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{ "pk": 17205, "title": "Nonfatal Injuries Sustained in Mass Shootings in the US, 2012-2019: Injury Diagnosis Matrix, Incident Context, and Public Health Considerations", "subtitle": null, "abstract": "Introduction: The epidemic of gun violence in the United States (US) is exacerbated by frequent mass shootings. In 2021, there were 698 mass shootings in the US, resulting in 705 deaths and 2,830 injuries. This is a companion paper to a publication in JAMA Network Open, in which the nonfatal outcomes of victims of mass shootings have been only partially described.\nMethods: We gathered clinical and logistic information from 31 hospitals in the US about 403 survivors of 13 mass shootings, each event involving greater than 10 injuries, from 2012-19. Local champions in emergency medicine and trauma surgery provided clinical data from electronic health records within 24 hours of a mass shooting. We organized descriptive statistics of individual-level diagnoses recorded in medical records using International Classification of Diseases codes, according to the Barell Injury Diagnosis Matrix (BIDM), a standardized tool that classifies 12 types of injuries within 36 body regions.\nResults: Of the 403 patients who were evaluated at a hospital, 364 sustained physical injuries—252 by gunshot wound (GSW) and 112 by non-ballistic trauma—and 39 were uninjured. Fifty patients had 75 psychiatric diagnoses. Nearly 10% of victims came to the hospital for symptoms triggered by, but not directly related to, the shooting, or for exacerbations of underlying conditions. There were 362 gunshot wounds recorded in the Barell Matrix (1.44 per patient). The Emergency Severity Index (ESI) distribution was skewed toward higher acuity than typical for an emergency department (ED), with 15.1% ESI 1 and 17.6% ESI 2 patients. Semi-automatic firearms were used in 100% of these civilian public mass shootings, with 50 total weapons for 13 shootings (Route 91 Harvest Festival, Las Vegas. 24). Assailant motivations were reported to be associated with hate crimes in 23.1%.\nConclusion: Survivors of mass shootings have substantial morbidity and characteristic injury distribution, but 37% of victims had no GSW. Law enforcement, emergency medical systems, and hospital and ED disaster planners can use this information for injury mitigation and public policy planning. The BIDM is useful to organize data regarding gun violence injuries. We call for additional research funding to prevent and mitigate interpersonal firearm injuries, and for the National Violent Death Reporting System to expand tracking of injuries, their sequelae, complications, and societal costs.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "mass shootings, firearm violence, gunshot wound, injury epidemiology, trauma, emergency medicine" } ], "section": "Trauma", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/23f959cj", "frozenauthors": [ { "first_name": "Matthew", "middle_name": "", "last_name": "Czaja", "name_suffix": "", "institution": "University of California, Irvine and Ponce Health Sciences University", "department": "None" }, { "first_name": "Chadd", "middle_name": "", "last_name": "Kraus", "name_suffix": "", "institution": "Geisinger Emergency Medicine, Danville, Pennsylvania", "department": "None" }, { "first_name": "Su", "middle_name": "", "last_name": "Phyo", "name_suffix": "", "institution": "Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada", "department": "None" }, { "first_name": "Patrick", "middle_name": "", "last_name": "Olivieri", "name_suffix": "", "institution": "Valley Health Emergency Medicine, Las Vegas, Nevada", "department": "None" }, { "first_name": "Dalier", "middle_name": "", "last_name": "Mederos", "name_suffix": "", "institution": "Broward Health Medical Center, Division of Trauma and Critical Care Services, Fort Lauderdale, Florida", "department": "None" }, { "first_name": "Salman", "middle_name": "", "last_name": "Mohammed", "name_suffix": "", "institution": "Kirk Kerkorian School of Medicine at UNLV, Department of Emergency