Addressing Systemic Racism and Racialized Violence to Reduce Firearm Injury and Mortality Inequities.

This JAMA Forum discusses systemic racism and racialized violence, promising approaches to address inequities in firearm violence, and ways to treat the trauma of gun violence.

Trends in pediatric firearm-related injuries and disparities in acute outcomes.

Background: Firearm-related injuries (FRI) are an increasing cause of death and injury in children. The etiology for this rise is multifactorial and includes socioeconomic factors. Despite its prevalence and documented increase over COVID-19, there is a paucity of research on disparities and the influence of social determinants of health (SDH) in pediatric FRI. This study aims to explore the epidemiology of this vulnerable population in Atlanta, trends over time and relevant dates such as COVID-19 and a state firearm law, and disparities in clinical outcomes. Methods: Retrospective cohort of patients with FRI (0-20 years-old, x̄=9.8, Median = 11) presenting to our hospital EDs from January 2014 to April 2023 (N = 701) and eligible for the Trauma Registry. This period includes two major events, namely the COVID-19 pandemic (March 2020), and passage of state law Constitutional Carry Act (SB 319) (April 2022), allowing for permit-less concealed firearm carry. Single series interrupted time series (ITS) models were run and clinical outcome differences between race and insurance groups were calculated unadjusted and adjusted for confounders using inverse propensity treatment weights (IPTW). The primary outcome was mortality; secondary are admission and discharge. Results: Majority of FRI involved patients who were male (76.7%), Black (74.9%), publicly insured (82.6%), ≤12 years-old (61.8%), and injured by unintentional shootings (45.6%) or assault (43.7%). During COVID-19, there was a sustained increase in FRI rate by 0.42 patients per 1,000 trauma visits per month (95% CI 0.02-0.82, p = 0.042); post-SB 319 it was 2.3 patients per 1,000 trauma visits per month (95% CI 0.23-4.31, p = 0.029). Publicly insured patients had 58% lower odds of mortality than privately insured patients (OR 0.42, 95% CI 0.18-0.99, p = 0.047). When controlled for race and mechanism of injury, among other confounding factors, this association was not significant (p = 0.652). Conclusion: Pediatric FRI are increasing over time, with disproportionate burdens on Black patients, at our hospitals. Disparities in mortality based on insurance necessitate further study. As social and economic repercussions of COVID-19 are still present, and state firearm law SB 319 is still in effect, assessment of ongoing trends is warranted to inform preventative strategies.

Pancreaticoureteric fistula following penetrating abdominal trauma: A Case Report.

Pancreaticoureteric Fistula (PUF) is a very rare complication secondary to penetrating abdominal trauma involving the ureter and pancreatic parenchyma. Pancreatic injuries carry h igh morbidity due to the involvem ent of surrounding structures and are d ifficult to diagnose due to thei r retroperitoneal location. A case of a patient is reported at Civil Hospital, Hyderabad who presented with a history of firearm injury and missed pancreatic duct involvement on initial exploration that eventually led to the development of Pan creaticoureteric Fistula. He was managed v ia p erc ut aneous nep hrostomy ( PCN ) for the right ureteric injury and pancreatic duct (PD) stenting was done for distal main pancreatic duct injury (MPD).

Application of OFA-based ERAS for video-assisted thoracoscopic surgery in elderly patients with airway stenosis: A case report.

BACKGROUND: Thoracic surgery without general anesthesia can be traced back to the First World War, and thoracic epidural block was used to complete the operation due to a large number of patients with gunshot wounds who needed emergency thoracic surgery. By reducing the intraoperative opioid dose, intraoperative and postoperative opioid-related adverse events such as respiratory depression, nausea and vomiting, delirium, hyperalgesia, and other side effects can be reduced to the benefit of patients. METHODS: A 72-year-old male patient was admitted to the hospital with a 5-day history of multifocal pain throughout the body caused by a fall. The injury was not treated at that time, and the pain gradually increased, accompanied by cough with difficulty expelling sputum. DIAGNOSES: Left lung contusion; traumatic pneumonia; multiple left rib fractures; left fluid pneumothorax; thyroid tumor of unknown nature, possibly malignant. Grade I tracheal stenosis; Sequelae of cerebral infarction. Because of goiter and severe tracheal compression, the patient was not intubated and received deopiated general anesthesia combined with epidural anesthesia to preserve spontaneous breathing. OUTCOMES: At the end of the video-assisted thoracoscopic exploration, the patient was immediately conscious and returned directly to the ward 6 min later. The patient was able to move freely after surgery and eat normally within 6 h of surgery. The postoperative visual analog scale score was 2 points, and there were no anesthetic complications during the follow-up. CONCLUSION: The opioid-free anesthesia strategy of tubeless general anesthesia, allowing spontaneous breathing combined with epidural anesthesia in elderly patients with tracheal stenosis undergoing video-assisted thoracoscopic surgery can not only avoid accidents and injuries caused by tracheal intubation and mechanical ventilation, but can also significantly reduce postoperative respiratory complications, optimize postoperative analgesia, and help achieve enhanced recovery after surgery.

