Gun Violence: A Health Crisis (With Dean Angela Amar)

Why is gun violence considered a public health issue? UNLV School of Nursing Dean Angela Amar returns to the podcast to explain gun violence from a nurse leader perspective. Topics include potential preventive measures; the long-term mental health implications stemming from these incidents; and the risks of becoming desensitized to shootings in our society. Show Advisory: this episode contains references to mass shootings, including 1 October and may trigger those experiencing trauma.

Joe Gaccione 0:02
Hello, and welcome to Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, Communications Director for the School of Nursing. There is no easy solution to the topic of gun violence and it feels at times there's no easy way to talk about it. With each mass shooting or firearm injury, there’s shock, outrage, sadness, and a call to action to prevent future shootings. With the increase of violence around the US and greater publicity of these incidents, these calls to change something grow louder and louder. But it's also important to understand the context of gun violence not just in political arenas or legal rights, but in the realm of an ongoing health crisis. Here to discuss gun violence as a public health emergency and how nursing can play a role in mitigating it is Angela Amar, Dean and Professor at UNLV School of Nursing. Dean Amar, thanks for coming back on the show.

Angela Amar 00:47
Thanks for having me, Joe.

Joe Gaccione 00:49
And I want to preface this too, for those of you out there, this is not going to be a conversation about self-defense, about Second Amendment rights. We're not going to get into those realms, this is strictly, objectively, health related. And on that topic, is it fair to call gun violence a public health crisis?

Angela Amar 1:03
Absolutely. Public health is concerned with promoting health, with preventing death, and enhancing life. And when we think about gun violence, it is a threat to someone's life. And it's also predictable and if you can predict something, you can prevent something.

Joe Gaccione 1:20
Now your expertise includes trauma-informed care, dating violence, survivors of violence and trauma. How common was gun violence in your research?

Angela Amar 1:27
Gun violence, I mean, I think the most common thing that, that you see is suicide. And when you think about domestic violence, often you see or hear the murder-suicide. So, the person who kills his spouse and then kills themselves. It's a very lethal form of death. And so, we don't always hear about the suicides as much. But certainly, we hear about in domestic violence, the most common cause of death would be gun violence.

Joe Gaccione 1:54
And we talk about gun violence, it is not just mass shootings, we talk about suicides, there's intentionally self-inflicted, like we just mentioned, unintentional, legal interventions, and I'm just going through some fast facts from the CDC. When we look at motivations behind gun violence, specifically, we're talking about mass shootings, in this case, it's common to argue that, “Don't look at the gun, look at the person behind it,” like they might not be there mentally, to put it bluntly. Where do you draw the line on that distinction?

Angela Amar 2:19
Mental health is important. I mean, our country has sort of stripped a lot of the services, a lot of the resources that could be available to prevent mental illness, and we can find the relationship. One thing that's interesting, though, to note, is that persons with mental illness are more likely to be victims of violence than perpetrators of violence. And so, that's a huge misnomer, because not that everyone who has mental illness is violent. What we do know about violence though, in any form, is that there are predictable upstream sort of factors that we could look at. So, being exposed to violence is a huge predictor. Past experiences of violence, whether as victim or perpetrator, huge predictor of violence. Violence to animals, huge predictor of future violence. They're all, these, and so, if we know all these factors that occur, that can lead to violence, our emphasis really should be on preventing these upstream factors that are part of this so that we don't have to get to this end result of gun trauma.

Joe Gaccione 3:22
And that leads into my next question, as a nurse, as a health care expert, what do you propose for preventative measures?

Angela Amar 3:28
I mean, I think a lot of the factors, like we're not talking anti-Second Amendment rights, we're talking about, if you think about what happens health wise. So, someone who gets, who has those automatic assault rifles that can unload hundreds of bullets in one sitting. So, we have the child who couldn't be recognized, except for her shoes, because her body is so torn apart. When you see people who make it to the ED who've experienced violence in this way, the wounds are catastrophic, the wounds are big, if someone survives, they’re surviving with major problems. So, having at least some limits, and who can get those, who has access to, helps then in the long run to not have the major trauma. I mean, I think that there's got to be some responsible policies that sort of, if we think about the shooting in Illinois, there were predictable things, it been called to the cops, the cops, excuse me, being called to the home. So, we knew that there was some trauma in some areas, the fact that he was able to get that much weapons is a problem. And so, I think we do have to look at considering the upstream factors that contribute to violence and how do we, in a responsible way, because we're not just talking about eliminating rights, but we're also thinking about the rights of the people who get shot innocently at a parade and how do we protect them? And so, where do we kind of draw balance and think about ways that cause the least harm and most benefit?

