Q&A With ‘Firearm Injuries in Youth’ Researcher Natasha Saunders

The following is an interview with Natasha Saunders, the lead researcher and author of a study published yesterday in the Canadian Medical Association Journal, “Risk of firearm injuries among children and youth of immigrant families.” (See TheGunBlog.ca’s First Take on the study.)

Saunders spoke by telephone today. The interview was edited for clarity.

Some people are suspicious of the study’s timing, that it recommends gun control just as the government is preparing gun-control legislation. Any response to that?

Which specific gun-control legislation are you referring to?

The Liberal government has said that they are planning tougher laws related to shooting and access to firearms.

This particular study was totally independent of that, not funded in any way by any of that. This study has been going on for the last year.

I am interested in immigrant children and their health outcomes, and understanding who’s at risk and understanding some of the risk factors so that we can reduce some of the injuries in children and youth. When we were looking at all causes of injuries in children — so drownings and poisonings and falls and burns and those sorts of things — we noticed that there were a relatively high number of firearm injuries. That’s why we wanted to do a deeper dive into this, that’s what motivated this study. It wasn’t anything to do with government posing any legislation or making changes to the legislation.

The Canadian Paediatric Society is a member of the Canadian Coalition for Gun Control, and they just updated their policy yesterday. I don’t know if they’re related to your research, but it was an interesting coincidence.

In terms of the release of the paper, we had been working on this paper and it was ready to go for a few months now. They had heard that we were releasing, so we wanted to release at the same time.

My study just looks at sheer numbers, it doesn’t talk about causation, it doesn’t talk about prevention strategies. It just says, “Hey, here are the groups we need to look at for prevention strategies. These are the injuries that are occurring, and we need to really contextualize them and understand them.” We didn’t have Canadian or Ontario data before that. The Canadian Paediatric Society looked at some of the evidence from the U.S. and the very little existing evidence from Canada around strategies for firearm prevention. So theirs was done in parallel, but I hadn’t seen their release until my release was done.

Why group all the injuries together, without distinction between boo-boos and loss of an eye or a limb?

The reason is that we just haven’t gotten to it yet. This study was the absolute first study we’ve done on firearm injuries in children like this. This was just to capture the numbers and some of the socio-demographic factors that are at play.

The next study, which is underway, is to look at: what are the injuries, what body part first of all, what are the health-system utilization and health-system costs, as well as the later disability costs of these injuries, for quality of life. Are these injuries where you hit the leg bone you break a bone, and you’re in a cast for six weeks, and then it’s over and done, versus, is this a pellet gun shot by a 13-year old towards a friend and they’re blind for life, and they need special school services and that kind of thing.

We don’t have that kind of information yet, but it is coming down the pipeline in terms of studies to be done. Realistically it will be about a year before that data is published.

Do you have any indication about the number of small, medium or severe injuries?

The only difference that we calculated at this point were the deaths versus emergency-room visits and hospitalizations. On average 24 children and youth die per year from firearm injuries, so 2 per month.

So no idea how many were a slight penetration of the skin vs. broken leg, lost eye or welt from a paintball game?

We don’t at this point. Although, just because it hits a leg or a non-vital organ, it’s a near-miss. In children and youth, it’s equally as dangerous.

Will it be possible to classify injuries by type of firearms? It was a bit confusing to see big, powerful guns in the same basket as piddly BB guns.

At this point we don’t have differentiation in terms of the data between which was a handgun, rifle, or pellet gun for example, or if it was not documented.

We are looking at that data, and we can get that breakdown. The challenge is that many of the firearm injuries are coded as “undefined,” so someone might come in with a bullet wound, but it doesn’t say if it was from a handgun or a rifle or a BB gun. We’re going to see if we can tease some of that information out with the data that we have, and potentially — if we need to — pull in police data, but we’re not there yet. Right now, we’re just trying to get the breakdown from the data that we have.

Any clues if we’re going to see mainly bullet wounds or mainly BBs and pellets?

No, I don’t have that data yet, so I can’t say and I don’t want to speculate.

The study included firearms discharged in “legal interventions” by police. Does that include rubber bullets, bean-bag rounds and tear-gas grenades?

Tear-gas grenades, no. These would be only from a firearm.

I did a quick run of those numbers, and zero was the number for that population. So although they were included in our study, none of the injuries in our study were from legal interventions.

The study was about the shooting victims, not about the shooters. How do you make the leap from not knowing who the shooters are and how the shootings happen, to proposing recommendations?

We have to understand the context and that these are the victims, and not the perpetrators. In terms of the unintentional injuries, which do make up the majority of these, if there’s no gun around, if a child cannot access a gun, they can’t be injured by a firearm. In the U.S., Congress has passed this bill where they say, it’s not guns that kill people, it’s people that kill people. But there still has to be a gun there.

Just practically, if you have guns away from children, or stored and locked or inaccessible to children, and used only by the intended user, who is trained and has taken a safety course …

There’s tons and tons of guns in households across Canada, and most people are probably complying with existing legislation. But for those that are not, and are keeping their grand-father’s old gun in the garage or in the shed, unlocked and loaded, those are the people we need to target, enforcing existing legislation.

