Prevent the Bleed: How Surgeons Can Lead the National Conversation About Firearm Safety Forward.

: In the 5 years since the Sandy Hook elementary school shooting that claimed the lives of 20 children and 6 of their teachers, we have witnessed intolerably more mass shooting events. In the intervening years, over 150,000 Americans have died because of firearm violence, 3 times the number who lost their lives during the Revolutionary war. In the last 2 months, we have been left reflecting on 2 more tragedies. The first came on October 1 in Las Vegas, at the Route 91 music festival where 58 were killed and over 500 injured by a single gunman. The second, on November 5, took place in Sutherland Springs, Texas (population 600) near San Antonio and claimed the lives of 26 men women and children while they prayed. As was witnessed in Orlando and San Bernardino, these most recent mass casualty incidents strained first responders, law enforcement, and the state's trauma systems to their breaking point.Once again, we were left searching for the reasons behind these tragedies asking predictable questions: who did this and why? Was it part of a terrorist plot or a lone psychopath with a grudge? Were the weapons obtained legally, and why would anyone need so many? How can we stop this from happening again?

Survey of American College of Surgeons Committee on trauma members on firearm injury: Consensus and opportunities.

BACKGROUND: In the United States, there is a perceived divide regarding the benefits and risks of firearm ownership. The American College of Surgeons Committee on Trauma Injury Prevention and Control Committee designed a survey to evaluate Committee on Trauma (COT) member attitudes about firearm ownership, freedom, responsibility, physician-patient freedom and policy, with the objective of using survey results to inform firearm injury prevention policy development. METHODS: A 32-question survey was sent to 254 current U.S. COT members by email using Qualtrics. SPSS was used for χ exact tests and nonparametric tests, with statistical significance being less than 0.05. RESULTS: Our response rate was 93%, 43% of COT members have firearm(s) in their home, 88% believe that the American College of Surgeons should give the highest or a high priority to reducing firearm-related injuries, 86% believe health care professionals should be allowed to counsel patients on firearms safety, 94% support federal funding for firearms injury prevention research. The COT participants were asked to provide their opinion on the American College of Surgeons initiating advocacy efforts and there was 90% or greater agreement on 7 of 15 and 80% or greater on 10 of 15 initiatives. CONCLUSION: The COT surgeons agree on: (1) the importance of formally addressing firearm injury prevention, (2) allowing federal funds to support research on firearms injury prevention, (3) retaining the ability of health care professionals to counsel patients on firearms-related injury prevention, and (4) the majority of policy initiatives targeted to reduce interpersonal violence and firearm injury. It is incumbent on trauma and injury prevention organizations to leverage these consensus-based results to initiate prevention, advocacy, and other efforts to decrease firearms injury and death. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level I; therapeutic care, level II.

Initial experience with single-incision laparoscopic cholecystectomy.

BACKGROUND: Single-incision laparoscopic surgery is now increasingly used as an approach for cholecystectomy, based on anecdotal reports of decreased pain, reduced need for hospitalization, and a better cosmetic result. This is a report of a single surgeon's (JKE) initial experience with single-incision laparoscopic cholecystectomy (SILC). STUDY DESIGN: We collected concurrent data on 238 consecutive patients undergoing SILC by 1 surgeon in a community hospital over 12 months. RESULTS: From June 2008 to June 2009, 238 consecutive patients underwent an attempted SILC for biliary colic or dyskinesia (75%) or acute cholecystitis (25%) by a single surgeon. Conversion to a standard laparoscopic cholecystectomy was necessary in 6 patients (2.5%) for inflammation or bleeding (n = 4) or short cystic duct (n = 2). Conversion to an open cholecystectomy was necessary in 1 patient (0.42%) for a short cystic duct. No injuries to the common bile duct occurred, the average operative time was 40 minutes, and 95% of patients (n = 226) were discharged home on the day of operation. Postoperative port site hematomas occurred in 3 patients (1.3%), and dehiscence of the umbilical skin incision in 2 (0.8%). No perioperative deaths occurred. CONCLUSIONS: This initial experience with SILC documents that the results of the procedure are equivalent to those with the standard procedure using 4 widely-spaced ports when performed by an experienced laparoscopic surgeon. Randomized trials will be necessary to document the suggested benefits of decreased pain and shorter hospitalization.