Joe Gaccione 4:54
And we talked about mental health before, it's not just the act itself, but the long-term effects. Not just the physical, but the mental are so Important to looking at more resources for post-traumatic stress. We talked about survivors, we mentioned survivors before, victims, just to be able to go on with life, not necessarily forgetting what happened, but just try to manage those feelings.

Angela Amar 5:13
Trauma is a hard thing. When people experience some kind of violence, I often say, you know, it's a major assault on the body and the body reacts in multiple ways. And they're not always just physical, although a lot of times we, physical manifestations of stress are common. So, all the headache, backache, stomachache, all those things have a stress-related component. So, when someone experiences a major traumatic event, it often intrudes on their activities of daily living, they re-see things, sounds trigger them, events trigger them, anniversary dates, memory, I mean, there's all kinds of things that trigger. And when you look at it, we talk sometimes in healthcare about, we can call it a thick-chart syndrome with people who have experienced violence and trauma, and they end up in healthcare seeking all kinds of complaints. And usually, they’re all, there’s some, pain, all kinds of things. And when you get to the bottom of it, if we could deal with the psychological effects of the trauma they've experienced, all of the rest of this stuff becomes a different thing to deal with.

Joe Gaccione 6:15
I remember the night of 1 October, I wasn't there at the, at the harvest festival, but I was working in TV news. And at that moment, I was not in the station, we got called in, you know, everyone, all hands on deck kind of situation. But I remember hearing sirens that night, and we lived in Henderson. So, we were a good 20, 25 minutes away, and even though I didn't see where they were going, I know where they were going. And to this day, I still hear sirens. And I just, my mind goes to that moment. Weeks later, Metro Police releases body cam video of officers responding to the scene and we were never going to air these clips because it'd be too traumatic. We felt it'd be too traumatic for the viewers because it just hits too close to home. But hearing the gunfire, that's something that I, I’ll never forget.

Angela Amar 6:56
Exactly. And the person who was hurt by it feels it even, even at a greater depth because it really affected them. Everybody responds differently, so there's no one pattern, there's no one way people respond. Different, some people, people always look for a classic victim, and some people do laugh, some people are serious, some people cry, some people scream, some people will do all kinds of things because we're all individual, we're all unique. The key factor is that it affects everyone in some way and nothing can just sit inside you, it comes out. And so, we see it manifested in a variety of things that are also then, if we deal with those things, we can help, and in the persons who are perpetrators, if we deal with their upstream sort of factors that predict violence, we can certainly decrease what we see.

Joe Gaccione 7:43
What about on the other end of the spectrum? I imagine at any given day, week, month, frontline nurses see multiple gunshot wound victims. They know how to treat the wounds, but I wonder, does it become a situation where they treat so many, it becomes so second nature, that they almost become desensitized to it, to the violence?

Angela Amar 8:01
Freud gave us a lot of defense mechanisms that people use, and one common one is that sort of compartmentalizing and so, it becomes real easy. You just had a baby, your child vomits, your child has messy diarrhea. You don't really think about what you're doing and you're just, you pick up your child out of the vomit, you wipe up the vomit, you clean the bed, you do all the stuff. After, you may say, “Oh my god, that was horrible. It was nasty, I can't believe I did that.” And so, I think it's the same thing when you're at the hospital that it's, a person comes in, there's this problem, you know that it's a high-stress situation and you dig in, you treat the wounds, you treat the injuries, you attend to the family, you do all the things you have to do. You step back from it and collapse almost, because it's very anxiety-producing, intense, but our body has that, our physical-mental body has that ability to sort of compartmentalize. The problem becomes, you do it too many times and if it becomes a part of what you do, then people aren't dealing with their feelings, they aren't addressing them and then we see all the other problems that can result, all the way up to suicide, drug use, among health professionals because you need a way to manage those feelings. But it is a part of people kind of as you do when your kid’s sick, not to minimize, but it is similar that you just deal with the problem and you dig in and kind of collapse and take care of yourself later.

