Sunday, February 25, 2018

ACS statement on Parkland

The American College of Surgeons (I am a Fellow in the College myself) released an official statement last week in response to the horrific school shooting in Parkland, Florida:
Statement regarding the events of February 14, 2018
The American College of Surgeons (ACS) is extremely distressed by the continuing violence at our nation's schools, churches, and other places where people should feel safe. At its most recent meeting, the ACS Board of Regents unanimously approved a plan to expand the College's focus from the very successful Stop the Bleed® program, which has trained and equipped thousands of people to stop severe bleeding from any cause, to a broader prevention initiative that focuses on strategies that include research, advocacy, and strategic collaborations. A specific action plan is under development that will ultimately lead to open dialogue on the issues standing in the way of meaningful change and the eradication of these tragic events. We will keep you apprised of further developments.
My thoughts on this statement, and the Parkland shooting in general,  run as follows:

  • I must say I am somewhat disappointed with this rather vapid statement from the ACS.  The Stop the Bleed program is a worthy initiative.  Teaching the population at large how to apply pressure to pulsatile wounds and the basics of tourniquet technique is a public good (similar to widespread CPR training programs made available to the public in previous eras).  I have no problem with disseminating this valuable information.  But in the context of this epidemic of mass shootings in public spaces, perpetrated by disturbed individuals armed to the teeth with military grade weaponry, it misses the mark.  High velocity ordinance fired in quick cadence from semi-automatic rifles tear gaping holes in the flesh of children at school. You cannot put a tourniquet around a blown off limb.  You can not stanch the flow of blood exsanguinating from a portal vein or aortic injury; you're just ruining all the gym towels.   You cannot  expect a teacher or custodian to "Stop the Bleed" of an injury heretofore most commonly seen after a firefight on the streets of Fallujah during the aughts.  To emphasize on-site field intervention by ordinary citizens is to willfully obfuscate the obvious.  It is to meet a measles epidemic with a reductionist slogan like "Wash Your Hands" without saying a word about vaccines. 
  • The second part of the statement is vague and unpromising.  Sans specifics, we are left with the underwhelming promise of future research and "strategic collaborations".  This is a hedging, craven kind of corporate speak that means nothing.  It is a covenant written in sand.  It is a  pledge to follow up on abstract good intention.  Just you wait, we are told.  Very smart, very well credentialed people are working tirelessly on solutions.  
  • Taking a stand is always a form of courage.  The worst form of cowardice is to try to dress up an equivocation as firm advocacy; to say nothing at all while going through the motions of going out on a limb with an official proclamation.  The College would have showed more courage is they had just stayed silent.  Or simply stated something meek and capitulating, such as--- The ACS has no comment on the shootings at Parkland, or mass shootings in general, because inevitably such talk veers into the realm of gun control legislation and, frankly, that is just too much of a political grenade for us to touch right now.  We further have too many members in the College who might be needlessly alienated if we took too strong a stand on this issue.  Thank you. We will keep you apprised of any changes.  This at least would have been honest and therefore more courageous than the blathering, equivocating statement the ACS put out.  
  • And there is no reason for this cowardice.  Currently there is broad support, across the political spectrum, for reasonable gun control legislation.  In particular, the public disdain for these weapons of mass destruction seems to have reached a tipping point.  Furthermore, mass shootings are directly related to the profession of trauma surgery.  Level I trauma centers across the nation are taxed for resources as it is.  The last thing Maryland Shock Trauma or Cook County Trauma need is a sudden influx of 50 patients seriously wounded by military weaponry. It is a public health emergency especially relevant to our chosen field.  There is no reason why the ACS could not take a stronger stand on politically charged but broadly popular initiatives such as banning semi-automatic weapons like the AR-15 (involved in so many of the recent mass shootings) and banning or minimizing high capacity magazines.  
  • I have yet to hear a cogent or convincing argument for why weapons like the AR-15 should be legally available for purchase in this country.  There are two schools of thought I hear from gun advocates. One, are those who believe any and all form of regulation of forearm sales is an attack on the 2nd Amendment.  Of course, following the logic of this radical position can only lead one back to an anarchic, lawless world where anything at all is possible.  Surface to air missiles, grenade launchers, automatic weapons.  An attempt to outlaw or regulate any aspect of firearms is an attack on the entirety of the 2nd Amendment.  A strange notion when the very wording of the Amendment contains the notorious phrase, "a well regulated militia"....
  •   The other, more adolescent, argument I hear proffered is that these weapons are necessary to ensure "American freedom from tyranny of the federal government".  It would be a laughable conceit if it weren't true that so many Americans actually believe this nonsense.  Once again you have to ask these people to follow the logic of their own avowals.  Imagine some dystopian future when the US government, having veered inexplicably into fascist authoritarianism, suddenly decides to train the full force of its massive military upon its own citizens.  All that will save us then, according to the Red Dawn fan boys, are the various rag tag collections of Real Americans who horded a stash of semi-automatic rifles and 50 round magazines, along with various other commando cosplay equipment, just for such a moment.  And they will emerge from the woods in their pick up trucks and camo gear to reclaim American autonomy from.... battalions of highly trained infantry, enough F-16 fighters to darken the sky, squadrons of special ops commandos, the world's largest Navy, and, by that time, an elite armada of drones and AI robotic soldiers?  I mean, come on dude.  

1 comment:

Unknown said...

Dr. Parks:
I found your blog through the link you posted on the ACS forums. As you yourself do read there you will know that while there is broad support for "reasonable restrictions" there is no broad consensus on what constitutes a reasonable restriction. I agree with you strongly that in the absence of an evidence supported and specific recommendation for policy the ACS should stick with advocating for research and quality trauma care. Regarding the stop the bleed campaign as a response, how many of those killed in school shootings die from exsanguinating injuries outside "the box"? Most if not all of those victims can be saved with Stop the Bleed training. Your remark about Fallujah is particularly interesting, are you unaware of the origins of the Stop The Bleed campaign?

Now to expand your understanding of perspectives on the second amendment to the United States constitution:
1. I am tired of hearing well regulated in the 20th century sense applied to an 18th century document. A clock that keeps time is well regulated. A militia composed of men familiar and skilled with military weapons is well regulated. A society with a large number of regulations would be described as having "swarms of officers".
2. With regard to Red Dawn fantasies, I agree these are improbable events, but before dismissing those who prepare for them consider that an armed population can be obliterated but not subjugated. This has been the experience of our own military in the middle east.
3. Your Red Dawn fan acquaintances ascribe a far too narrow purpose to the second amendment. It was worded carefully. The amendment considers two goals, security and a free state. Security implies protection from foreign invasion and domestic criminal misdeeds. With regard to foreign invasion, the goal was to make a standing army (already identified as a hazard to the maintenance of a free state) unnecessary by maintaining a large population of private citizens proficient with infantry weapons. With regard to domestic criminals, an armed populace can secure itself from criminal violence without a vast and pervasive police force. The private resolution of criminal violence also makes expanding the powers of the state a hard sell.