By Laura Ostrowsky, RN, CCM, MUP, FCM 

In August 2024, there were three separate incidents of accidental shootings by children aged 3, 5, and 8; two were fatal. On the first day of school in Georgia, on September 4th, a 14-year-old killed four people and injured 9. These tragedies have become alarmingly familiar to all of us. 

This year, the U.S. Surgeon General published an advisory on gun violence, identifying it as a public health crisis. Gun violence is, therefore, a healthcare issue, not a political issue, and healthcare professionals are obligated to help address and correct this grave situation. Politicians pass the laws but need the incentives and guidance of health experts to initiate legislation. (https://www.hhs.gov/sites/default/files/firearm-violence-advisory.pdf). 

New laws do not have to eradicate all guns or violate Second Amendment rights. The laws should focus on preventing the death and injury toll from mass shootings, suicides, and accidents. Common sense interventions like background checks, gun safety training, and secure storage can do much to mitigate this crisis. Training and a license are required to operate a motor vehicle in all states in this county, while firearms can be purchased in many states without these guardrails. This discrepancy exists even though the leading cause of death in children is firearm-related, not disease or motor vehicle accidents, a stunning statistic. (Current Causes of Death in Children and Adolescents in the United States. The New England Journal of Medicine, 386(20), 1955–1956. https:// doi.org/10.1056/NEJMc2201761). 

The danger of gun possession and use is also tied to the types of firearms available. Automatic and semiautomatic weapons, weapons of war, are not recreational and have no place in civilian use. They are not sporting weapons and are useless for hunting since their targets are torn and damaged beyond recognition. When used by mass shooters, these firearms increase the number of victims, both fatal and injured. A study done by researchers at Brigham and Women’s in Boston analyzed 18 years of FBI data, finding that when semiautomatic rifles are used, twice as many people are wounded or killed. https://www.sciencealert.com/first-of-its-kind-study-calculates-deadly-semi-automatic-rifles-gun-control-violence-firearms  Details of the study were published in JAMA in an article entitled” Lethality of Civilian Active Shooting Incidents With and Without Semiautomatic Rifles in the United States.” https://jamanetwork.com/journals/jama/article-abstract/2702134 Types of injuries are also more severe, due to the high velocity of the bullets, resulting in greater and more substantial bodily damage than shots from an ordinary weapon. A more detailed explanation can be found in “A surgeon explains why AR-15-style rifles are so deadly.” https://www.salon.com/2022/07/12/ar-15-style-rifles-doctor-perspective/ 

The American Public Health Association came out with a fact sheet, “Gun Violence is a Public Health Issue” (https://www.apha.org/- media/files/pdf/advocacy/speak/220617_gun_violence_prevention_fact_sheet.pdf), highlighting the morbidity burden and advocating a public health approach to mitigating the problem. 

How can case managers, as health care professionals, help? We can educate the public and provide facts showing how gun violence is affecting their communities. We can advocate for national gun safety laws that require background checks and waiting periods for all gun purchases. Firearm owners would be required to have a license like car drivers. Currently, no federal law requires a license or permit to own or purchase a weapon. Gun owners in every state need to be required to store their guns securely to prevent unauthorized access and use. Licensing should be time-limited, and renewal should depend on refresher courses in skills training, safety, storage, and first aid. Automatic and semiautomatic weapons have no place in our society and should be outlawed for civilian use. 

I propose that this issue be added to our public policy initiatives. We already focus on the issue of mental health treatment and access to care, and there is an overlap with the current crisis of gun injuries and deaths. Americans are dying at alarming rates. This is a problem with a solution. It’s time to take a stand, use common sense and save lives.

Curious about how to effectively share the critical challenges facing case managers with your elected officials? Wondering what it takes to participate in Capitol Hill Days or how a virtual advocacy session unfolds? Join CMSA Public Policy Chair, Debra Emery and Committee Members, Carol Hiner and Therese Quinn, as they review the 2025 CMSA Virtual Hill Visits program, review the tools, resources and support provided for a successful event and illustrate the importance of your participation. https://cmsa.org/hill-day/

Bio: Laura Ostrowsky, RN, CCM, MUP, FCM spent 20 years from 1999-2019 as the Director of Case Management at Memorial Sloan-Kettering Cancer Center (MSKCC) and is currently teaching with the Case Management Institute and consulting on all things case management. Laura was the 2012 CMSA Case Manager of the Year. Her program at MSKCC was nominated by Case in Point for excellence in Utilization Management, Discharge Planning and Transitions in Care. She created a patient advocacy program to assist patients in obtaining access to specialty care despite network restrictions. The program has been featured in articles in Advance for Nursing, The Wall Street Journal, Case in Point, and Case Management Monthly. Laura holds a master’s degree in Health Planning and Policy from Hunter College. She has been a CMSA member since 2005, and has served on the Board of Directors of the NYC Chapter since 2011, and CMSA National from 2016-2018 and 2021-2024. Laura has over 30 years of health care experience, including time as a staff nurse, QA Coordinator, Director of UR and QA at Montefiore, followed by directorships in CM at New York Presbyterian(NYP) and Memorial Sloan Kettering Cancer Center. She also spent 3 years in information services at the NYP Network overseeing the selection, acquisition and implementation of an integrated hospital information application for UR, QA, Credentialing and Risk Management at 5 network hospitals. Laura has published articles on Case Management in CMSA Today, Professional Case Management, Case in Point, The Patient Flow Journal and other periodicals. She regularly presents at national conferences including CMSA, the Patient Advocate Institute and others on topics ranging from case management, patient flow and payer provider collaboration to advocacy, collaborative practice and case management’s role in the changing health care environment. She is also a past member of the Genentech speaker’s bureau where she presented on topics in oncology case management, palliative care and hospice.