The National
Spinal Cord
Injury Association

SCI Life
Fall/Winter 1998

Handgun Violence: The Devastating and Deadly Consequences Controlling the Epidemic

Violence is out of control in America. The consequences are felt by everyone in our homes, streets, schools, and playgrounds. Children are killing children. Children are killing adults, their parents, their siblings and their friends. Kids are seemingly without conscience. Parents are doing the same. Adults in our society have taught dchildren how to solve problems and conflict using physical force and aggression. Children in America are taught the way to win in life is by power and force. Violence is prevalent in our media and entertainment, and in our interpersonal and intimate relationships. Violence is indeed a learned behavior.

Violence affects how we administer our schools, run our business, and our sporting and entertainment events. It also has affected how we defend our homes, cars and indeed, ourselves. Easy handgun access has escalated the problem. The American icon of violence is the handgun. At the height of the polio epidemic there were 3,500 deaths of all ages in one year. Since 1980, over 50,000 children have died in America from handguns. Most individuals are under the impression that a handgun in the home is protective when in fact it is 43 times more likely that the handgun will be used to kill you or someone you know.

The healthcare community response to this epidemic is changing. Trauma care is an illness crisis response health care delivery system. As the Neurosurgical Coordinator of the Department of Neurological Surgery at the University of Miami/Jackson Memorial Medical Center for the past 20 years, I have witnessed the increase in the incidence of SCI due to handgun violence. Sustaining a violent injury, even a gun shot wound is not a deterrent or protective factor against sustaining a second or third similar injury. The prevalence of recidivism in violent trauma is frightening and costly. However, patching and mending must not be the only medical intervention initiated to the renegade children of the ghettos and the potential suburban outlaws on the road from anger to delinquency to death. Solutions to halting the epidemic of violence are not quick or easy. Defining violence as a Public Health issue and indeed an epidemic was the first step. This paradigm shift has given many disciplines and organizations an opportunity to seek realistic collaborative strategies.

The profile of the individual with a violent spinal cord injury has changed over the past 10 years. The injury scenario used to be someone shot and rendered paralyzed while running from the police. Now we see children shot in drive-by shootings, fathers shot by their own gyn that their child found, and gang revenge shootings as strong retaliatory revenge messages to rival gangs. Most patients sustaining SCI used to spend some time in a rehabilitation setting. If police charges were pending, they were dropped, the injury itself considered sufficient punishment. The jail and prison systems also were not equipped to deal with the disabled. Now after minimal rehabilitation in acute care, patients are discharged directly to the jail system. Many of these individuals return to life on the street in a wheelchair, choosing to remain homeless and pursue their previous lifestyle of drug dealing and substance abuse.

Rescuing is far more glamorous than prevention. Safety has a poor public image in a society that gorifies risk taking and accepts violence as a societal norm. The basic tenants of injury preventon are inadequate without the support and resources of individuals, communities, and state and federal agencies. The community's awareness and perception of the problem must be defined as solvable and pro-active. Violence is in fact understandable, predictable and preventable. The negative attitude that there is nothig that can be done is inappropriate and inaccurate.

Unfortunately, many children are born to violent parents and into violent environments. Our violent culture has developed violent children with no skills at anger management and an inability to deal with their internal rage or frustration. Children's learned violent responses and behaviors can be detected early by screening for risk factors and referred for early treatment interventions. The early identification of these children can detour these self-destructive youth from the pathway of a short life of adolescent violence. Potential warning signs are well established signals to parents and professionals to seek help to prevent violent behaviors escalating. These signs change as the detached toddler becomes the cruel preschooler, then the disruptive, inattentive elementary student escalating until he or she becomes the defiant, truant, non-empathetic, abusive adolescent. Parents, teachers, healthcare professionals, and the community need to know how to raise children to resist violence. Resilience also is a learned behavior which can be taught to children and is a protective factor for interpersonal violence.

Clinicians took a leadership role using the public health approach to reduce tobacco use and define smoking as an unhealthy behavior. The change in the past decade of the public's perception, tolerance and use of cigarettes is evidence that widespread attitudes and behaviors can be changed with education. Young children will accept educational information from parents, teachers and role models. Adolescents however, on their way to independence, are much more influenced by their peers. Fortunately, there are windows of opportunity to access this high risk adolescent population, points of rare vulnerability in the invicible teenage population. Prevention programs using credible peer messengers such as the Think First Brain and Spinal Cord Injury Prevention Program can play an effective part in reaching high risk teenagers in the classroom environment. Collaborative programs between organizations and disciplines are also effective in reaching at risk youth -- healthcare professionals team up with police gang units to mentor potential gang recruits.

The risks and consequences of easy gun access plays a significant role in the problem. Child trigger safety locks could prevent most unintentional pediatrics deaths and injuries. Violence intervention in America must be a balanced plan of punishing, policing and prention in order for children to have a better future and to reduce the number of devastating spinal cord injuries.

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