According to data collected by EducationWeek there have been 119 school mass shootings since 2018. Of these, 88 children died and 213 were injured. Not included in these statistics is the toll of chronic mental and physical trauma that endures in those who survive the carnage and the family members who lose loved ones. It is devastating.
We in South Texas would hear of these events far, far away in Newtown, Connecticut, Oxford, Michigan, and in Columbine, Colorado. Well, not anymore. We just had one of these horrendous events in our own backyard. A teenager walked into an elementary school in Uvalde and killed 19 children and two adults, and injured many.
These catastrophic events are a disease, and it is pandemic in the U.S. Health professionals need to be actively involved in preventing and treating this illness because politicians have done nothing.
What are the causes and how do we treat firearm violence? To study the cause, we need an environment where the disease is rampant. We do not need to go too far. A study published in JAMA showed that in 2016, the U.S. and five other Latin American countries accounted for 51% of all people who died from firearm injury in the world. The U.S. is the Petri dish to study this medical phenomenon.
A study of school mass shootings by investigators from Boston Children’s Hospital showed that the causes were divided into four domains: people, policy, environment and equipment. Many factors were cited under each domain but here are some examples. For people these were mental illness and social rejection; for policy it was politicians and firearm laws; for environment it was lack of school safety and firearms at home; and for equipment it was automatic rifles.
Because the cause is multifactorial the treatment must be multifaceted. For the people domain, a treatment most politicians point to is mental illness. It hasn’t worked. First, there is a shortage of mental health providers. Second, there is a maldistribution of mental health providers. Patients who need the services the most have fewer providers available than those who need it less. Third, once the patient enters the healthcare system, the mental health provider needs to find the needle in the hay. Of all individuals diagnosed with mental illness only 4% go on to commit firearm violence. Fourth, there is no biochemical lab test to diagnose mental illness. A diagnosis is based on what the patient tells the provider on the day of the visit. Fifth, drugs used to treat mental illness have side effects and are expensive. Sixth, who is going to pay for the services and drugs?
In 2021 Gov. Abbott cut $211 million from the agency that funds mental health treatments. When you hear a politician on TV point to mental illness, my advice is to change the channel.
Treating rejection might yield better results. Schools’ health curriculums do have lesson plans on bullying. Teachers can give an extra focus on this lesson. Tell students in trouble and those who know of them that teachers have their ears and backs.
For policy the treatment is encouraging. Vote. I know, the process of voting has become unnecessarily more difficult. But it is still no excuse.
For environment the treatment, with state funding, is to spruce up school safety measures such as metal detectors, security cameras, zero-tolerance policies and automatic secured locked doors. A study showed that the presence of school resource officers was not associated with any reduction in school shooting severity. And a survey of teachers, school administrators and parents found that 73% opposed arming teachers. Lastly, firearms at home must be locked and secured always.
For equipment the treatment is to ban weapons designed to kill a large number of fellow Americans rapidly. Mass shootings are 70% less likely in areas where automatic rifles are banned. The teenager who went into Robb Elementary had just purchased two automatic rifles.
How damaging are these weapons? If anyone ever wondered why parents waited for hours to identify their children, let me explain. I did my fellowship training in critical care medicine at ChicagoMedicalSchool. I saw and treated the damage and impact AK-15 bullets have on tissues and organs. These bullets leave the muzzle at three times the speed of a handgun bullet. They have so much energy that they can disintegrate three inches of leg bone and when they enter soft tissues the bullets explode creating a large cavity in the flesh. The babies at Robb Elementary were unrecognizable and needed DNA to be identified.
Please be open and let’s study the implementation of these interventions, and let’s quantify the results.
Roberto P. Treviño, M.D., director of the Social and HealthResearchCenter in San Antonio.