Firearm injury and the Deloyers procedure: case report and literature review.

Following extended colon resections, it may not always be possible to perform colorectal anastomosis. The Deloyers procedure, which involves the transposition of the right colon, has been identified as a viable solution. This report aims to discuss the circumstances under which the Deloyers procedure was performed, as well as to evaluate the early and late postoperative outcomes, by reviewing cases conducted between 2010 and 2023. In a 22-year-old female patient who suffered major organ and tissue loss (with injuries to the sigmoid colon, descending colon, transverse colon, and mesentery) due to a firearm injury, the Deloyers procedure was applied during restorative surgery following initial damage control surgery. The procedure involved mobilizing the cecum and right colon, performing a cranio-caudal rotation over the ileocolic artery pedicle, followed by an appendectomy, and creating a colorectal anastomosis using circular staplers. There were no complications during the postoperative follow-ups. By the 14th postoperative day, the patient was discharged and experienced bowel movements four times a day, managed with 2.5 mg of diphenoxylate hydrochloride and 0.025 mg of atropine sulfate. At the 6-month follow-up, the frequency of bowel movements had decreased to twice daily without the need for medical treatment. Given the functional outcomes in patients after extended left colectomies, the Deloyers procedure, with its low associated morbidity, stands out as a viable option.

Receptivity of providing firearm safety storage devices to parents along with firearms safety education.

Background: In the United States, 33% of households with children contain firearms, however only one-third reportedly store firearms securely. It's estimated that 31% of unintentional firearm injury deaths can be prevented with safety devices. Our objective was to distribute safe storage devices, provide safe storage education, evaluate receptivity, and assess impact of intervention at follow-up. Method: At five independent, community safety events, parents received a safe storage device after completing a survey that assessed firearms storage methods and parental comfort with discussions regarding firearm safety. Follow-up surveys collected 4 weeks later. Data were evaluated using descriptive analysis. Result: 320 participants completed the surveys, and 288 participants were gunowners living with children. Most participants were comfortable discussing safe storage with healthcare providers and were willing to talk with friends about firearm safety. 54% reported inquiring about firearm storage in homes their children visit, 39% stored all their firearms locked-up and unloaded, 32% stored firearms/ammunition separately. 121 (37%0.8) of participants completed the follow-up survey, 84% reported using the distributed safety device and 23% had purchased additional locks for other firearms. Conclusion: Participants were receptive to firearm safe storage education by a healthcare provider and distribution of a safe storage device. Our follow up survey results showed that pairing firearm safety education with device distribution increased overall use of safe storage devices which in turn has the potential to reduce the incidence of unintentional and intentional self-inflicted firearm injuries. Providing messaging to promote utilization of safe storage will impact a firearm safety culture change.

Firearm screening and secure storage counseling among home visiting providers: a cross-sectional study of SafeCare® providers in the U.S.

