The CDC is helping states address gun injuries after years of political roadblocks

Each year, Utah sees its share of accidental injuries caused by firearms. When state health officials looked carefully at the hundreds of injuries that required emergency treatment in hospitals, they found most resulted from lapses in the most basic elements of gun safety.

Nearly three-quarters of all unintentional injuries in the state are to males between the ages of 15 and 44, most of whom accidentally shoot themselves while mishandling or cleaning the weapons. With funding from the Centers for Disease Control and Prevention, Utah streamlined its data collection on gun injuries and used that information to create a public service campaign to help prevent accidental gun injuries.

But getting to that point required a compromise to a 1996 federal rule that prohibits the CDC from using federal funds to advocate or promote gun control.

The amendment made access to granular information — things like who is being injured by firearms and the circumstances that caused those injuries — difficult to come by for health officials, policymakers and politicians. It would often take a year or longer to get such statistics as they worked their way from hospitals and through the public health bureaucracy. That has frustrated efforts to address the tens of thousands of gun deaths that occur in the United States each year.

Starting in 2020, however, nine states and the District of Columbia have received money from the CDC to set up pilot programs to speed the dissemination of this data, with the goal of using it for better public health approaches to the problem.

The near real-time data gleaned through the Firearm Injury Surveillance Through Emergency Rooms (FASTER) program spurred Utah to launch its public service campaign three years ago. Parsing age data and type of nonfatal injury, which includes intentional self-directed, unintentional, and assault-related, "helped with the messaging," says Joel Johnson, communication coordinator for the Violence and Injury Prevention Program at the state's Department of Health and Human Services.

It's difficult to draw a direct cause-and-effect relationship between the campaign and fewer unintentional gun injuries, especially because such injuries peaked in 2020, likely due to the pandemic, says Jerry Nelson, a state firearm injury epidemiologist. But, he says, the trend is back down to pre-COVID levels.

Marissa Zwald of the CDC's National Center for Injury Prevention and Control, says when she helped launch FASTER three years ago, "the main goal ... was to address the timeliness issue in our firearm injury data at the national level."

"Our traditional surveillance systems to monitor firearm injuries are usually lagged by about two years," she says.

A path around a ban on studying gun violence and prevention

FASTER grants of around $225,000 to states involved in the pilot program have allowed them to set up tools to pull the codes physicians use on electronic hospital records to record patient diagnoses. The money was made available by a congressional compromise over the 1996 Dickey Amendment. The amendment had largely stifled government research to study firearms violence and prevention. However in 2018, Congress agreed to free up to $25 million for research and the money was included in a 2020 spending bill.

Amanda Dylina Morse, who helped set up Washington state's FASTER program, says previously "a large number of state- and county-level health departments were paid by CDC to engage in lots of sort of opioid-related surveillance and response work" and that FASTER mirrored some of those methods and procedures. With opioids, Washington worked with health officials at the local level to share data, which, in turn, helped improve the effectiveness of prevention, intervention and treatment programs. The hope is that more rapid availability of firearm injury data will result in similar successes.

Morse, who is now a clinical instructor for the Department of Health Services at the University of Washington School of Public Health, says the main difference was funding that had been cut off under the Dickey Amendment. Because of the congressional compromise on the ban, "it was the first time that the federal government has been able to really spend any kind of CDC money on firearm work in a very long time."

A more complete picture of gun violence

Kenan Zamore, an epidemiologist with the Washington, D.C., Department of Health, says that traditionally most firearm injury data has come from law enforcement, but that doesn't present the full picture. "Not all firearm injuries are tied to the prosecution or a criminal complaint," he says.

Washington, D.C., has used some of its CDC funding through FASTER to create a public dashboard that went live in recent weeks. It pulls in diagnostic data as well as the age and ethnicity of victims, including the ward and ZIP code where they live. Among other things, the dashboard currently shows an alarming 18% year-on-year increase in firearms-related visits to hospital emergency departments. A heat map on the site also indicates that around 11 p.m. is the peak time of day for hospital visits related to firearms injuries.

Further, Zamore says, D.C. has found that as many as 40% of people in the District who show up at hospitals with nonfatal gun injuries go on to be killed by a firearm. So, being able to identify and successfully intervene to prevent further violence is likely to save lives.

One way that information is being used is to prepare hospital-based violence interruption programs designed to de-escalate conflict and offer mediation to resolve conflicts between potential assailants and victims. Where these programs have been introduced, they have proven very effective.

With real-time data, health officials can help make sure such programs are properly staffed, Zamore says. "That actually helped us effectively deploy resources, but also [gave] them more information."

The same has been true in New Mexico, which has also received FASTER funds. Rachel Wexler, the Injury and Violence Prevention section manager at New Mexico's Department of Health, says the city of Albuquerque, for example, has "a pretty solid community violence intervention program running."

With the ready availability of firearms injury data, "they would have more ability to know where physically in Albuquerque they should be directing their efforts," she says.

It all goes back to pump handles, says Morse. It's a concept in public health that traces its origins to the 1854 London cholera outbreak. When the city removed the pump handle to a drinking well, it proved contaminated water was the culprit. "For firearms, you're not going to be able to find your pump handle if you don't understand all of those nonfatal incidents," she says.

You can't help people killed by gun violence, "but you absolutely can help the people who live," Morse says.

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