Oregon emergency rooms saw gun injuries nearly double in two years, OHSU report shows.

From 2019 to 2021, Oregon emergency rooms saw nearly double the number of gun-related injuries. That’s according to an OHSU report that looked at hospital and emergency room data on these types of accidents throughout the state. The report found that, on average, there were at least two visits to the ER for firearm injuries per day in 2020 and 2021. Kathleen Carlson is the director of the gun research collaboration at OHSU and an author of the report. Robert McCauley is the emergency department medical director for Good Shepherd Medical Center in Hermiston. They both join us to share what gun violence is looking like in Oregon.

The following transcript was created by a computer and edited by a volunteer:

Dave Miller: From the Gert Boyle studio at OPB, this is Think Out Loud. I’m Dave Miller. From 2019 to 2021 Oregon emergency room visits for gun related injuries nearly doubled. That is according to a new OHSU report. It collected statewide hospital and emergency room data. They found that on average there were at least two ER visits from firearm injuries every day. Kathleen Carlson is the director of the gun injury research collaboration at OHSU and an author of this report. Robert McCauley is the Emergency department medical director for Good Shepherd Medical Center in Hermiston. They join us now to give us a statewide look at firearm injuries in Oregon right now. It’s good to have both of you on the show.

Kathleen Carlson: Great to be here.

Robert McCauley: Thank you, Dave.

Miller: Kathleen Carlson first, what’s the big idea behind this collaboration?

Carlson: Our big idea is to look at firearm injuries like we do at any other public health issue, track injuries just like we would a disease or rates of cancer across our population. And in doing so, we can discover patterns and other hints and clues for what might be driving increases, or what might be helping decrease rates of whatever we’re tracking over time, in this case firearm injuries.

Miller: What’s new about the data you’re collecting now or the way you are collecting it?

Carlson: These data are a summary of all emergency departments and urgent care visits across the state of Oregon, which pushed their data on almost a near-time basis to our state health department. And then we’re using those data to look at rates of firearm injuries. We haven’t had a source of information on mainly non-fatal injuries related to firearms before. We’ve had a pretty good handle on deaths from firearm injuries and the context and circumstances around those deaths, but this is the first time that we really get to get the lay of the land in terms of nonfatal firearm injuries.

Miller: Can you give us just a ballpark sense for the ratio there, of fatal firearm injuries as opposed to non fatal ones?

Carlson: It varies. Nationally, we see about two nonfatal firearm injuries for every fatality. There’s about 45,000 firearm injury deaths in the US annually, we have about 90,000 nonfatal injuries treated in our health care system. So about 135,000 total injuries across the country that are related to firearms. In Oregon, the pattern is somewhat similar. We’re trying to disentangle that right now. It looks to be about one to two nonfatal firearm injuries that are at least showing up in our healthcare system for every death that’s counted.

Miller: I’m curious about the regional patterns that showed up for you. First of all, what counties had the highest rates of firearm injuries when you look statewide?

Carlson: The highest numbers of treated injuries are of course in the most populous counties. If we look at a map of the counties in Oregon, we’re seeing the highest numbers up and down the I-5 corridor, which probably reflects activity along the I-5 corridor, but also the highest populations.

But when we look at per capita rates of firearm injuries, you see a different pattern. We do see Multnomah County pop out as having the highest rate. But we then also see Jefferson County and Douglas County as having rates that are on par with Multnomah County. And then next rung down from those three counties, we see Umattila, Malheur, Coos County, Josephine County and Marion County also having high rates.

Miller: Those are overall numbers. But what about regional variations in the kinds of injuries? Whether it’s accidents or intentional, self inflicted gun injuries or assaults.

Carlson: I can talk about the breakdown for the state overall. We’re still working on parsing out the intent of injuries at a more granular level. But we do know from our other research and our colleagues’ research that self harm injuries and unintentional injuries appear to be more frequent in our rural regions, and then assaultive injuries more frequent in our urban regions. In Oregon, of the injuries that we manually reviewed - triage notes that came with the data that were uploaded to us - that we could identify as firearm injuries and then classify their intent, half were deemed unintentional injuries, 38% were assaults, and 12% were self harm. It’s almost an inverse of what we see with fatal firearm injuries, where the majority are self harm, then assault, then unintentional.

