Nov. 10, 2022
Though some might question how traumatology work reconciles with gun safety, Henry J. Schiller, M.D., a trauma surgeon at Mayo Clinic's campus in Rochester, Minnesota, does not see a rigid dichotomy between the two: He believes guns can be compatible with work as a trauma professional.
"I have handguns and long guns," he says. "I enjoy target shooting and duck hunting."
Dr. Schiller says his three sons have learned gun safety and enjoy the shooting range. His middle son has participated in high school trapshooting, a sport Dr. Schiller says has become popular for this demographic. A Minnesota State High School Clay Target League article indicates trapshooting has the lowest school sports injury rates compared with sports such as football, he says.
"I've attended competitions with hundreds of kids walking around with guns, yet it's incredibly safe," Dr. Schiller says.
The reason he feels safe at youth trapshooting competitions is the students have thorough gun safety training and follow best practices, such as:
- Storing firearms unloaded and locked or in a gun safe.
- Keeping ammunition separated from guns.
He personally follows these best practices at home.
"I have a strong gun safe," he says. "Only I have the combination. I keep ammunition and guns separated, locked away. I keep tight control of my ammunition."
Yet Dr. Schiller sees accidental, homicidal and suicidal gun injuries in his trauma work. In fact, he indicates trauma from firearms has grown from one incident a year when he arrived at Mayo Clinic in 2001 to now occurring several times monthly. He recognizes broad measures to maintain safety when guns are present are crucial.
What gun safety implies
Nicole M. Guerton, M.S., a trauma center injury prevention coordinator at Mayo Clinic's campus in Rochester, Minnesota, believes gun safety requires responsible use and storage.
"If you think about it, cars — like firearms — are tools if used properly, but they also can be weapons and giant disaster machines," she says. "Gun safety is not always about taking things away — such as guns for sport or protection — but proper securing of the firearm and ammunition so everyone's protected. Guns are another tool, and there's a reason we don't let three- or four-year-olds use deadly tools."
Proper gun storage protects against curiosity and impulsivity — especially for children, teens and young adults — and irrational thinking, which can lead to unintentional or intentional injury.
Overcoming gun safety objections
You may find members of your community object to locked guns stored separately from ammunition.
They may ask, "If I have a personal protection firearm, how do I access it quickly? If my gun's unloaded, what good does it do me?"
Guerton acknowledges these as understandable perspectives. Depending on storage budget, she proposes biometric safes, opening in under two seconds, may address this concern.
Spreading community gun safety awareness
Guerton recommends trauma centers participate in gun safety initiatives, with or without education.
"Education is wonderful, but it doesn't dictate behavior or supersede curiosity," she says. "We need to employ more than education; we also need to guard against curiosity and misuse."
Guerton suggests inviting community members to learn about the following concepts to help overcome curiosity or impulse control with firearms:
Secure firearms at home
Encourage safe storage of firearms and avoid leaving them out in the open. Safe home firearm storage helps protect against emotion-based decision-making. Encourage firearm owners to purchase or obtain a free gun lock at a police station or use a safe.
"I grew up on a farm," she says. "My dad had a gun accessible for wild animals. If my dad told me not to touch it, I wouldn't do it. But many people, children especially, aren't like that. We have to ensure guns are safe with a trigger lock or gun safe, and ammunition is kept separate from the firearm. Appropriate storage also may depend on the gun's priority. According to Gallup polling on guns, most home firearms are for personal protection, target shooting or hunting."
"We know brains don't fully develop till we're in our 20s," she continues. "If a firearm is out and available, despite education or rules about which objects not to touch, curiosity can and will arise in your child, neighbor, relative or visitor, and will overpower rational thinking."
For adults, impulsivity may arise in a situation where they feel threatened, producing an adrenaline rush impairing judgment.
Dr. Schiller says individuals dying by suicide are more likely to have a gun in the home, as noted in a Harvard T.H. Chan School of Public Health article. However, proper firearm storage decreases suicide risk, according to an article by Dr. Shenassa and colleagues published in the Journal of Epidemiology & Community Health.
"Most gun owners I know are reasonable and responsible; they were raised with guns," he says. "But everyone has bad periods in their lives with some impulsivity. If someone has a loaded gun around, impulsivity becomes a bigger issue, and job loss or alcohol can amplify that. Men, in particular, have a higher firearm suicide risk. If someone's in crisis, I'd suggest looking for somewhere to voluntarily store any guns for a time."
Support laws limiting children's gun access
According to a 2020 RAND Corporation gun policy report, proven, successful community gun safety strategy involves laws limiting children's gun access. As stringency of these laws increases, pediatric suicides decrease significantly.
"Regardless of how threatened people feel, if children are in the home, they'll find a gun — there will be a tragedy," he says.
He says Minnesota has strong child gun access prevention laws. If children can get hold of firearms, law enforcement can charge adults in the home.
Identify firearm dangers for your children at others' homes
Beyond safe gun storage, Guerton says parents have a responsibility to educate their children about gun safety and identify if their children are visiting friends' homes with unstored guns.
She suggests, "When children go to friends' houses, find out parents' names and phone numbers, discuss allergies or phone restrictions, and talk about firearms."
However, she says the way you inquire about guns in the home may make all the difference.
Guerton says, "Use something open-ended, including the word 'how,' inviting discussion, rather than 'Do you have firearms?' "Say, 'If you have firearms in your home, how're they safely secured?'"
Guerton says any awkwardness in this conversation is worth it to know that unsecured guns aren't available at the friend's home, to endanger your child.
Talk to patients after admission for firearms trauma
Guerton says when patients are admitted for gun-related injuries, discreetly mentioning gun safety is critical. Later in their hospital stays after they have some distance from the trauma — and, crucially, when patients appear physically and psychologically ready — may be an appropriate time for a discussion. Probe to see if violence exists at home, and if there are mental health concerns for someone they live with or other safety concerns. If the patient owns a gun, ask about priorities for it.
Guerton recommends trauma staff members educate themselves about gun storage or lock options, especially for different budgets.
Ask yourself, "If a patient has X firearm priority and Y budget, what will put them in a safer position?" she says.
Guerton recommends using open-ended questions to avoid putting patients on the defensive.
She also advocates for firearm safety discussions integrated into primary care patient physicals.
Trauma and primary care physicians also can refer patients owning firearms to local gun safety classes. Guerton also suggests recommending patients and families participate in a free online gun safety seminar or review other online gun safety information, such as Project ChildSafe's guide about responsible gun ownership.
To reach those without primary care, she suggests trauma professionals work with local police, shooting range personnel, military members, and conceal-and-carry course instructors, forming a coalition to spread gun safety and responsible use messages. She emphasizes the importance of ensuring your coalition includes diverse professions, beliefs, values and ethnicities to accurately represent your local population and consider all viewpoints.
"You need people willing to listen and learn about others' perspectives and beliefs," she says. "People won't consider change unless they feel heard."
For more information
Is trapshooting high school's safest sport? Minnesota State High School Clay Target League.
Firearm access is a risk factor for suicide. Harvard T.H. Chan School of Public Health.
Shenassa ED, et al. Safer storage of firearms at home and risk of suicide: A study of protective factors in a nationally representative sample. Journal of Epidemiology & Community Health. 2004;58:841.
Smart R, et al. The science of gun policy: A critical synthesis of research evidence on the effects of gun policies in the United States. 2nd ed. RAND Corp; 2020.
Project ChildSafe. A guide to responsible gun ownership, safe handling and secure storage. National Shooting Sports Foundation.
Guns. Gallup.
Refer a patient to Mayo Clinic.