Bullet Related Injury and Policy in St. Louis and the United States

3 units

The United States holds some of the least desirable superlatives of any nation on Earth when it comes to Bullet Related Injury (BRI), including having one of the highest rates of BRI deaths in the world. 1 Globally, the U.S. ranked 7 th for rates of BRI homicides in 2021, and among high-income countries with populations of at least 10 million, it ranked first.2 In 2022, nearly 50,000 Americans died from BRI, and as of 2020, BRI was the leading cause of death for American children and adolescents.3,4 BRI is also the leading cause of death among Black men from birth to middle-age. 5 Locally, from 2017 to 2023, St. Louis had the highest rate of fatal BRI of any city in the United States,6 and in 2022, Missouri ranked 5 th in the nation for its rate of fatal BRI, with nearly 1,500 deaths.7 This course, co-taught by Dr. LJ Punch, a St. Louis trauma surgeon and advocate, and Dr. Caitlin McMurtry, a Brown School assistant professor, asks students to reconsider everything they know about “gun violence.” It upends the way we think about firearms, trauma, and violence in our communities by using Bullet Related Injury as a framework to consider the wounds that bullets create – “the physical, emotional, social, and spiritual impact a bullet has;”8 the injuries seen and unseen, in individuals, families, communities, and our society. In addition to learning about the history and politics of BRI and modes of BRI transmission (including intentional and unintentional injuries and those inflicted by oneself and by others), we will center the experiences of those most affected by BRI, hearing from patients and their loved ones. We will consider gun positive and gun negative attitudes in Black Americans and how those perspectives impact perceived risk of BRI and attitudes toward firearm ownership. We will explore how BRI in one person can create a self-perpetuating cycle of injury and what it means to treat BRI at every level – how we practice medicine, how we care for the whole person, how we change the social determinants of BRI, and how we un-break broken trust in our communities.