Miller: As I noted, Robert McCauley is with us as well. Robert McCauley, we heard that Umatilla County is essentially in the second highest tier of counties in terms of per capita rates of firearm injuries. How common are firearm injuries in your hospital over the last couple of years?

McCauley: Well, we have the data actually by diagnostic code for the past three years, and I think that captures most of it, but probably it’s possible you could miss some, especially more minor injuries. In 2020, we had basically two accidental discharge injuries, and the next year we had three. And neither year did we have any assault injuries.

Interestingly though, this year we’ve had one accidental discharge injury, but we’ve had three intentional assaults, gunfire injuries. That’s really a jump for us. And it’s also interesting listening to Kathleen. Even though this is a small sample size, our numbers of accidental versus intentional is almost exactly the ratio she brought forward, which I found to be very interesting. Just a point of reference, we see about 20,000 patients a year, I think this year will be about 24,000 patients, give some perspective for those numbers.

Miller: So even if the state has seen a big increase overall in terms of firearm injuries, the raw numbers you’re looking at still remain a relatively small percentage of the overall patients who are coming into your emergency department.

McCauley: That’s correct. Anything is preventable, we want to see that of course. But it is still a fairly small number for us. And I will submit that these numbers may slightly underestimate our total volume of gunshot, which is probably quite, quite close.

And it is interesting, also going back to something that Kathleen had mentioned, I think almost all of our accidental discharges involve an extremity or something that is less life threatening. Maybe limb threatening, but not usually life threatening.

Miller: But then there were this year, as you noted, three intentional assaults that turned into cases at your emergency department. Are gunshot wounds different to treat emotionally than, say, injuries from car crashes for the doctors and nurses in an emergency room?

McCauley: That’s a great question. I think most of the time, probably not because of the nature of what we deal with, and it just depends on the kind of injuries, whether it’s a car accident or gunshot. What does make it a little different, however, with assault, especially in a smaller facility where you don’t necessarily have all the security resources that you might in a level one trauma center, is when there’s a gang related or suspected gang related incident. It does make everybody a little more nervous. We have to often go down on lockdown for things like that because you don’t know what else may be going on and what else may occur. So that creates a little more stress and changes the environment some, but otherwise I think the rest is pretty similar.

Miller: Kathleen Carlson, you noted at the beginning that the point of this work is not just to collect data for data’s sake, it is with the ultimate goal of reducing gun violence. What’s the hope for how that could work? Connect the dots if you don’t mind, how can getting a more granular picture of what firearm violence or firearm injuries looks like statewide lead to a reduction in gun violence?

Carlson: It would be similar to what we’ve all lived through with reductions in motor vehicle crash deaths and injuries. We’ve seen major improvements in motor vehicle safety, through engineering, design, behavior changes, policy, roadway design, seatbelts. This was decades in the making. So as a public health professor, I look at these numbers, I look at this issue and look at the fear and the concern about the rising numbers, and I say there are myriad ways that we can go about systematically chipping away at these injuries and deaths, the same way that we do with other major public health problems.

Miller: Meanwhile, the numbers I mentioned earlier, nearly doubling from 2019 to 2021, that’s the most recent full year data. But we’re almost done with 2022, and you did note that if I understand correctly, there’s almost real time data sharing. So does that mean that you already have a pretty good sense for what 2022 looks like statewide?

Carlson: We will soon have those data available.

Miller: Can you give us any sense for what it looks like?

Carlson: I’m sorry I can’t, I haven’t looked at those numbers yet.

Miller: And then briefly, we’re also talking about the delay, potentially for a while, potentially almost no delay in terms of the implementation of Measure 114. What do you think Measure 114 could mean for this conversation?

Carlson: Well, I’m anxious to contrast the implementation of that policy as well as our other safety related policies here in Oregon against the rates of injuries and deaths that we’re seeing. So having established these data for the past four and then five years and then moving forward, we have this baseline data that we can then compare against as these new measures are taking effect. So I’m optimistic. We shall see. Evidence generated in other states and other jurisdictions by my injury and violence prevention colleagues suggest that we’ll see reductions in deaths and injuries. So I’m excited to see that.

Miller: Kathleen Carlson and Robert McCauley, thanks for your time today.

Carlson: Thanks for having us.

McCauley: Thank you.

Miller: Kathleen Carlson is the director of gun research collaboration at OHSU. Robert McCauley is the medical director for Good Shepherd Emergency Department in Hermiston.

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