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. 2023 May 2;24(3):552-565.
doi: 10.5811/westjem.58395.

Nonfatal Injuries Sustained in Mass Shootings in the US, 2012-2019: Injury Diagnosis Matrix, Incident Context, and Public Health Considerations

Matthew P Czaja  1 , Chadd K Kraus  2 , Su Phyo  3 , Patrick Olivieri  4 , Dalier R Mederos  5 , Ivan Puente  5 , Salman Mohammed  6 , Ross P Berkeley  6 , David Slattery  6 , Thomas H Gildea  7   8 , Claire Hardman  9 , Brandi Palmer  10 , Melissa L Whitmill  11 , Una Aluyen  12 , Jeffery M Pinnow  13 , Amanda Young  14 , Carly D Eastin  14 , Nurani M Kester  15 , Kaitlyn R Works  16 , Andrew N Pfeffer  16 , Aleksander W Keller  17 , Adam Tobias  17 , Benjamin Li  18 , Brian Yorkgitis  19 , Soheil Saadat  20 , Mark I Langdorf  20
Affiliations

Nonfatal Injuries Sustained in Mass Shootings in the US, 2012-2019: Injury Diagnosis Matrix, Incident Context, and Public Health Considerations

Matthew P Czaja et al. West J Emerg Med. .

Abstract

Introduction: The epidemic of gun violence in the United States (US) is exacerbated by frequent mass shootings. In 2021, there were 698 mass shootings in the US, resulting in 705 deaths and 2,830 injuries. This is a companion paper to a publication in JAMA Network Open, in which the nonfatal outcomes of victims of mass shootings have been only partially described.

Methods: We gathered clinical and logistic information from 31 hospitals in the US about 403 survivors of 13 mass shootings, each event involving greater than 10 injuries, from 2012-19. Local champions in emergency medicine and trauma surgery provided clinical data from electronic health records within 24 hours of a mass shooting. We organized descriptive statistics of individual-level diagnoses recorded in medical records using International Classification of Diseases codes, according to the Barell Injury Diagnosis Matrix (BIDM), a standardized tool that classifies 12 types of injuries within 36 body regions.

Results: Of the 403 patients who were evaluated at a hospital, 364 sustained physical injuries-252 by gunshot wound (GSW) and 112 by non-ballistic trauma-and 39 were uninjured. Fifty patients had 75 psychiatric diagnoses. Nearly 10% of victims came to the hospital for symptoms triggered by, but not directly related to, the shooting, or for exacerbations of underlying conditions. There were 362 gunshot wounds recorded in the Barell Matrix (1.44 per patient). The Emergency Severity Index (ESI) distribution was skewed toward higher acuity than typical for an emergency department (ED), with 15.1% ESI 1 and 17.6% ESI 2 patients. Semi-automatic firearms were used in 100% of these civilian public mass shootings, with 50 total weapons for 13 shootings (Route 91 Harvest Festival, Las Vegas. 24). Assailant motivations were reported to be associated with hate crimes in 23.1%.

Conclusion: Survivors of mass shootings have substantial morbidity and characteristic injury distribution, but 37% of victims had no GSW. Law enforcement, emergency medical systems, and hospital and ED disaster planners can use this information for injury mitigation and public policy planning. The BIDM is useful to organize data regarding gun violence injuries. We call for additional research funding to prevent and mitigate interpersonal firearm injuries, and for the National Violent Death Reporting System to expand tracking of injuries, their sequelae, complications, and societal costs.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Distribution of Emergency Severity Index triage level at the primary receiving hospital for 403 survivors of 13 civilian public mass shootings in the United States (2012–19) compared to data from the 2017 National Hospital Ambulatory Medical Care Survey.
Figure 2
Figure 2
Anatomic distribution of nonfatal gunshot wounds and other trauma sustained by 403 survivors of 13 civilian public mass shootings in the United States (2012–19). Colored circles are proportional to the number of coded injuries, with black denoting gunshot wounds (n=357), yellow, fracture (n=157), blue, neurologic (n=34), and red, vascular (n=30).
See this image and copyright information in PMC

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