Background: Firearms used in pediatric firearm deaths are most often obtained from the child's home, making secure firearm storage initiatives imperative in prevention efforts. Evidence-based home visiting (EBHV) programs are implemented with over 277,000 families annually, providing an opportunity for secure firearm storage counseling. The purpose of this study was to assess EBHV providers' experiences with firearm screening ("assessment"), secure storage counseling, and their perceptions for related training needs. Methods: Providers in the U.S. from SafeCare®, an EBHV program often implemented with families experiencing increased risk of child neglect and physical or emotional abuse, were invited to participate in a survey to examine firearm assessment and attitudes toward and experiences with firearm safety counseling. Survey items were primarily Likert scale ratings to indicate level of agreement, with some open-ended follow-up questions. Descriptive statistics (i.e., frequencies and percentages) were used to report item-level agreement. A post hoc analysis was conducted using Spearman correlation to examine the association between assessment and counseling and provider-level factors. Results: Sixty-three SafeCare providers consented to and completed the survey items. Almost three-quarters (74.6%) agreed/strongly agreed that they assess in-home firearm availability. However, 66.7% agreed/strongly agreed that they have not been adequately trained to discuss firearm safety topics. A substantial proportion (80.6%) indicated they would counsel more if materials and training on this topic were available. Response variability emerged by level of urbanicity. A post hoc analysis found that providers' self-reported frequency of assessment and counseling were associated with their comfort level discussing firearm safety and whether or not they had worked with families impacted by firearm injury. Conclusion: SafeCare providers report a need for materials and training on secure firearm storage, and a willingness to provide more counseling with proper training to the families they serve. Findings illuminate the need for secure storage initiatives for EBHV programs, which have broad service reach to a substantial number of at-risk U.S. families annually.

Outcomes by time-to-OR for penetrating abdominal trauma patients.

INTRODUCTION: Time-To-OR is a critical process measure for trauma performance. However, this measure has not consistently demonstrated improvement in outcome. STUDY DESIGN: Using TQIP, we identified facilities by 75th percentile time-to-OR to categorize slow, average, and fast hospitals. Using a GEE model, we calculated odds of mortality for all penetrating abdominal trauma patients, firearm injuries only, and patients with major complication by facility speed. We additionally estimated odds of mortality at the patient level. RESULTS: Odds of mortality for patients at slow facilities was 1.095; 95% CI: 0.746, 1.608; p = 0.64 compared to average. Fast facility OR = 0.941; 95% CI: 0.780, 1.133; p = 0.52. At the patient-level each additional minute of time-to-OR was associated with 1.5% decreased odds of in-hospital mortality (OR 0.985; 95% CI:0.981, 0.989; p < 0.001). For firearm-only patients, facility speed was not associated with odds of in-hospital mortality (p-value = 0.61). Person-level time-to-OR was associated with 1.8% decreased odds of in-hospital mortality (OR 0.982; 95% CI: 0.977, 0.987; p < 0.001) with each additional minute of time-to-OR. Similarly, failure-to-rescue analysis showed no difference in in-hospital mortality at the patient level (p = 0.62) and 0.4% decreased odds of in-hospital mortality with each additional minute of time-to-OR at the patient level (OR 0.996; 95% CI: 0.993, 0.999; p = 0.004). CONCLUSION: Despite the use of time-to-OR as a metric of trauma performance, there is little evidence for improvement in mortality or complication rate with improved time-to-OR at the facility or patient level. Performance metrics for trauma should be developed that more appropriately approximate patient outcome.

Evaluation of emergency department admissions of mass casualty patients using the revised trauma score, injury severity score, and trauma and injury severity score.

BACKGROUND: There is a need for studies evaluating prognostic scoring systems in mass trauma patients in conflict regions to predict patient prognosis for emergency surgical prioritization. In this study, we aimed to evaluate scoring systems such as the Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) in trauma patients admitted due to mass trauma in Northern Syria. METHODS: This study was a retrospective evaluation of patients admitted due to mass trauma to the emergency departments of hospitals in Northern Syria. The diagnostic efficiency of RTS, ISS, and TRISS scoring systems was evaluated in these admissions in the first half of 2021. RESULTS: The most common causes of mass trauma were bomb blast (67.3%), gunshot (28.8%), and 14 (3.9%) patients admitted with other causes. When the odds ratio (OR) was analyzed, a one-unit increase in the RTS score increased the odds of survival by a factor of 6.133, and a one-unit increase in the TRISS score increased the odds of survival by a factor of 1.057. Differently, it was found that each 1-unit increase in ISS decreased the patient's probability of survival by 0.856 units. When RTS, TRISS, and ISS scores were analyzed, the area under the ROC curve was statistically significant for all of them (p<0.001) and all of them had a diagnostic value for mortality with sensitivities of 99.0%, 94.8%, and 91.9%; specificities of 87.8%, 90.5%, and 88.6; AUC of 0.958, 0.975, and 0.958, respectively. CONCLUSION: The use of trauma scoring systems, especially TRISS, may be useful for prioritizing patients in mass casualty settings in the presence of overcapacity.

School Shootings in the United States: 1997-2022.

