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Newtown Amicus Brief: Firearms with Scaled Lethality in the Civilian Setting

Christopher Barsotti, MD, FACEP

Assault rifles have altered the reality of civilian emergency medicine practice. These high-capacity rifles were engineered to discharge a large volume of low-recoil ammunition rapidly and with extreme kinetic force in order to optimize target destruction. When utilized at their engineered potential in the civilian setting, assault rifles cause an exponential scale of injury, as observed in a number of public shootings, such as at the Pulse nightclub last year in Orlando, FL, and at the Sandy Hook Elementary School, in Newtown, CT, in 2012, among several others. 

Assault rifles are diffusely available in US society. Individuals intent on perpetrating civilian violence will continue to utilize these weapons for their engineered potential. In response to this reality, physicians have come to anticipate a high volume of casualties with imminently lethal injuries when crafting emergency preparedness and response plans. Examples include the ACEP High Threat Emergency Casualty Care Task Force, the American College of Surgeons Hartford Consensus on improving survival during active shooter events, and the Stop the Bleed campaign promoted by the US Department of Homeland Security. This knowledge is also embedded in ubiquitous active shooter plans.

The scaled lethality associated with these weapons may also contribute to estimations of risk in medical threat assessments. From EM-PRN data, we know that firearms augment clinical concern in acute danger determinations1. Although these data do not differentiate between types of firearm, it is realistic for physicians to be concerned about mass violence when psychotic patients have access to assault rifles.

Professional medical organizations and individual physicians have a respected role in advising society of the medical realities associated with substances and consumer goods. With respect to firearms, concerns about the health consequences of assault rifles have been raised by numerous professional medical organizations whose member constituents routinely address violence in clinical practice2. The scaled lethality associated with this type of weapon is a consistent, specific concern.

Many of our colleagues have dealt with the health consequences of assault rifles among their patients, and can speak personally, and authoritatively, on what scaled lethality means to individual patients, communities, physicians and health systems in the civilian setting. Their experiences and perspectives provide essential information to those who are in a position to make policy and/or legal decisions regarding the role of this weapon in civil society.

Several of these physicians have contributed to an amicus brief, filed on behalf of medical stakeholders to the State of Connecticut Supreme Court, and in support of the claim proposed by families of victims of the Sandy Hook school shooting that manufacturers and marketers of the AR-15 assault rifle (used to kill their children and family members) should bear responsibility for the exceptionally lethal qualities of the weapon.

Their stories are relevant to all of us in acute care medicine. Full copies of the amicus brief are available for download at the links below.  



  1. Ranney M, and Barsotti C. Opinion: firearm injury prevention is more than pro/con debate. ACEP Now. 2016;35:4-5. 
  2. Weinberger S, Hoyt D, Lawrence H, Levin S, et al. Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Ann Intern Med. 2015;162:513-516.

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