Dr. Eileen Bulger, the chief of trauma at Seattle's Harborview Medical Center, knows from 20 years of working in the Northwest region's Level 1 trauma center just how much damage a gunshot can do to the human body.
In July alone, 48 people were treated at Harborview for gunshot wounds, up from 26 gunshot patients seen in July 2019, representing a surge in shootings that's mirrored in cities across the country.
"We're not unique in this ... but what we're seeing is concerning," Bulger said, noting 19% of the 108 gunshot patients treated between May and July were under the age of 19.
"It doesn't reflect the (full scope of the) problem because it doesn't include the number of people who died before they got to the hospital," she said. "We have more people dying from firearm injuries in this country than in motor-vehicle crashes, so it's a huge public health problem."
Though the Centers for Disease Control and Prevention (CDC) publish annual data on the number of firearm-related deaths in the country, no one knows how many Americans survive being shot each year -- and without hard numbers or an understanding of who is at risk of getting shot, it's difficult to know the extent of the problem or develop evidence-based strategies to reduce gun violence.
The national debate over gun ownership and gun control has long been politicized and polarizing, but in recent years, the medical, criminal justice and public health communities have moved to reframe the growing problem of gun injuries and deaths as a public health crisis.
On Tuesday, Harborview and more than 100 trauma centers across the country kicked off a two-year research project to collect extra data on gun injury patients, including detailed information about the circumstances surrounding a shooting to help identify risk factors. The large number of hospitals participating in the study will allow researchers to make population estimates on the rate of non-fatal injuries and "understand the scope of the problem in different parts of the country," Bulger said.
Locally, the King County Prosecuting Attorney's Office began collecting data on shootings, primarily from the eight police departments responsible for investigating the majority of shootings in the county. Between January and June, there were 424 shooting incidents, a number that includes fatal and injury shootings as well as those that resulted in property damage and those that did not, though police found shell casings or other evidence. That number is down slightly from the three-year average of 437, but the number of fatal shootings rose 44% and injury shootings increased 21% in the first half of 2020 compared to the three-year average, the office found.
But that program, called the King County's Shots Fired Project, is unique, and little to no data is available at the state or national levels.
The national gun-injury study Harborview is participating in is being funded with a $700,000 grant to the American College of Surgeons' Committee on Trauma, which Bulger chairs. The money will be used to build a data platform, and pay for an analyst to manage the project and a group of investigators who will ensure the data is properly interpreted, with the college and individual hospitals offsetting additional costs.
"My hope is, by setting up the information software, that the (trauma) centers will want to continue" collecting data after the study ends, Bulger said. "This will get it off the ground. The centers are participating because they think this is important. It's the right thing to do to improve the outcome for patients."
The grant was awarded by the National Collaborative on Gun Violence Research, established in 2018 with $20 million in seed money from Arnold Ventures, a private nonprofit, with other organizations, including Wells Fargo, Missouri Foundation for Health, the Conrad N. Hilton Foundation, and the Harry Frank Guggenheim Foundation, also contributing.
Last year, the collaborative awarded $9.8 million to fund 17 research projects, and this year, 15 projects received $7.5 million in funding, said Asheley Van Ness, director of criminal justice for Arthur Ventures' policing team.
Each project proposal was vetted and selected by the RAND Corporation, a 70-year-old nonprofit, nonpartisan think tank, Van Ness said.
"There's a gap in our understanding about gun injuries. We don't have that information," she said. "We know from past experience in battling public health crises that research is what really turns the tide. We can't answer research questions, we can't answer policy questions if we don't have data."
The National Collaborative on Gun Violence Research seeks research in five main areas: urban gun violence, domestic gun violence, mass shootings, suicides, and officer-involved shootings.
Compared to research into other leading causes of death -- cancer, heart disease, motor-vehicle crashes -- the U.S. government has underfunded gun-violence research by an estimated $100 million a year, said Van Ness.
That's because the 1996 Dickey Amendment -- a provision backed by the National Rifle Association (NRA) -- prohibited federal funds from being used to advocate or promote gun control.
The amendment had a profound chilling effect on research into gun violence, said Dr. Fred Rivara, a pediatrician and professor at the University of Washington School of Medicine who co-founded the Harborview Injury and Prevention Research Center in 1985. He is one of four investigators who will help guide the national nonfatal gunshot injury study that began last week.
