Stopping the Bullets From Traveling

Written by Nathan Irvin, MD, MSHPR, Johns Hopkins Department of Emergency Medicine

“That bullet hit more than just my son. It has riddled my entire family with emotional and psychological wounds that persist today…I remember eating all day and still being unable to fill the void of emptiness inside of me.”

These poignant words were expressed by a mother who has been agonizing over the loss of her son for nearly 18 years. As physicians, it is very easy to have a myopic view of injury and treatment, focusing only on the individual that was directly injured and ignoring the collateral damage the bullet does to the health of the family and community. This damage often manifests as psychological issues including anxiety, PTSD, depression or substance abuse and can foster abnormal adolescent development in affected youth. Though equally real and potentially just as debilitating, these “invisible” wounds are far too often left unaddressed and communities of individuals are left to deal with these festering injuries all alone.

Failing to acknowledge and address these collateral injuries has devastating effects on the health of the community and society. Evidence suggests that people suffering from untreated trauma tend to have higher burdens of chronic disease, which can lead to increased health care costs and premature death. These conditions are also thought to contribute to the cycle of victimization that claims nearly 17,000 lives annually. Furthermore, family units and earning potential are too often shattered as individuals are shuttled between jail and the grave or subjected to lives burdened by physical and emotional disability from their injuries. These bullets definitely hit more than just one individual – they affect us all.

“We must stop the bullets from traveling” eloquently stated this mother when asked about solutions to this problem. In order to do so, we must move beyond just addressing the physical wounds of individuals directly injured by violence, and employ a more holistic response that recognizes the impact trauma has on all individuals affected. Employing a “Trauma- Informed Care” model, wherein both systems and providers of care approach patients with an understanding of the role trauma and violence plays in their lives, is both practical and essential to stopping the impact of these bullets. By viewing our patients through a lens that is inclusive of the impact that trauma and violence has on their lives and health, we validate their experiences and empower them to address some of the issues affecting them.

To find gun violence prevention information, helpful resources, and action opportunities, please visit