OBJECTIVES: Gun violence in the United States is a public health crisis. In 2019, gun injury became the leading cause of death among children aged birth to 19 years. Moreover, the United States has had 57 times as many school shootings as all other major industrialized nations combined. The purpose of this study was to understand the frequency of school-related gun violence across a quarter century, considering both school shootings and school mass shootings. METHODS: We drew on 2 publicly available datasets whose data allowed us to tabulate the frequency of school shootings and school mass shootings. The databases contain complementary data that provide a longitudinal, comprehensive view of school-related gun violence over the past quarter century. RESULTS: Across the 1997-1998 to 2021-2022 school years, there were 1453 school shootings. The most recent 5 school years reflected a substantially higher number of school shootings than the prior 20 years. In contrast, US school mass shootings have not increased, although school mass shootings have become more deadly. CONCLUSIONS: School shootings have risen in frequency in the recent 25 years and are now at their highest recorded levels. School mass shootings, although not necessarily increasing in frequency, have become more deadly. This leads to detrimental outcomes for all the nation's youth, not just those who experience school-related gun violence firsthand. School-based interventions can be used to address this public health crisis, and effective approaches such as Multi-Tiered Systems of Supports and services should be used in support of students' mental health and academic and behavioral needs.

Defining the Problem: 53 Years of Firearm Violence Afflicting America's Schools.

BACKGROUND: Firearm violence and school shootings remain a significant public health problem. This study aimed to examine how publicly available data from all 50 states might improve our understanding of the situation, firearm type, and demographics surrounding school shootings. STUDY DESIGN: School shootings occurring in the US for 53 years ending in May 2022 were analyzed, using primary data files that were obtained from the Center for Homeland Defense and Security. Data analyzed included situation, injury, firearm type, and demographics of victims and shooters. We compared the ratio of fatalities per wounded after stratifying by type of weapon. Rates (among children) of school shooting victims, wounded, and fatalities per 1 million population were stratified by year and compared over time. RESULTS: A total of 2,056 school shooting incidents involving 3,083 victims were analyzed: 2,033 children, 5 to 17 years, and 1,050 adults, 18 to 74 years. Most victims (77%) and shooters (96%) were male individuals with a mean age of 18 and 19 years, respectively. Of the weapons identified, handguns, rifles, and shotguns accounted for 84%, 7%, and 4%, respectively. Rifles had a higher fatality-to-wounded ratio (0.45) compared with shooters using multiple weapons (0.41), handguns (0.35), and shotguns (0.30). Linear regression analysis identified a significant increase in the rate of school shooting victims (ß = 0.02, p = 0.0003), wounded (ß = 0.01, p = 0.026), and fatalities (ß = 0.01, p = 0.0003) among children over time. CONCLUSIONS: Despite heightened public awareness, the incidence of school shooting victims, wounded, and fatalities among children has steadily and significantly increased over the past 53 years. Understanding the epidemic represents the first step in preventing continued firearm violence in our schools.

Transition to Permitless Open Carry and Association with Firearm-Related Suicide.

BACKGROUND: Firearm-related death rates continue to rise in the US. As some states enact more permissive firearm laws, we sought to assess the relationship between a change to permitless open carry (PLOC) and subsequent firearm-related death rates, a currently understudied topic. STUDY DESIGN: Using state-level data from 2013 to 2021, we performed a linear panel analysis using a state fixed-effects model. We examined total firearm-related death, suicide, and homicide rates separately. If a significant association between OC law and death rate was found, we then performed a difference-in-difference (DID) analysis to assess for a causal relationship between changing to PLOC and increased death rate. For significant DID results, we performed confirmatory DID separating firearm and nonfirearm death rates. RESULTS: Nineteen states maintained a no OC or permit-required law, whereas 5 changed to permitless and 26 had a PLOC before 2013. The fixed-effects model indicated more permissive OC law that was associated with increased total firearm-related deaths and suicides. In DID, changing law to PLOC had a significant average treatment effect on the treated of 1.57 (95% CI 1.05 to 2.09) for total suicide rate but no significant average treatment effect for the total firearm-related death rate. Confirmatory DID results found a significant average treatment effect on the treated of 1.18 (95% CI 0.90 to 1.46) for firearm suicide rate. CONCLUSIONS: OC law is associated with total firearm-related death and suicide rates. Based on our DID results, changing to PLOC is indeed strongly associated with increased suicides by firearm.

