Emphasizing the Necessity of Long-Term, Holistic Care for Gun Violence Survivors

A recent comprehensive review published in JAMA highlights the urgent need for integrated, long-term medical care for survivors of firearm injuries, an issue that has escalated significantly in the United States due to increasing gun violence. The review underscores that while immediate emergency responses are well-established, the ongoing recovery process for survivors—particularly outside hospital settings—is often inadequately defined and inconsistently applied. This gap in care contributes to persistent physical, neurological, psychological, and social challenges faced by these individuals.

The review, authored by experts from the University of Maryland School of Medicine, consolidates current evidence on the lasting consequences of firearm injuries, excluding brain and spinal cord injuries. It emphasizes that effective management of these survivors extends beyond acute medical intervention, encompassing chronic pain management, neurotrauma, mental health support, and social reintegration.

Key findings include that nearly 68% of firearm injury survivors experience daily pain at 6 to 12 months post-injury, suggesting that multimodal pain management approaches—combining medication with physical and alternative therapies—are necessary. Additionally, approximately 75% of survivors are discharged with bullet fragments still present, which can lead to lead poisoning; regular blood testing and surgical removal, when feasible, are recommended.

The psychological toll is profound, with over half of survivors screening positive for PTSD within a year of injury. Mental health screening programs and therapies like trauma-focused cognitive behavioral therapy are vital components of comprehensive care. Survivors also face significant functional limitations, with nearly 60% not returning to work within a year, and report lower quality of life levels compared to other trauma populations.

A particularly alarming statistic is the 10% recurrence rate of firearm injuries among survivors, especially among young Black men. Hospital-linked violence intervention programs that provide holistic support have demonstrated some success in reducing recidivism.

Commenting on the findings, lead author Bethany Strong stressed the importance of guiding primary care physicians, psychiatrists, and rehabilitation specialists in managing the long-term needs of firearm injury survivors. Dr. Thomas Scalea, another senior author, called for the medical community to extend efforts beyond initial trauma surgery to address chronic pain, disability, mental health issues, and the risk of reinjury.

The analysis also discusses the broader societal costs of gun violence—estimated at $557 billion annually—highlighting its disproportionate impact on low-income communities. UMSOM Dean Mark T. Gladwin emphasized that improving access to comprehensive post-injury care and supportive services could lessen the heavy economic and human toll of gun violence.

This review serves as a crucial wake-up call to healthcare providers and policymakers alike, advocating for a coordinated, long-term approach to caring for firearm injury survivors to improve outcomes and reduce repeat injuries.