commentary

(Health Affairs Blog)

December 26, 2012

Responding to Newtown

by Arthur L. Kellermann

The horrific massacre of 27 children and adults in Newtown, Connecticut ranks second only to Virginia Tech among U.S. mass shootings. These tragedies are part of a lengthening list of mass killings in such varied places as a shopping mall, a movie theater, a Sikh Temple, a high school, a congressional constituent meeting, and a military base. But this one was different. Not only were the death toll particularly high and the killings particularly savage; the killer's victims were first-grade students, teachers and school staff.

Millions are deeply touched by this tragedy, but few of us can fathom the shock and grief felt by the survivors, parents, family members and friends of those who died. Our first concern must be to comfort them and support what will likely be a long and difficult recovery. But few people are prepared to stop with that. This event, unlike its predecessors, has sparked a movement to challenge the inevitability of mass shootings, not to mention the thousands of individual gun homicides that occur each year in the United States.

In response, President Obama has signaled his intention to submit legislation to the Congress by end of January. To prepare for this action, he is convening an Administrative task force, led by Vice President Biden, to craft a package of proposals. What this panel recommends, and how the public reacts over the next few weeks, could be decisive in determining what will come from this terrible tragedy.

The investigation of the incident is still in its early stages. We already know that many of the early reports from the scene were wrong. As witnesses are interviewed and evidence is meticulously reviewed, elements of the story may evolve. We should not be surprised if the final picture looks different from the one we have today.

Nevertheless, enough is known from broad outlines of the attack and past research on gun violence to offer some preliminary thoughts to the Administration's task force and the public:

  1. The weapon matters. America is not the only nation that has witnessed attacks against students. The same day the killings at Sandy Hook Elementary occurred, a deranged villager in Henan Province, China slashed 22 schoolchildren with a knife. Although many of the students required surgery, none were critically injured and none died. More than 4 decades ago, Franklin Zimring analyzed a large series of gun and knife attacks and confirmed that attacks with guns are far more likely to end in the death of the victim than attacks involving knives, even after controlling for the strength of the offender's intent to kill. The type of firearm used matters as well. Although the Newtown shooter carried 3 weapons — two large caliber, semi-automatic handguns and a Bushmaster AR-15 assault rifle — he did most of his killing with the assault rifle. Its physical characteristics and the capacity of the magazines it accommodates enabled him to achieve a volume and accuracy of fire that would be nearly impossible for an inexperienced shooter to match with a Glock 10 mm or a Sig Sauer 9 mm.
  2. Learn from what went right, as well as what went wrong. As we mourn the terrible loss of life in Newtown, we must remember that it could have been much worse. But for the heroic actions of Dawn Houchsprung, the school's 5 foot 2 principal, and other staff members who died confronting the shooter or attempting to shelter their students, the shooter might have killed even more children. Had other teachers rushed into the hallway with their young charges, rather than hiding and quieting them, the death toll would have been higher. In at least some instances, lockable doors saved lives. Because the police responded swiftly, the killer opted to shoot himself rather than hunt for more children.
  3. The best time to stop gun violence is before the 911 call. Even though Newtown's police and emergency medical responders responded swiftly, by the time they arrived there was no offender to stop and few living casualties to treat. This is not unusual with gun attacks. In 1996, a team of researchers I led documented the outcomes of gunshot injury victims (PDF) in three U.S. cities served by an advanced life support ambulances and level I trauma centers. Fully 97 percent of those who died were either pronounced dead on the scene, or succumbed within 24 hours of the injury. This finding suggests that we are already pushing the envelope with what can be accomplished with trauma care alone. Future gains in survival must come through prevention. The same logic applies to law enforcement. When the NRA rejects more gun control and calls instead for "aggressive enforcement of our nation's existing gun laws," they are generally referring to tough prosecution and lengthy sentences for violent gun offenders. Reactive policing has its place, but it's not enough. Research has shown that smart, proactive enforcement of laws that prohibit the purchase, transfer, and/or carrying of guns by felons, juveniles and other legally-proscribed individuals can substantially reduce rates of homicide and gun violence.
  4. Don't judge the feasibility of various policy options through the lens of a single event. Just as generals are often accused of planning to fight the "last war", policymakers tend to embrace or reject measures based on the last incident. Consider the accretive way we've added layer upon layer of procedures to the screening process at airports. So beware those who reject a good idea out of hand because "that wouldn't have worked at Newtown". Just because an intervention doesn't work 100 percent of the time doesn't mean it can't — or won't — decrease the frequency or severity of gun violence. Some people die in car crashes despite wearing a seatbelt, but we know that the toll of severe injuries and deaths in crashes has been dramatically reduced as a result of widespread use of seat belts. Likewise, cast a skeptical eye on claims that any policy change will set us on a "slippery slope" that will swiftly lead to confiscation of all firearms. Over the last 20 years, the number of Americans dying in motor vehicle crashes has declined by 31 percent. Deaths from fires and from drowning have fallen even more, by 38 percent and 52 percent, respectively. As Dr. Fred Rivara of the University of Washington and I note in a commentary posted by JAMA, this progress was achieved without banning automobiles, swimming pools or matches.
  5. Don't despair. Perhaps the greatest obstacle to a constructive response is the self-defeating sense that nothing can be done. Pessimism is an understandable point of view. After all, the power of the gun lobby is legendary, and it is backed by supporters who hold positions of great power. And the public remains conflicted about what to do. A story in this morning's issue of the Washington Post notes that the Newtown massacre has sparked a run on Bushmaster rifles. Gun control advocates, anticipating that protracted legislative fight will lead to a stalemate and ultimately no action, will be tempted to ram through any measure they can get even if it is long on symbolism but short on substance. Gun control opponents are probably banking on the assumption that the public's attention span is short, and once the passions of the moment cool, life can get back to normal. My hope is that we'll chart a middle course: one that swiftly identifies effective actions that the vast majority of Americans can support, backed by the political will to get it done. If we fail, the children and teachers of Newtown will have died in vain.

This commentary was first published on December 21, 2012 on Health Affairs Blog. Copyright ©2012 Health Affairs by Project HOPE — The People-to-People Health Foundation, Inc.


Arthur Kellermann is the Paul O'Neill–Alcoa Chair in Policy Analysis at the RAND Corporation.

This commentary appeared on Health Affairs Blog on December 26, 2012

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