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process of leading and participating in trauma systems.
Trauma system development has flourished in regions
where patient-centered consensus decisions are made,
balancing freedom and autonomy with responsibility.
The principles in Table 1 are as applicable to leading performance improvement and patient safety initiatives in
trauma centers as they are to firearm injury prevention.
The COT’s initial pilot work demonstrates that a
professional, collegial dialogue is achievable, and that
when ACS COT surgeons engage in such discussions,
they tend to agree more than they disagree, and when
they disagree, they are able to continue the dialogue
with a common goal of reducing injury and death. Once
the COT survey was fully analyzed, the survey results
were shared with COT members in a Town Hall at the
COT Annual Meeting in March 2016. This was a purposeful forum to facilitate a discussion regarding firearm
injury prevention. This Town Hall meeting was a model
of collegiality and professionalism. The attendees provided input on interpreting the study and their ideas and
thoughts with how best to proceed. One of the foci to
emerge from the conversation was development of comprehensive programs aimed at reducing violence. It was
determined that verified ACS trauma centers should be
leveraged as a platform to reduce all forms of violence
in our communities.
Based on these consensus principles, the COT Injury
Prevention and Control Committee has moved forward
with a comprehensive strategy aimed at reducing violence and injury. The first step was to conduct a survey
TABLE 1. BRIDGING THE CHASM
Lessons learned in the COT firearms injury
prevention consensus-building process
• Promote professionalism, respect, and collegiality
• Focus on doing the right thing and
doing things right for our patients
• Use objective data
• Recognize that everyone constructs stories
or narratives using objective and subjective
data; these narratives will legitimately differ
• Acknowledge and respect opposing narratives
with the understanding that a different
point of view may be helpful in moving
to a creative and better consensus
• Appeal to the middle ground:
What can we live with?
• Respect minority views and commit to
moving forward only with a consensus
involving elements of both narratives
• Focus on improving safety and reducing
harm rather than on restricting
legal firearm ownership
• Promote not just freedom, but
freedom with responsibility
FIGURE 2. AGE-ADJUSTED DEATH RATE:
MOTOR VEHICLE CRASHES VERSUS GUNSHOT WOUNDS
CDC National Center for Health Statistics, 1999–2015
MVC = motor vehicle crashes
GSW = gunshot wounds