Multidisciplinary Simulation for Blunt and Penetrating Pediatric Trauma Utilizing Standard and Rapid Cycle Deliberate Practice Models.

Introduction: Pediatric trauma resuscitations are low-frequency, high-stakes events that require skilled multidisciplinary teams with strong medical knowledge and communication skills. Methods: This pediatric trauma simulation training session included two cases and formats. The first case was designed in a traditional format and featured a 12-month-old child with inflicted blunt head and abdominal trauma. The second case was organized in successive rounds utilizing the rapid cycle deliberate practice (RCDP) model and featured an 18-month-old with gunshot wounds to the abdomen and chest. Educational objectives included effective communication in a multidisciplinary team, timely completion of primary and secondary surveys, awareness of systems and processes related to trauma care, and increasing competency with low-frequency pediatric trauma skills. Necessary equipment included high-fidelity toddler-sized mannequins, chest tube task trainer or applicable mannequin and equipment, intubation equipment and supplies, intraosseous access, and blood products with rapid delivery infusers. This training session was designed for learners in a multidisciplinary team including physician trainees, nurses, and advanced practice providers; adjustments could be made to the team members as desired. Results: Quantitative and qualitative evaluations demonstrated high learner satisfaction and engagement, particularly in the RCDP style of learning. Discussion: Multidisciplinary team practice of pediatric trauma scenarios, particularly utilizing the RCDP simulation model, provides the opportunity to improve teamwork and communication, practice procedural skills, and deepen team members' understanding of and comfort with trauma resuscitations.

The burden and outcomes of firearm injuries at two district-level emergency centres in Cape Town, South Africa: A descriptive analysis.

BACKGROUND: In South Africa (SA), injuries are the second leading cause of years of healthy life lost, and interpersonal violence dominates the SA injury profile. Half of all injury-related deaths in SA are intentional, and firearms contribute to a quarter of these deaths. Injury surveillance systems are essential to develop, implement and monitor strategies that reduce preventable trauma. OBJECTIVES: To describe the burden of patients with firearm injuries and their outcomes at district-level emergency centres in the Western Cape. METHODS: This study was a retrospective analysis of a prospectively collected database. All patients who presented to two district-level emergency centres with a firearm injury over a 12-month period (1 January 2019 - 31 December 2019) were eligible for inclusion. RESULTS: Firearm injuries represented 5.7% of the trauma burden at the two district emergency centres. Of the 776 patients with firearm injuries who were included, the median age was 27 years, and 91% were male. A total of 520 (67%) patients self-presented, and there were 18 (2.3%) deaths in the emergency centre and a further 23 (3%) as inpatients. Of the total where wound location was determined (n=595), 30.4% sustained more than one firearm injury, and 112 out of the 167 admitted to Mitchells Plain Hospital required at least one visit to theatre. This accounted for 413 theatre hours and 1 376 inpatient bed days at Mitchells Plain Hospital. A significant proportion of patients (n=219, 29%) were transferred from the emergency centres to a tertiary service for further care. CONCLUSION: Firearm injuries represent a substantial proportion of the trauma burden at district emergency centres in the Western Cape Province. Managing patients with firearm injuries is resource intensive, as evident by their high acuity, the need for operative care, the long length of stay, the high burden on emergency medical services with interfacility transfers and the high demand for tertiary care. Data from this study aid our understanding of the prevalence and burden of firearm injuries at district level emergency centres, and multisectoral action, supported by evidence-based primary and secondary preventive strategies, is required to reduce the burden of firearm injuries, and mitigate their effects.

Mangled Thumb Injury Reconstruction with the Use of Definitive External Fixation and the Masquelet Technique: A Case Report.

CASE: A 23-year-old right-hand dominant man presented with a high-velocity gunshot wound injury to the right thumb with severe soft-tissue damage, vascular injury, and large osseous defect of the right thumb metacarpal. The patient was successfully treated with metacarpophalangeal joint arthrodesis and metacarpal reconstruction using definitive external fixation, an intramedullary Kirschner wire, and use of the Masquelet bone grafting technique. CONCLUSION: The authors' treatment approach for a mangled thumb injury with definitive external fixation and utilization of the Masquelet technique resulted in restoration of a large osseous defect, avoidance of infection, and limited loss of mobility.

Protocol for creating a dataset of U.S. state alcohol-related firearm laws 2000-2022.