Medicine, Las Vegas, Nevada", "department": "None" }, { "first_name": "Ross", "middle_name": "", "last_name": "Berkeley", "name_suffix": "", "institution": "Kirk Kerkorian School of Medicine at UNLV, Department of Emergency Medicine, Las Vegas, Nevada", "department": "None" }, { "first_name": "Thomas", "middle_name": "", "last_name": "Gildea", "name_suffix": "", "institution": "St. Louise Regional Hospital, Department of Emergency Medicine, Gilroy, California\nSanta Clara Valley Medical Center, Department of Emergency Medicine, San Jose, California", "department": "None" }, { "first_name": "Claire", "middle_name": "", "last_name": "Hardman", "name_suffix": "", "institution": "Wright State University Boonshoft School of Medicine, Department of Surgery, Dayton, Ohio", "department": "None" }, { "first_name": "Brandi", "middle_name": "", "last_name": "Palmer", "name_suffix": "", "institution": "Wright State University Boonshoft School of Medicine, Department of Surgery, Dayton, Ohio", "department": "None" }, { "first_name": "Melissa", "middle_name": "", "last_name": "Whitmill", "name_suffix": "", "institution": "Ponce Health Sciences University School of Medicine, Ponce, Puerto Rico", "department": "None" }, { "first_name": "Una", "middle_name": "", "last_name": "Aluyen", "name_suffix": "", "institution": "Geisinger Emergency Medicine, Danville, Pennsylvania", "department": "None" }, { "first_name": "Jeffery", "middle_name": "", "last_name": "Pinnow", "name_suffix": "", "institution": "Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada", "department": "None" }, { "first_name": "Amanda", "middle_name": "", "last_name": "Young", "name_suffix": "", "institution": "Valley Health Emergency Medicine, Las Vegas, Nevada", "department": "None" }, { "first_name": "Carly", "middle_name": "", "last_name": "Eastin", "name_suffix": "", "institution": "Valley Health Emergency Medicine, Las Vegas, Nevada", "department": "None" }, { "first_name": "Nurani", "middle_name": "", "last_name": "Kester", "name_suffix": "", "institution": "Broward Health Medical Center, Division of Trauma and Critical Care Services, Fort Lauderdale, Florida", "department": "None" }, { "first_name": "Kaitlyn", "middle_name": "", "last_name": "Works", "name_suffix": "", "institution": "Kirk Kerkorian School of Medicine at UNLV, Department of Emergency Medicine, Las Vegas, Nevada", "department": "None" }, { "first_name": "Andrew", "middle_name": "", "last_name": "Pfeffer", "name_suffix": "", "institution": "Kirk Kerkorian School of Medicine at UNLV, Department of Emergency Medicine, Las Vegas, Nevada", "department": "None" }, { "first_name": "Aleksander", "middle_name": "", "last_name": "Keller", "name_suffix": "", "institution": "St. Louise Regional Hospital, Department of Emergency Medicine, Gilroy, California", "department": "None" }, { "first_name": "Adam", "middle_name": "", "last_name": "Tobias", "name_suffix": "", "institution": "St. Louise Regional Hospital, Department of Emergency Medicine, Gilroy, California", "department": "None" }, { "first_name": "Benjamin", "middle_name": "", "last_name": "Li", "name_suffix": "", "institution": "Santa Clara Valley Medical Center, Department of Emergency Medicine, San Jose, California", "department": "None" }, { "first_name": "Brian", "middle_name": "", "last_name": "Yorkgitis", "name_suffix": "", "institution": "Wright State University Boonshoft School of Medicine, Department of Surgery, Dayton, Ohio", "department": "None" }, { "first_name": "Soheil", "middle_name": "", "last_name": "Saadat", "name_suffix": "", "institution": "Kettering Health Main Campus, Trauma Research Program, Kettering, Ohio", "department": "None" }, { "first_name": "Mark", "middle_name": "", "last_name": "Langdorf", "name_suffix": "", "institution": "Kettering Health Main Campus, Trauma Research Program, Kettering, Ohio", "department": "None" } ], "date_submitted": "2022-09-09T20:18:31-04:00", "date_accepted": "2022-09-09T20:18:31-04:00", "date_published": "2023-05-02T14:29:01-04:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/17205/galley/8697/download/" } ] }