Last Tuesday, Christopher Colwell, MD, chief of emergency medicine at Zuckerberg San Francisco General Hospital and Trauma Center, was looking forward to a rare dinner that his entire family of five would be able to attend.
He had left his shift at the emergency department and drove straight home, listening to music in the car rather than the news. But when he arrived, he knew something terrible had happened. His wife, as well as his daughter, who is in high school, and his two sons, who are in college, were sitting on the couch waiting for him. They had heard about the horrific mass shooting in Uvalde, Texas, in which 19 children and two teachers were killed. And they knew the emotional impact it would have on Colwell, who responded to the scene at Columbine High School 23 years ago.
In fact, since the mass shooting at Columbine, during which 12 students and a teacher were killed, Colwell has also witnessed the brutal aftermath of two other similar tragedies — the Aurora movie theater shooting in 2012, in which 12 people were killed and dozens of others wounded, and the San Francisco UPS shooting in 2017, in which three workers were killed and several more injured.
“I’ve gone through different iterations of this,” Colwell told MedPage Today. “In 1999, it felt kind of lonely. There weren’t that many medical folks who had dealt with mass shootings. You just didn’t see events like Columbine. At that point, it felt relatively unique. As time has gone on, reliving some of this, it’s painful each time and becoming more so, knowing that it’s no longer lonely.”
The medical professionals who experienced the aftermath of the two most recent mass shootings — in Uvalde, and the killing of 10 Black, mostly elderly, people in a Buffalo, New York, supermarket — are going to have to live with that for the rest of their careers, he said.
Colwell and other physicians said that one reason the U.S. is seeing more and deadlier mass shootings is the prevalence and accessibility of AR-15-style weapons. Now, the nation is in a “far, far worse place” than in 1999, when there was still a federal ban on assault weapons, Colwell noted.
“You have to see the damage that these weapons do to really respect and understand how dangerous these weapons are,” he said, adding that he’s not arguing that a .22 pistol can’t end a life, but there’s a reason why you don’t see them used in mass shootings today.
“There’s no way to cause the type of havoc that these people are looking to cause without something of the power and speed of an assault weapon,” he continued. “Assault weapons are specifically designed to more rapidly eject bullets, and the power that they have, and the speed that they have, there is no question … most of the devastating injuries happen in the first minutes of the event.”
Colwell went to Columbine High after the horrific events unfolded, hoping to find someone alive. However, all of the carnage had happened almost immediately.
“The primary way you can cause that kind of damage in that amount of time is with a weapon shooting that powerful of a ballistic that quickly,” he pointed out. “Over and over again, what are they using? I’ve never seen the number of devastating wounds when you’re not dealing with assault weapons — the number of victims and the number of wounds.”
Colwell’s memories of the young victims at Columbine have stayed with him.
“I vividly remember seeing one of the victims at Columbine [who] had a text book that I had in high school,” he recalled. “It really did put me back in our high school library.”
“They barely had a chance to hide,” he added.
There’s no way a shooter could have done that with a pistol or non-semi-automatic weapon, he said. Seeing the wounds, the facial expressions of the victims, and the way they were lying at the scene, the emotional impact lasts forever, he noted.
William Begg, MD, vice president of medical affairs at Vassar Brothers Medical Center in Poughkeepsie, New York, and an emergency medicine physician at Danbury Hospital in Connecticut, has also seen the horror of mass shootings firsthand.
He attended to young patients in the aftermath of the 2012 shooting at Sandy Hook Elementary School in the Newtown, Connecticut borough, in which 20 children and six adults lost their lives. The fact that it happened again in Uvalde struck him especially hard.
“The more closely a mass casualty relates to one you’ve already been involved in … the more you’re affected,” Begg told MedPage Today. “This tragedy in Uvalde disproportionately affected my institution and myself compared to all the other mass shootings over the years because we could so closely identify with the pain and sadness and anger that those healthcare workers are dealing with presently.”
Though hospitals and communities across the nation experience other disasters, natural ones like hurricanes and tornadoes aren’t self-induced, he said.
“This was a self-inflicted injury from our country’s culture,” he noted. “And it was preventable.”
“It’s a public health issue somewhat unique to the U.S.,” he added. “If you look at all the other developed countries … no country in the world has even close to the number of mass shootings. When you have a public health crisis, you have options to respond. And we in our country have not taken all the options to respond.”
Begg said that the use of assault weapons by those who are not military or law enforcement is completely unnecessary, as is the allowance of high-capacity magazines. Not having background checks related to gun purchases is also a failure.
When you have a child that is hit with between three and 11 high-capacity bullets that explode inside their body, “it’s not a survivable event,” he noted. “That’s why all these children died at the scene.”
Regular handgun bullets come out one at a time, he pointed out. With the lower velocity, the survival rate is significantly higher, both for children and adults. And that is why there are scarce data on those who are shot with assault weapons — because, most of the time, no one survives.
The only survivors of Sandy Hook were those who were shot in the arms or legs, he said, as opposed to those who were shot in the head, neck, abdomen, or pelvis. Sadly and similarly, those in Uvalde who were shot multiple times in the center of the body did not survive.
In previously testifying before Congress, Begg recalled using a simulation video to show the difference between damage inflicted by a regular bullet and an assault weapon bullet. The regular bullet went in and out of an artificial block representing a human body. However, the assault weapon bullet went through what would have been organs, like the liver or heart, and completely blew them apart.
Without prevention efforts, Begg predicts that the U.S. will have “more and more shooters” who “become more brazen.”
There comes a point where a great infrastructure for trauma and resuscitation has already been developed, he added. “The biggest opportunity is prevention.”
Mark Kline, MD, chief medical officer and physician-in-chief at Children’s Hospital New Orleans, concurred.
“I’ve worked in children’s hospitals and pediatric trauma centers long enough to have seen a lot of the physical damage — there’s too much of it, and there has been a long time,” Kline told MedPage Today. “It really has reached epidemic proportions, I think. It’s not just mass shootings … it’s accidental shootings in the home, it’s kids caught in crossfire. There’s just too darn many guns, and it just seems to me that the least we can do, as we debate the role of mental health issues and gang violence and video games … is try to restrict access to the high-power guns that hold big magazines that can shoot however many rounds per minute, and inflict the kind of damage that we saw in Uvalde.”
“They’re weapons of war,” he added of assault weapons. “They really have no purpose in civil society.”
The explosive power and velocity from the projectiles “disintegrate organs,” and “there’s nothing to repair,” he added.
The people of Uvalde will never be the same, from the families who lost children, to the children who witnessed the horrific event, and to the entire community and to the first responders, Kline said.
For Colwell, he feels that speaking out is the only way to bring about change.
“We have to, as a medical community, make our political leaders as uncomfortable or more uncomfortable facing us than gun lobbyists,” he said. “That, in my mind, has to change.”
“We can continue to talk about how we can prepare for these things,” he added. “But there’s no way you’re going to prepare for something that has my family waiting in the living room 23 years later. Until our voices are heard … these events are not only going to keep happening, but keep happening more frequently.”
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