#ThisIsOurLane — Firearm Safety as Health Care’s Highway

On November 6, 2018, in response to a position paper on firearm injuries and death from the American College of Physicians,¹ the National Rifle Association (NRA) fired off a tweet admonishing “self-important anti-gun doctors to stay in their lane.” Physicians — many of whom are also gun owners — quickly responded that the topics of gun violence and firearm-injury prevention are squarely within our lane. Then, less than 12 hours after the NRA tweet, another mass shooting took place, in Thousand Oaks, California. On November 7 and 8, the Twitter hashtag #ThisIsOurLane went viral (see figures).

Use of the hashtag exploded beyond the usual confines of #medtwitter in part because it was inclusive. #ThisIsOurLane calls attention to the role of physicians from many walks of medical life — emergency medicine, radiology, anesthesiology, surgery, physical medicine, rehabilitation, psychiatry, and forensic pathology. It encompasses our other colleagues as well: paramedics who face carnage in the field, nurses who provide massive transfusions, housekeeping staff who clean blood-soaked floors, pharmacists who assist with ICU medication dosing, and everyone who helps survivors piece their lives back together and helps families recover from loss. This is their lane, too.

The hashtag was also visceral, inspiring responses that went beyond words. Photographs of blood-stained scrubs, face masks, and skin peppered the Internet and news broadcasts, exposing the public to the gruesome reality that we health care providers know too well. And #ThisIsOurLane is personal, as tragically highlighted by the November 19 shooting deaths of an emergency physician, a pharmacist, and a police officer at a Chicago hospital. We don’t just treat this epidemic; we are victims of it, too.

The hashtag’s power reflected some existing momentum — the pump had been primed for a strong response to the NRA’s misguided assertion. Over recent years, health care and public health professionals and others have concertedly built a consensus that it’s essential to resume the science of firearm-injury prevention. This science had all but stalled in the United States, owing to a 1996 rider on an omnibus spending bill, the Dickey Amendment, prohibiting the use of Centers for Disease Control and Prevention (CDC) funds for advocacy or promotion of gun control. Although firearm-injury prevention is not synonymous with gun control, and although this amendment did not explicitly ban federal funding for firearm-related research, Congress has since appropriated $0 for the CDC to study gun-violence prevention. Related funding from the National Institutes of Health (NIH) has been less than 2% of what would be predicted on the basis of the burden of disease.² Over the past two decades, junior researchers — including two of us — had received advice from well-meaning mentors to “stay away from” the subject of firearm injury. Only a brave few investigators continued to examine causes, correlates, and prevention of firearm injury in the face of these funding limitations. Recently, the NIH funded a large initiative, the Firearm-safety Among Children and Teens consortium (FACTS), to restart research on preventing firearm injuries in the pediatric population. But we all know that more is needed.

After every shooting — daily private tragedies and increasingly frequent mass shootings alike — the medical community’s commitment to change has grown. This movement has been determinedly nonpartisan and inclusive. After the Sandy Hook shooting, a joint position statement was published by eight medical specialty organizations — the American College of Physicians (ACP), the American College of Surgeons (ACS), the American Congress of Obstetricians and Gynecologists, the American Public Health Association, the American Psychiatric Association, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Emergency Physicians — along with the American Bar Association, calling for implementation of several public policies (such as universal background checks), improved research funding, and improved mental health care.³ It specifically stated that the recommended steps were compliant with both the Second Amendment and recent Supreme Court rulings.

Every day for the past 4 years, health care professionals have collectively worked toward solutions to the gun violence epidemic. The numerous examples include the following. The ACS worked with surgeons from across the political spectrum to create, and publish, nonpartisan and actionable recommendations. It has also developed the #StopTheBleed campaign, which trains laypeople to mitigate the consequences of shootings.⁴ The American Medical Association (AMA) has declared gun violence to be a public health problem and is developing continuing medical education programs to help physicians have culturally competent discussions with patients at risk for firearm injury. The American Academy of Pediatrics has been a consistent leader in developing physician guidance and intraspecialty funding opportunities. Health care leaders from multiple specialties came together to create the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM), a nonpartisan group committed to creating change through evidence generation and collaborative action. And at the American Public Health Association annual meeting in November, Surgeon General Jerome Adams declared: “As a trauma anesthesiologist, if I want to talk to my patients about gun safety, it’s totally within my lane.” As a profession, we have become determined not just to develop solutions to this epidemic, but to make sure they’re implemented.

The broad and rapid response to #ThisIsOurLane reflects not a new movement, but rather the convergence of multiple paths on which physicians had already embarked. Sadly, this road gets more traffic with each additional shooting. As one physician, Judy Melinek, put it, “This isn’t just my lane. It’s my [expletive] highway.” Physicians throughout the country were already committed to solving this epidemic. The hashtag has helped us share this commitment with the wider world.

So where do we go from here? As with any complex problem, there is no simple solution. Addressing such deep-rooted issues will take work by all of us, from all points on the political spectrum. It will require us to unite as health care professionals who witness the human toll of this epidemic, rather than as liberals or conservatives, urban or rural. It will require gun-owning and non–gun-owning physicians alike to listen carefully to our colleagues and patients. By emphasizing inclusion, perhaps we can begin to overcome the partisan standstill and generate real change.

Moving forward will also require recognition that firearm-injury prevention is not the same thing as gun control. The distinction may be difficult for many people to grasp, but it is essential. Many physicians, including some of us, own firearms. As a movement, we are not anti-gun; our focus is on stopping shootings before they happen and on saving human lives.

Let us keep our voices front and center, bringing the focus of discussions about gun-injury prevention back to the person who matters: the patient. Let us continue to seek both public funding and private partnerships for conducting needed research and then implement evidence-based strategies that can reduce the toll of firearm suicide, homicide, accidental shootings, and mass shootings. Let us be collaborative in our efforts, involving stakeholders on all sides of this issue. As an example, we can look to the field of suicide prevention, in which local partnerships between public health professionals and firearm ranges have grown into a national program jointly supported by the National Shooting Sports Foundation and the American Foundation for Suicide Prevention. In this program, gun-shop owners provide suicide-prevention education to customers and employees of shooting ranges learn how to identify at-risk customers.⁵ Another example is work that AFFIRM, the ACP, the AMA, and the ACS are doing with colleagues at academic health centers around the country to create best-practice guidelines for physician counseling of at-risk patients. This work specifically acknowledges the importance of both evidence (the mainstay of all conversations about prevention) and cultural competence (just as we practice for conversations about safe sex, cigarettes, and alcohol).

At the end of the day, we all want our children, families, and communities to be safe. There are tens of thousands of us who know that we are on the cusp of transforming this epidemic. As physicians and allied health care professionals, we have a responsibility to continue to insist that this is our highway. We’ll keep driving forward, together.