Efforts aim to prevent gun injuries
As seatbelts, car seats and other auto safety features have become common, the fatality rate for young people from car crashes has dropped significantly over the years.
The doctors who treat children and adolescents who have been victims of gunfire, as well as those who work to keep young people safe, want to see a similar decline in deaths and injuries from firearms.
In 2014, the rate at which young people died from firearms injuries and car crashes was about the same: 1.76 per 100,000 died because of guns vs. 1.75 from car accidents. Since then, both rates have begun to rise.
“The things we’ve done for cars, the fact that you have to be safe when you’re in your car … I think we can apply that same template to firearm safety,” said Dr. Kirsten Bechtel, comedical director of the Injury Prevention, Community Outreach and Research Program at Yale New Haven Hospital.
A basic way to do that is by “reducing access to firearms to people who won’t safely use a firearm. It’s all about safety,” she said. When it comes to guns, the goal should be “to store them safely and to keep them away from people who should not have them,” she said.
Since 2011, 85 youths under 18 have been treated for gunshot wounds at Yale New Haven Hospital. Seven of those victims died, but that number doesn’t include victims who died before they could be brought to the hospital.
Not all gunshot victims treated at Yale New Haven come from the city. As a Level 1 trauma center, patients suffering severe gunshot wounds may be taken to the hospital from other parts of the state, even from as far as Waterbury, Dodington said.
In 2018, nine of 78 gunshot victims treated at the hospital were under 18, with one dying of his wounds. That was Ethan Song, the 15-year-old boy from Guilford who died Jan. 31, 2018. The Waterbury state’s attorney ruled he accidentally shot himself at a friend’s house.
According to Dr. James Dodington, also co-medical director of the hospital’s Injury Prevention, Community Outreach and Research Program, “the majority of those patients do fall between the ages of 18 and 35,” with very few fatalities among victims under 18.
“They’re very small numbers in the grand scheme of things,” Dodington said of younger victims. Connecticut is “a very low-risk state” for children dying of firearms, and almost none of them is a victim of homicide.
“Thankfully, we see very few firearms-related injuries in New Haven and the state of Connecticut in our system,” Dodington said.
On July 16, 2017, however, a 14-year-old New Haven boy, Tyrick Keyes, was shot on Bassett Street. His killer has not been found.
At Bridgeport Hospital, there were 35 shooting victims under 18 between 2014 and 2018, one of whom died, according to Dr. Justin Cahill, quality officer for the hospital’s Department of Emergency Medicine. Those under 18 totaled about 11 percent of all shooting victims seen at Bridgeport Hospital during those five years, Cahill said.
The one fatality was 12-year-old Clinton Howell, who was shot in the chest Dec. 18, 2018, on Willow Street in Bridgeport. Police said the target of the shooting was his cousin. Tajay Chambers, 18, was charged with murder with special circumstances in Clinton’s slaying.
“Probably weekly at least we’ll see a gunshot, not always of a young person,” Cahill said. “It’s pretty rare that we’ll see someone as young as this 12-year-old.”
The Bridgeport area also is served by St. Vincent’s Medical Center, which in 2018 treated nine gunshot victims between 15 and 18 years old, with no fatalities, according to spokeswoman Danielle Swift.
All the doctors said the medical treatment needed is just part of the difficulty when a young person suffers a firearm injury. “When it’s a child, dealing with that emotionally with the parents involved and other family members, it’s always an emotionally charged situation,” Cahill said.
Gunshot injuries create more than physical wounds too. “When you get shot, you’re at high risk for PTSD, substance abuse,” Bechtel said. She pointed to statistics saying that as many as 30 percent of those injured by gunshots suffer from post-traumatic stress disorder or depression six months after the event. Other problems include a risk of dropping out of school, problems with authority and in social relationships and a higher rate of suicide attempts.
Nationally, according to a 2017 article in the journal Pediatrics, about 1,300 youths up to age 17 are killed and almost 5,800 are treated for firearms injuries each year. The study showed that in 2007, two trends reversed course.
Based on data from 17 states, because national statistics are not available, the article stated: “Child firearm homicide rates increased significantly from 2002 to 2007, increasing 17% … and exhibited a significant decline from 2007 to 2014, decreasing 36%. … Child firearm suicide rates, on the other hand, showed a significant downward trend between 2002 and 2007, decreasing 23% … but then a significant upward trend between 2007 and 2014, increasing 60% … to the highest rate seen over the period examined. Unintentional firearm deaths exhibited a significant overall decrease between 2002 and 2014.”
According to the paper, while the overall rate of death by firearm was 1.76 per 100,000 youths, it was 1.5 per 100,000 for whites, 4.1 for blacks, 1.15 for Hispanics, 2.15 for American Indians and 0.39 for Asians. Boys were more than four times as likely to die from firearms as girls — 2.84 per 100,000 vs. 0.64, according to the report.
The rate for nonfatal firearms injuries was 7.86 per 100,000, 71 percent of them the result of assault, with the rest being accidental.
Young people suffering firearms injuries is far more of an American problem than it is for the rest of the world. According to the Pediatrics article, 91 percent of all firearms deaths of children 14 and younger in high-income countries occur in the United States.
“Approximately 19 children a day die or are medically treated in [a hospital emergency department] for a gunshot wound in the United States,” the article stated. “The majority of these children are boys 13 to 17 years old, African American in the case of firearm homicide, and white and American Indian in the case of firearm suicide.” Younger victims are most often innocent bystanders “caught in the crossfire,” it said.
“In Connecticut, we have very few people who die because of unintentional injury,” Bechtel said. “We see very few kids die by suicide compared to the rest of the nation.”
On the other hand, according to Dodington, “the majority of intentional violent injury” are in New Haven, Bridgeport and Hartford. “So we are working with our hospital and community to improve the care of victims of violence. We want to improve not only your care, but we want to coordinate with our community partners to prevent reinjury.”
Young people who are victims of shootings are at high risk for being injured again, Dodington said, so Yale New Haven is working with community partners to prevent firearms injuries from occurring.
“Yale New Haven as of 2019 has founded and begun to staff the first hospital-based violence intervention program in the state,” Dodington said. “Our goal is to serve victims of violence and give the best kind of clinical care and followup. … You need both hospitals and community partners to join together to prevent violence.”
Dodington said doctors need to “interface with schools, youth services [to] both track and intervene [with] those who are both victims of violence and those who might be at risk of violence or violent involvement.”
Bechtel said intervening before violence occurs is key. “Just like with any injury, you have to kind of walk backwards to understand how an adolescent or a child got access to a gun,” she said.
“The overarching goal is, we just want to interrupt somebody who is not supposed to access a gun from accessing a gun,” she said.
While accidental injuries by firearms are rare in Connecticut, “in the wake of Ethan Song’s death, the firearm-access laws will get even stricter here,” Dodington said. The General Assembly will be taking up a bill known as “Ethan’s Law,” sponsored by state Rep. Sean Scanlon, D-Guilford, and promoted by Ethan’s parents, Kristin and Mike Song, which would place responsibility for an accidental firearm injury on the gun owner, whether the owner knew the weapon was loaded or not.
Both Bechtel and Dodington are members of the National Network of Hospital-Based Violence Intervention Programs, which promotes programs such as National ASK Day, when parents are encouraged to ask others if they have an unlocked gun in their home, as well as gun buybacks.
Pediatric emergency medicine physicians, Dr. James Dodington, left, and Dr. Kirsten Bechtel, in their offices at University Towers in New Haven.