Columbine.  Santana High.  Rocori.  Red Lake.  Chardon.  Sandy Hook.  Reynolds High.  Arapahoe.  Marysville-Pilchuck.  Kids killing kids in school.  15 years.  More than 75 deaths.  More than 100 wounded.  Communities all over this country wondering if they are next.  Americans are 20 times more likely to die via a shooting than any other developed country in the world, and children between the ages 5 of 14 are 17 times more likely to suffer this fate.  The National Rifle Association offers young children free membership for six months and the chance to win a high-powered rifle or shotgun on ”NRA Youth Day.”  What, me worry?

Well, at least here in New Hampshire we have not had any school shootings yet.  Bomb threats?  Now you are talking.  When it is your own teenage child at the school where the bomb threat happens, you suddenly understand how each of those parents since Columbine felt until they talked to or hugged their son or daughter.  New Hampshire was not alone earlier this month, as schools in Massachusetts were also threatened to have explosives on their school property.  The sad truth about school bombings, rare as they may be, is that the real ones usually are not preceded by a threat, credible or not.  According to the U.S. Bureau of Alcohol, Tobacco, Firearms and Explosive, only 14% of more than 1,000 bomb incidents in schools were accompanied by a warning to the school or other authorities.

Ultimately, these events may not be categorized as ”Adverse Childhood Experiences,” or ACE, according to a study that began in the 1990s out of Kaiser Permanente in San Diego and has looked at the health, social and economic risks that result from childhood trauma.  A partnership in the study now includes the Centers for Disease Control.  As the number of adverse experiences increases, so does the risk for developing long-term health problems, such as ischemic heart disease, COPD, alcoholism, depression, sexually transmitted disease, smoking and suicide attempts.  Even though these school traumas don’t fit in the classic ACE categories of abuse, neglect or household dysfunction, children (and parents!) need to be able to process through the real or perceived threat of walking through the schoolhouse doors every morning.

So as physicians, what can we do for our patients when a horrible school event occurs, either across the country or in our hometown?  On a large scale, if you work with a school district, find out what the emergency plan is for such a mass-casualty event.  It turns out that in the shootings on Friday in Marysville, Washington, air ambulances were turned away in favor of ground transport, even though they could have taken the victims to a higher level trauma center.

On an individual scale, it seems appropriate to allow children to talk about their feelings, and encourage emotional interaction.  Let them know that your office is always a safe place for them and their families to reflect on these issues, and, hopefully, home is a safe place for them, too. Parents need to maintain their own physical and mental health, but need to watch for signs of problems or issues with their children.  Trying to keep the routine “normal” is also helpful.  See the article in Current Psychiatry.

What is the root cause of all this madness, one may ask.  Bullying?  Teenage love scorned?  Easy access to firearms at home?  How to stop it? Ballistic whiteboards?  Bulletproof backpacks?  Door barricades?   Many questions, fewer answers, as the body count keeps increasing.  Make sure you hug your kids tonight.

Dedicated to the memories of Gia Soriano and Zoe Galasso.

See the story of how the Seahawks welcomed the Marysville-Pilchuck football team.


Stuart J. Glassman, MD

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There may have not been a school shooting in NH yet, but a 6th grader did bring a loaded handgun to my daughter's middle school (SAU16 district) last spring. Luckily no one was hurt and the police investigation determined that the child "had no ill intent" whatever that means. He did not get the weapon from his own home. It is only a matter of time before it happens in this state. We need to take a deep long look at our society and why this is happening. I believe it is Australia that put an end to gun violence in schools after a tragedy in their country. Perhaps looking at their example could help us stop this madness.

As you are likely aware, the Florida Governor and State House has banned physicians from broaching the topic of guns w their patients - imagine being prohibited to ask a depressed elderly pt about the presence of weapons in the house (highest accomplished suicide rate is in older men) Pediatricians, primary care docs and any concerned physician needs to send a message to Florida, and it would be strongest if sent through our NHMS. I suggest NHMS loudly encourage it's members to travel elsewhere for medical CMEs until Florida repeals this NRA sponsored nonsense -the Fla statehouse make take responsibility when business complains about their potential tourist hit. hanks for your editorial Ken Dolkart MD FACP

Seriously, please correct me if I am wrong but it is my understanding that docs in Florida can talk a blue streak to patients about gun safety whether they know what they are talking about or not. I think that they are just not allowed to ask if firearms are present in the home and then to subsequently document that answer. Clarification on this issue seems important.

Florida Statutes: Chapter 790 Section 338 (State Statute 790.338) Please read the statute for yourselves. There is NO mention of making the discussion of firearms with a patient illegal. It is only the direct questioning and documenting whether there is a firearm in the home and or ownership of firearms by the patient or others if that questioning is not relevant to the patient's medical care or safety, or the safety of others that has been prohibited. I know people have different opinions on many of the thorny subjects we deal with in medicine and we should. What we don't have is the right to disseminate either purposefully or through lack of sufficient knowledge nonfactual information regarding these issues.