When Dr. Christina Johns, a pediatric emergency medicine physician, thinks about her time working at Children’s National Hospital in Washington, one case always comes rushing back:
Two-year-old. Gunshot wound. Chest. ETA five minutes.
The child was rushed to the emergency department after being accidentally shot by an older sibling who was playing with a gun that was left unlocked in the house.
“I’ll never forget the … child on the stretcher and the blood-curdling screams of the parent outside the room, lying on the floor, distraught,” Johns said.
Every 30 minutes, an emergency department treats another firearm injury, according to a new analysis from researchers at the US Centers for Disease Control and Prevention that looked at 10 jurisdictions, including the District of Columbia.
But cuts from the US Department of Health and Human Services and proposed changes to the federal budget could threaten research that reveals these kinds of firearm injury patterns. Experts say it would be nearly impossible to replicate the scale and scope of the timely firearm research the federal government is able to conduct.
The recent study, which was published last week in the journal Annals of Internal Medicine, says that the firearm injury visits are not evenly distributed. There were more firearm injury presentations at night, on the weekends and on some holidays, like Independence Day and New Year’s Eve.
Experts say the results are not surprising but that the findings from this analysis — which the authors say is the largest of its kind to use timely data in urban and rural areas — can inform staffing to provide better care.
Johns says the young child she treated survived because there was well-prepared staff at the hospital’s Level 1 trauma center.
“Just the sheer number of staff – there must have been 15 people, with the appropriate team inside the room and at the bedside,” Johns said. This included not only doctors and nurses but also blood bank runners, lab runners and many others who were ready for the child to arrive.
“Trauma care takes a village,” said Dr. Katherine Hoops, who leads the Clinical Programs and Practice Team at the Johns Hopkins Bloomberg School of Public Health’s Center for Gun Violence Solutions. Mental health professionals and social workers are also critical to have on staff for these responses, she noted.
Firearm injuries are the leading cause of death among children and teens in the US. Emergency medical service encounters for firearm injury spiked in 2021 and remain higher than before the Covid-19 pandemic. Firearm suicides have continued to rise and are now higher than at any other point in the past 50 years.
The study analyzed over 93,000 emergency department visits for firearm injury through data from the CDC’s Firearm Injury Surveillance Through Emergency Rooms, or FASTER, which collects real time data from select jurisdictions. Data from 2018 through 2023 in Florida, Georgia, New Mexico, North Carolina, Oregon, Utah, Virginia, Washington, West Virginia and DC was included.
The analysis specifically showed that most of the patients with gunshot wounds arrived at the emergency department between 2:30 and 3 a.m., and the slowest times were between 10 and 10:30 a.m. The peaks were highest overnights from Friday into Saturday and Saturday into Sunday. The case rates were highest in July and lowest in February.
Although emergency departments might have adequate staff at off times, other hospital resources might be limited at night and on weekends, which could be a problem in these emergencies, Johns said.
Experts say there can still be deviations from these patterns, underscoring the importance of continued emergency room staffing. The peaks can also differ for firearm injuries in pediatric patients, Johns explained.
Future of firearm research is uncertain
The FASTER program is run through the National Center for Injury Prevention and Control, a division of the CDC that was heavily targeted during federal job cuts this month.
More than 40 health organizations have urged US Health and Human Services Secretary Robert F. Kennedy Jr. to reinstate the center, which lost more than 200 employees, according to Sharon Gilmartin, executive director of the Safe States Alliance, which is leading the newly formed coalition.
“No other federal agency collects, analyzes and links hospital and public health data sets to help illustrate a comprehensive picture of the circumstances that lead to injury and violence,” the groups wrote in a letter to Kennedy. “State, local, municipal governments and universities rely on these data to inform the design and implementation of targeted injury and violence prevention efforts.”
The CDC says that FASTER has not been affected and continues to be operational. The database initiative was funded in 2023 through August 2028, according to the agency, but continuation of this work is contingent on future appropriations from Congress.
“Even if the data sets remain, they will be rendered useless because they have nobody to clean the data, analyze the data and tell you what it means,” Gilmartin said.
Firearm research has been stunted for years because of the Dickey Amendment, which was introduced in 1996 and prohibited the use of federal dollars on research that may promote gun control, according to the former National Center for Injury Prevention and Control employee. The budget for fiscal year 2020 reintroduced funding for gun violence research for the CDC and the US National Institutes of Health.
“As a result of banning us from doing that work, the field of firearm violence is pretty far behind,” the former employee said.
The document showed that the Trump administration is formulating plans to slash federal health spending and consolidate dozens of health programs into the Administration for a Healthy America, a new entity that Kennedy announced during the layoffs.
The plan could still change, but the document currently indicates that while some National Center for Injury Prevention and Control programs will become part of AHA’s primary care programs, others will be completely eliminated.
The center’s Firearm Injury and Mortality Prevention Research is among those with a zeroed-out budget in the proposal.