save a child, and a caregiver having a gun pulled on them while trying to provide care.

– Nurse consultant

Gun violence has affected our practice because we have experienced it at our doorsteps. The employees are afraid to work the night shifts.

– Radiologist

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