Joe Gaccione 9:24
And I feel it's, it is a necessary evil for healthcare professionals, law enforcement, military, you have to, to an extent, you have to power through because you have to get the job done. It's, it's just, it's part of it for better and for worse. But I think sometimes from an outside perspective, we hear so much about shootings that we dangerously get close to feeling like, “Well, here's another one. I guess it's never going to end. I guess we just have to accept it.” And that's, that's the desensitizing that I'm, I'm concerned about.

Angela Amar 9:54
When I think at a societal level, because I felt that about Sandy Hook, the fact that you would just think that somebody would walk into an elementary school with an assault rifle and gun down dozens of children, and you would have just thought, of course, our country has to say, “This can't go on.” We said, “This can't go on,” and we did all the thoughts and prayers, but the policy and the change and the regulation, look at, was it Sweden that had that mass shooting at a camp, and they banned the assault rifles immediately. And so, we had or when people say, the one guy with the bomb in his shoe, and we all take off our shoes at TSA now. And so, there wasn't that kind of response. Luckily, what's happened recently in Texas, we're seeing more response. But there is that danger of us just kind of taking for granted that kids are going to have mass shooter drills and practice hiding under a desk. And then we're all going to think that when we go to a movie, or Fourth of July parade, or whatever, that that possibility exists. And that is, I think, the desensitization, that's not as good for us.

Joe Gaccione 11:04
That's why it's important to have these conversations, so there's more context behind it, that it's not just, “It doesn't have to be this way,” but there, there are layers to it. Now, you recently presented along with other researchers at a webinar on gun violence through the American Association of Colleges of Nursing. Can you share some of the ideas that were discussed there?

Angela Amar 11:22
I think that it's interesting to think about people using their research. So, one of our presenters, Jackie Campbell, she'll be coming here in October, she has a tool called the danger assessment, and it's for women who are in abusive relationships, and it can help predict the likelihood that they'll be killed by their partner and the higher their score, the higher the likelihood. Discussing that with, with women or men who are in abusive relationships can be helpful because when you see the risk, when you see the, all these factors that contribute to that, it can make people decide to make change. In her career, being part of the having marital rape become a law in every, against the law in every state, being part of the Violence Against Women Act, which has been renewed several times now. But we can see the power of using your research to say, “Look what is happening, look, you know, what does this look like?” We told a story there about a woman who was killed coming into the court for a court appearance, and the husband, spouse, partner knew she would be there, so he shot her. So, now they've made it where all the people who are women who come into court park under the Courthouse with a judge's park, so they're safer. Terry Richmond does research on gun violence. She's an ED Critical Care Nurse, she sees the effects of the wounds, so she's saying, “I see what happens when you can't repair people from the damage and so, let's look at how we have safer laws that protect people's health, so if people are going to get shot, at least it's not these wounds that are debilitating and really change quality of life.” Sarah, who's on, does a lot of policy work. And so, a lot of this happens at the state level too, in terms of thinking about how we think about the laws. New York just had the concealed carry law that was overturned. And so, and then, the other piece of policy is thinking about since we know that violence is predictable, if something is predictable, it's preventable. So how do we determine who's at risk earlier? How do we look at different programming? How do we look at things that sort of build people up, and that treat mental illness as it occurs versus making it a choice for people to get? And I’m not saying I'm anti-choice for mental illness, but at some point, people need help, and if you're already in a non-well mental place, it's hard to make good decisions about your healthcare at that point, or medicines. So, making health, mental healthcare more available, child support programs, looking at preventing child abuse in early ages, because future paths, violence, future violence. So, it's all those things of, “How do we as a society think differently about ensuring that everybody gets to develop with full agency and develop to be well rounded citizens that aren't just resorting to violence?”

Joe Gaccione 14:09
Well, Dean Amar, that's all I have. Thank you very much for coming on the show. Obviously, big issue. We're not going to solve the world's problems in one sitting, but at least this information can benefit other people out there. So, thank you again.

Angela Amar 14:21
Thank you, Joe.

Joe Gaccione 14:22
Everyone out there, thanks for listening, and have a great day.

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Angela Amar
Angela Amar
Dean, Professor at UNLV School of Nursing
Gun Violence: A Health Crisis (With Dean Angela Amar)
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