Long before Tennessee lawmakers started this week’s special session on gun safety in the General Assembly, public health officials have been weighing in on the impact of gun violence on hospitals and caregivers.
Last April, Dr. Jason Yaun wrote a letter to Governor Bill Lee from the Tennessee Chapter of the American Academy of Pediatrics. In recent years, he’s seen the number of gunshot victims rise at LeBonheur Children’s Hospital. His letter, which followed the Covenant School shooting in Nashville, called for Tennessee politicians to pass proven policies to reduce gun violence. Over 3,500 of his colleagues across the state signed it.
“What we saw after the tragic school shooting in Nashville was that people are united in many areas around the issue of gun violence prevention, and especially pediatricians and the pediatric community,” Dr. Yaun said.
He and other doctors across Tennessee have begun urging lawmakers to treat gun violence as they would a public health crisis. Dr. Andy Kerwin is the Chief of Trauma at Regional One’s Elvis Presley Trauma Center, where more than 960 gunshot victims have been treated already this year. He said the same model has been used to combat other causes of deadly injuries, such as automobile accidents.
“You work your way down the list of all healthcare problems that have been approached with a public health mindset, and we've done better things, and taken care of those problems, and made cars safer, bikes safer, roads safer, and awareness much greater to the public to know how to handle these things,” Kerwin said.
Dr. Martin Croce, Senior Vice president and Chief Medical Officer at Regional One, adds that medical professionals are focused on saving lives through solutions supported by both research and the consensus of citizens. As with deadly diseases, he said, this shouldn’t be a controversial political issue.
“Look at any poll, whether it's published by right-leaning media or left-leaning media, it really doesn't matter,” he pointed out. “These are commonsense solutions that are widely accepted regardless of which side of the aisle one sits on, and they're all designed to reduce the number of bullet holes in people.”
A Vanderbilt poll conducted in April found that Tennessee voters across party lines are increasingly concerned about gun violence and support background check measures and "red flag" laws. But in Tennessee, the loosening of gun regulations over the last decade parallels an increase in deaths caused by gun violence. Firearms, many improperly stored, are the top killer of children across the state. But many elected officials and gun owners are opposed to measures that regulate firearm access and storage.
Robert Mabe, Division Chief of Training for the West Memphis Fire Department, said there’s a disconnect between those who value easy access to guns and the real-world cost of having that access. Part of the problem comes from a misunderstanding of how gun violence happens: Although a majority of firearm incidents are self-harm or from an acquaintance, stories of break-ins and criminals “get baked into the American firearm psyche, and everybody wants to be armed.”
“You have folks that demonstrate that they are willing to use violence against someone else and they don't restrict their firearms,” Mabe said. “So if you're not going to do that, then you need to fund your first responders and your trauma centers at an appropriate level.”
Mabe said hospitals and emergency response services are already overburdened and serve too-large a region. The results are life-threatening, and affect every county, red and blue.
“Let's say you are in Dyersburg Tennessee, and you’re shot on a rainy day,” Mabe described. “Your closest Trauma Center is Memphis, which by ground is almost an hour, hour and a half. You're dead.”
With shootings on the rise and significant gun legislation yet to be passed, many hospitals and programs are allocating resources to intervention and community-based aid.
Dr. Regan Williams is Trauma Medical Director at Le Bonheur, which started a hospital-based intervention program called SHIFT last year to support individuals involved in gun violence during and beyond the immediate recovery process. The program is supported by the City of Memphis and aims to help victims recover physically and mentally and avoid reentering cycles and environments of violence.
“Once you have been a victim of a violent injury, you're more likely to have a second injury,” Dr. Williams said. “You’re also more likely to become a perpetrator of a violent crime and more likely to end up in jail.”
While the program is still relatively new, Dr. Williams said that there are signs that it’s having a positive impact on children and their families.
“It's hard to say what success is,” Williams admitted. “We define it as not coming back injured, and we haven't had anyone come back injured so far, so that part's good.”
A critical part of the intervention process is mental health care and counseling services for gun violence victims. It’s also one of the areas of gun violence prevention that Tennessee politicians are most willing to fund.
Dr. Kiersten Hawes, Clinical Director of The BRAIN Center Trauma Counseling Services at Le Bonheur, works closely with children involved in gun violence incidents and emphasized that the positive impact of mental health care cannot be overstated.
“I've seen several teenagers just decide to make the change, to go on a different path, simply because we're providing a space where they feel seen and they feel heard,” she said. “When you have these people and these wraparound services at LeBonheur showing them so much love, safety, and security, it just makes a world of difference.”
Hawes said that childhood shooting survivors face short- and long-term mental impacts, from depression and anxiety to post-traumatic stress disorder and behavioral changes. Victims in the SHIFT program receive mental health care immediately after the traumatic event, but can also take advantage of unlimited free counseling sessions afterward.
Mental health care is just as important for breaking cycles of community violence as it is for preventing self-harm, but Dr. Hawes said that many people in neighborhoods affected by gun violence face barriers of accessibility and affordability. And while suicide deaths have been declining in Tennessee, homicide rates continue to rise.
“What that shows us is that the state programs that were focusing on suicide, they work and we should keep doing them,” Dr. Williams said. “But we should also have a parallel program that focuses on community violence.”
Many nonprofits have sprung up in recent years to aid hospitals through community outreach and research into the systemic factors behind gun violence. Memphis Allies, a program created by Youth Villages in 2021, is working with agencies and programs across the city on long-term projects to decrease violence while also implementing a more immediate intervention program to support those at highest risk.
After researching effective strategies across the country, Memphis Allies is targeting neighborhoods at risk of gun violence and pairs every patient with an outreach specialist, life coach, and case manager. Brittney Ragin, assistant director of clinical programs, emphasized how important an individually tailored plan is for effectively helping patients get what they need to escape the cycle of violence.
“If you were to walk into the building and all we offered was a GED course to get you to college to learn how to be a nurse, that's not going to work for everybody,” she said. “Our job is to bring as many community resources to the table because it is a unique path for each individual.”
By researching and identifying what parts of the city most urgently need support, Memphis Allies is able to more effectively target the overwhelming volume of gun violence that Memphis experiences. The program is also working alongside organizations across Memphis to put in place preventative measures and address issues like socioeconomic inequality. Ragin warned that it can take up to 15 or 20 years to see results from these initiatives, but that they’ve already “started to see a good amount of success with a handful of individuals we’re serving.”
The bottom line from medical professionals across the city and state is that there’s no easy fix for gun violence: It must be fought in every way possible, and treating it as a public health crisis involves the urgency, awareness, and resources needed to make effective change.
“Reform on gun availability is one issue, social determinants is another issue, behavioral health is another issue,” Dr. Croce said. “Unless all things are addressed I'm not sure we'll really get anywhere.”
Last year, more than 1,400 people showed up at Regional One with gunshot wounds. Paramedics, counselors, and health officials say treating this public health crisis starts far beyond the hospital doors, and will take widespread collaboration to address.
“I would like for the City of Memphis to say, you know, this affects us all, not ‘It just affects you,’ ‘It just affects you,’ Dr. Hawes said. “This is truly a community-wide issue and we should all take it on as a responsibility.”