In the late 1980s and early 1990s, Rivara was one of the researchers who worked with Dr. Arthur Kellermann on a series of studies that found having a gun in a home increased the risk of suicide and homicide.
"The NRA didn't like it and they successfully lobbied Congress and got the Dickey Amendment," named after Rep. Jay Dickey of Arkansas, who before his death in 2017 said "it was a mistake" to block gun-injury research, Rivara said.
"I think it drove young researchers away because there was no money to conduct it," he said. "It was disheartening to see this public health problem basically ignored."
While the Dickey Amendment still stands, Congress issued a report in March 2018 authorizing the CDC to conduct research into the causes of gun violence.
Last year, for the first time in more than two decades, Congress appropriated $25 million to be split between the CDC and the National Institutes of Health to fund gun-violence research projects.
"The new federal funding is welcome and needed. But there's still enormous ground we have to make up," said Van Ness.
Bulger and Van Ness point to the reduction in traffic deaths as an example of how scientific research was successfully used to combat a public health emergency.
As deaths from motor-vehicle crashes rose through the 1960s before peaking in 1972 with 54,589 deaths, Congress established the National Highway Traffic Safety Administration (NHTSA), which launched a slew of research projects that have led to safer vehicles, better roadway design and campaigns like "Click It or Ticket" and "Friends Don't Let Friends Drive Drunk" to influence driver behavior.
It's estimated that more than 300,000 lives have been saved over the years as a result, Van Ness said, adding the NHTSA funds $200 million a year in research.
In 2018, the CDC reported 39,740 people died from firearm-related injuries, surpassing the 36,560 people who were killed in motor-vehicle collisions that year, according to NHTSA data.
In the U.S., two-thirds of firearm deaths are suicides, with homicides making up the bulk of the balance. Accidental deaths represent only a tiny fraction. In Washington, Rivara said suicides account for 75% of firearm deaths.
Dave Workman, a spokesperson for the Bellevue-based Second Amendment Foundation, said the organization's founder, Alan Gottlieb, has long championed suicide prevention efforts.
"And preventing bad guys from committing heinous crimes is in everyone's interest," said Workman, who is also editor-in-chief of the foundation's online magazine, TheGunMag.com.
Meanwhile, the coronavirus pandemic and social unrest over police killings of people of color have led record numbers of Americans to request background checks required to purchase firearms, according to FBI data. And last month, the National Shooting Sports Foundation estimated nearly 5 million Americans became first-time gun buyers this year.
Asked about the surge in gun buying seen across the country, Workman, who regularly talks to gun-shop owners, said it began in March with the coronavirus outbreak. That month, 3.7 million people requested background checks, 938,000 more than in February, FBI data shows.
"People were concerned a pandemic wasn't only going to make for a lot of sick cops, but that they'd be unable to respond to emergencies," Workman said.
Requests for background checks dropped to 2.9 million in April before again increasing to 3.1 million in May, according to the FBI. After protests and riots broke out across the country in response to the death of George Floyd by police in Minnesota, requests for background checks rose to 3.9 million in June and 3.6 million in July -- more than 1.5 million more in each of those months compared to June and July 2019.
"When the nightly news is showing people trying to burn down a police precinct, that does alarm people," said Workman. He believes the rise in gun ownership is the result of a sentiment that "I'm going to protect my home and family even if the police can't show up."
In Washington, 650,000 people hold concealed pistol licenses -- a number that would undoubtedly be higher by now if sheriffs and police chiefs in the state hadn't suspended their issuance in March to prevent contact between applicants and fingerprint technicians during the pandemic, according to Workman.
He estimated that 40% of all guns purchased in the last six months were by "people who have never owned a gun in their life."
Workman said gun-rights groups don't oppose unbiased scientific research into gun injuries and deaths so long as it doesn't lead "to more restrictions on law-abiding gun owners who haven't harmed anybody."
Rivara, of the Harborview Injury and Prevention Research Center, said opposition to research into gun violence began to shift after the country suffered a string of school and mass shootings.
The public has come to realize "we need to do a better job at restricting access to guns by people who will use them to harm" themselves or others, he said.
"I think the tides have really changed. Yes, we have the Second Amendment and no, we're not going to take firearms away from law-abiding citizens," Rivara said. "We're really trying to do a better job in helping people and preventing these injuries."