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Gun Control and Canada’s emergency physicians

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In light of today’s tragedy in Connecticut it seems like a good idea to restate the position of Canada’s emergency physicians with respect to Gun Control in Canada. The following statement was made in response to the threat to dismantle Bill C-68, the Gun Control Bill, which we had worked extremely hard to see passed into legislation.

Gun related death in Canada remains a significant public health problem both from the perspective of suicide and domestic violence. The Gun Control Bill was working and having a positive effect on gun related mortality in Canada before its repeal last year.

Despite the obvious political expediency associated with cancelling Bill C-68 and its provisions, effective Gun Control remains a significant concern for Canadian emergency physicians.

“The Canadian Association of Emergency Physicians is the national specialty society for Emergency Medicine in Canada. We are here today as a member of a coalition of health organizations and prominent opinion leaders in health care who are concerned about the possibility of a repeal of the gun registry.

Firearm related death and injury is a significant public health problem in Canada. In 2004, there were 743 Canadians killed by the misuse of firearms, the vast majority, close to 80% of these deaths were secondary to suicide.

Deaths are not the only issue; a significant number of Canadians are also injured as a result of firearms misuse. In the 2001-2002 fiscal year, there were 606 hospital admissions to Canadian hospitals as a result of gunshot wounds. In Ontario, in 2004-200-5, there were 624 Ontario ED visits resulting from firearm-related injuries with 199 subsequent admissions.

There is also an economic cost to these deaths and injuries and it is currently estimated that gunshot wounds cost the Canadian economy an estimated $1.4 billion annually.

As an emergency physician and as a coroner I can tell you that there is also a tragic human toll and emotional cost that is, quite frankly, immeasurable.

It is also important to stress that firearm related deaths are not simply an urban problem. Firearm ownership is highest in the more rural provinces and territories and not surprisingly, the highest rates of death and nonfatal injury from firearms are in jurisdictions with the highest ownership rates.

The average annual rate of firearms-related deaths between 2000 and 2002 was higher in the three territories than in Canada overall. The rate for the territories was at least 10 deaths per 100, 000 population compared with the average of 2.6 for Canada.

Our Association believes that as with all injuries, most can be prevented. We also believe that it is far better and more economical to prevent an injury than to treat one. Accordingly, we are firm supporters of effective gun control.

We were supporters of the original Gun Control Bill C-68 back in the mid-1990s and in particular the provision of a firearms registry, in the belief that the registration process would in part change the culture of the gun in Canada and in particular that it would be helpful in our management, with police agencies, of suspected suicide risk or domestic violence.

Our prediction then was that the bill would prove clinically effective in dealing with the tragic consequences of firearm related injury and would be an important public health measure. This has largely come to pass. There has been a striking reduction in deaths from firearm related injury in Canada and our membership has been very clear that they expect their Association to maintain the support for the full provisions of the bill and the registry. It is clear to emergency health professionals that after fifteen years, things are getting better and the effects of Bill C-68 have shown a positive effect in lessening the burden of firearm related injury.

Suicide is the second most common cause of death in Canada for those aged 10-34 years and the ninth leading cause of death overall. Firearm deaths (in 1998) accounted for 22.1% of suicides and firearm related suicides represent close to 80% of all firearm related deaths.

Contrary to commonly held opinion the great majority of suicides are not premeditated and therefore predestined but rather impulsive in nature. Suicide attempts using a firearm are particularly lethal (with 96% completion) compared with overdose attempts, in which only 6.5% are lethal.

It should also be noted, in the context of this current debate, that suicide rates are higher in Aboriginal rural communities, where the use of firearms is overrepresented.

Overall firearm-related suicides have decreased by 43% since the introduction of stricter gun control laws in 1991 and by 23% since the introduction of the Firearms Act in 1995.

For us the gun control legislation is not crime control but effective public health and suicide prevention legislation.

Homicide is among the top ten causes of death in Canada. Despite increases in gang violence and homicide as a result of illegal guns, firearm homicides have decreased significantly since the 1991 introduction of stricter gun control: from 271 ( a rate of 0.99 per 100 000 people) in 1991 to 190 (0.58 per 100 000) in 2006.

Of firearm related homicides in Canada, 25% were by rifles and shotguns, 58% by handguns and 18% by prohibited firearms. Long guns were used in 72% of firearm related spousal homicides.

Since the implementation of the gun registry in 1995, a 30% reduction in homicides by long guns has occurred.

Intimate partner homicide is certainly an issue for emergency physicians as these women often present at some point in the continuum of violence to the emergency department.

In 2006, 21% of homicides were intimate partner homicides (0.28 per 100 000). The spousal homicide rate against women is 5 times higher than that against men.
Between 1995 and 2004, spouses using firearms were responsible for 31% of intimate partner homicides against women. Rifles and shotguns were used in 62% of cases.

Keeping a gun in the home is an acknowledged risk factor for spousal homicide.

Firearm use in spousal homicide has decreased by 36% since the 1995 implementation of stricter gun control laws.

Clearly, we believe that the gun control bill and its provisions, in their totality, has led to less firearm related mortality and a safer Canada. Why, we ask, should it be dismantled? Why subject Canadians to greater risk.

It is impossible to tease out the relative contributions of the various components of the bill but from our perspective the registry is integral.

We are often faced with the evaluation of patients who may have threatened or are considered at risk for suicide. We also have to consider the risk of patients who present to the emergency department with major depressive illness. Those in the former group, in particular, are often accompanied to the emergency department by police. The presence of a gun in a home is an acknowledged risk factor for suicide completion and we commonly ask the police to remove guns from the home of those identified as being at risk for suicide. Knowing that a patient or their family owns a gun is extremely valuable information as we determine their future risk of suicide.

Furthermore, we also consider police access to the registry when dealing with victims of intimate partner violence. The future safety of the person at risk is clearly of major concern to us and the removal of firearms from a home in which intimate partner violence is either implied, threatened or carried out is an important step in guaranteeing patient safety.

We also acknowledge and support those provisions of the registration process that identify and enable spouses and former partners to report their concern for their individual safety with respect to firearms held by their partners.

The maintenance of the registration process and provisions is important, in our view, to further reduction in morbidity and mortality from inappropriate firearms use.

The gun control bill is working. It represents a sensible package of regulations to minimize the risk of gun related injury and death.

We urge our legislative leaders to consider the provisions of Bill C-68, including the registry, not as elements of a crime control bill but rather as key elements of a socially responsible public health and safety bill.

There has been a dramatic reduction in firearm related mortality in Canada since the introduction of the Gun Control law and the gun registry and we, as emergency health providers, see no compelling reason, from a public health perspective, to dramatically and irresponsibly alter such effective legislation.”

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