Firearms are a major source of preventable morbidity and mortality in the United States, contributing to over 48,000 deaths in 2022 and generating societal costs in excess of $500 billion. A body of work has examined the relationship between US state level firearm laws and health outcomes, generally finding that some firearm regulations are associated with lower firearm-related mortality. Alcohol has been identified as an additional risk factor for both homicides and suicide and stronger state alcohol laws have been associated with lower rates of suicide. To date, there are no empirical studies that have investigated the impact of laws over a long period of time that target the intersection of alcohol and firearm. One reason for this may be because there is no existing dataset that includes the range of these state laws over time. This study describes the protocol for collecting, coding and operationalizing these legal data.

Children's toys no longer: a porcine model study of the lethality of modern air rifles.

AIMS: We observed modern spring-loaded air rifles reaching velocities similar to small-bore rifles, raising concerns about their potential lethality. After encountering two life-threatening thoracic injuries in our practice, we conducted a study to assess the injuries that a commonly available air rifle could cause in a porcine cadaver model. METHODS: We conducted shooting experiments from 5 and 10 metres away using a .22 calibre spring-loaded airgun, firing five shots into the anterolateral chest on the left side at both distances. Additionally, we repeated the experiment with ten shots into 10% ballistics gel behind an explanted chest wall to evaluate chest wall penetration reliability. RESULTS: Out of the ten combined shots, six resulted in lethal or potentially lethal injuries, including multiple cardiac injuries. Moreover, we observed chest wall penetration in 9 out of 10 shots, with an average penetration depth of 106mm. Non-life-threatening injuries appeared to be influenced by shot location rather than an inability to penetrate the chest wall. CONCLUSION: Our study raises significant concerns about the potential lethality of unrestricted air rifles in New Zealand. With muzzle velocities comparable to small-bore rifles, these firearms should be reconsidered in terms of regulation and possibly restricted to gun license holders.

Comparing the interactions of risk factors by method of suicide among veterans: A moderated network analysis approach.

Despite the well-established link between firearm access and suicide, less is known about other variables that may influence the risk for death by self-inflicted gunshot versus other methods of suicide. As individual factors have demonstrated limited predictive ability, scholars have called for studies that consider the multifaceted relations between myriad variables. One alternative to the typical cause-and-effect approach for investigating various forms of psychopathology is network analysis. However, few studies have applied this method to suicidal outcomes, particularly in the context of a veteran population. Data from 19,234 male veteran suicide decedents (89.1% White; Mage = 57.16, SD = 18.64) acquired from the National Violent Death Reporting System were used to investigate characteristics of veteran suicide decedents who died by self-inflicted gunshot (gun; 66.4%) versus alternative methods (nongun, e.g., poisoning, hanging; 33.5%). Results of the overall moderated network model indicated that veterans in the gun group were more likely to have a physical health problem that contributed to the suicide than veterans in the nongun group. Additionally, results of the moderated network model revealed several pairs of associated circumstances whose relationships were significantly moderated by method of suicide, the three strongest of which included having a physical health problem that contributed to the suicide. Overall, results suggest that public health prevention and intervention efforts aimed at reducing the overall burden of physical health problems among male veterans may mitigate the risk of firearm suicides. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

National Burden of Injury and Deaths From Shootings by Police in the United States, 2015‒2020.

Objectives. To describe all-outcome injurious shootings by police and compare characteristics of fatal versus nonfatal injurious shootings nationally. Methods. From July 2021 to April 2023, we manually reviewed publicly available records on all 2015-2020 injurious shootings by US police, identified from Gun Violence Archive. We estimated injury frequency, case fatality rates, and relative odds of death by incident and victim characteristics. Results. A total of 1769 people were injured annually in shootings by police, 55% fatally. When a shooting injury occurred, odds of fatality were 46% higher following dispatched responses than police-initiated responses. Injuries associated with physically threatening or threat-making behaviors, behavioral health needs, and well-being checks were most frequently fatal. Relative to White victims, Black victims were overrepresented but had 35% lower odds of fatal injury when shot. Conclusions. This first multiyear, nationwide analysis of injurious shootings by US police suggests that injury disparities are underestimated by fatal shootings alone. Nonpolicing responses to social needs may prevent future injuries. Public Health Implications. We call for enhanced reporting systems, comprehensive evaluation of emerging reforms, and targeted investment in social services for equitable injury prevention. (Am J Public Health. 2024;114(4):387-397. https://doi.org/10.2105/AJPH.2023.307560).