It’s not necessarily legislation to say we shouldn’t have guns at all. That’s not what I’m trying to say here. I’m trying to say we have to look at harm-reduction strategies to reduce the risk and ensure that children are safe.

Legislation right now dictates that a 12-year-old can use a firearm unsupervised. They can’t purchase a firearm, but they can use a firearm unsupervised. Do we need to relook at that? Do we need to look at legislation and policy that restricts BB guns, because they fire a few metres per second slower than say, a rifle, and their range is shorter, it doesn’t mean they’re any less dangerous if they can penetrate the skin or bone. If a BB happens to penetrate the skull and lodge a pellet in the brain, that’s pretty bad. Should we be restricting legislation around children and youth, and having policy around that?

Can a BB actually penetrate the skull?

It depends on the BB gun. I’m not an expert in the technology of guns. It depends on the range. According to some of the numbers I’ve read, a speed of more than 45 metres per second can penetrate bone or cause fracture.

The study gives information on the injured people, but we don’t know who’s doing the shooting, or how these accidents happen. How do you propose a solution when you don’t know who the shooters are or how the shootings happen?

In the future studies, looking at the types of firearm being used. If the majority are from BB guns, then we need to look at tighter legislation around restricting those for children and youth. Although we don’t know who the perpetrator was, somehow the gun is in the environment that the child is in, and that is being used in an unintentional way.

Any thoughts on an approach focused on education and training as opposed to legislation? Some people would say we need to go back to having some kind of firearms training in schools.

Absolutely. I think education is a key piece to this. As a health-care provider, we can educate families on this, and the risks of firearms in the home. Like, “Hey, don’t leave Grandpa’s gun in the garage.” It’s common sense. Many families may know that firearms potentially cause a problem, but to really appreciate that it is a true risk to leave a loaded firearm where children and youth are at play is very different from a theoretical risk versus a real risk. Education definitely plays a key role in this.

When I talk about policy and legislation, that doesn’t mean “restrict all firearms.” That also could mean legislation or policy that is evidence based — and we don’t have that evidence yet — around, for example, should there be a policy that every five years or every three years, anybody who has a firearm in the home where a child or youth is living there has to take a safety course. Would that work? I don’t know. Policy is a fairly broad term, but policy is definitely an education piece as well.

Sometimes, when it comes to protecting children, we can’t just leave things up to the individual family. Although we want them to have their autonomy, we also need to be able to have policies in place that protect children.

Right now when you fill out a firearms Possession and Acquisition Licence, it’s similar to a passport application. They look to see if there’s a spouse in the house, and the spouse has to be aware that you have a firearm in the home and they have to sign for that. But there’s zero mention of children. Should we have a policy that, if there are children and youth in the home, that the firearm owner has to take an enhanced course, for example. Who knows what that is? We don’t have evidence for that yet, but those are considerations that need to happen.

The study suggests a correlation between region of origin and risk of being injured by a gunshot wound. How do you avoid slipping from statements about correlation to ones about causation?

You raise a very important point. This is an observational study. There’s a statistical association, but we have not proven causation, nor were we intending to prove causation. We just know that there’s an association, and we have to explore the why, what are the causes of this. But this study does not look at that.

The study shows that Canadian-born children and young adults have more accidental shooting injuries than immigrants. Could it be that is because they shoot more?

Potentially. Again, this study didn’t look at that, so that would be entirely speculation. But common sense says that, if you have a gun and you’re at a shooting range, or if you have a gun around, there’s a higher likelihood that you’re going to be shot by one. If you don’t have a gun around, you can’t get shot by one. So that’s certainly a possibility.

Why did you focus on 0- to 24-year olds and not all ages?

I am a paediatrician, and wearing a paediatrician hat, I have a vested interest in keeping children and youth healthy and safe. That is where that comes from. All of my research looks at children and youth primarily. That’s the true way that this all started.

It’s not to say that looking at other groups of young adults, or older groups of adults, is not also important. But we know that injuries are most common in youths, so late adolescence and early adulthood, in that 15-24 age group. No pun intended, but that’s where we’re going to get the biggest bang for our buck for understanding what’s going on in terms of injury prevention for this group.

We definitely need to look across all the ages. If we find that 30-year-olds or 40-year-olds are being injured by firearms in future studies, then we have to look at strategies to prevent that.

Nobody should be injured by a firearm, whether used properly, when they’re stored safely, when people are educated around what to do with a firearm and how to disable firearms, then nobody gets injured. There’s a time and a place with firearms, unsupervised with children and youth is not the time and the place.

Other research has shown that in that age group, 15-24, even 15-30, that there’s a very high criminal and gang component.

It will be interesting to see when we get the breakdown of how many of these assault-related injuries are also from things like BB guns. If you’re being assaulted by a BB gun, just because it’s not a hunting rifle or a handgun, there are different implications for strategies for prevention. But at the same time, it’s important to understand that so that we can start the conversation around prevention strategies.

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