How to Prevent Mass Shootings – PAN Position Paper

On October 1, 2017, the United States witnessed the worst mass shooting in its history.  While innocent people were enjoying a country music concert 32 floors below, a man who had no criminal history opened fire on them from a hotel window and, using battlefield weapons and ammunition he had purchased legally, killed 58 and injured over 500 others.

Can catastrophes like this be prevented?  Sometimes it seems hopeless.  We’ve seen one horrific shooting after another in recent years, yet our political system seems unable to enact common sense legislation to prevent these events.  Many have come to believe in the myth of the invincible gun lobby.

The United States is not the only nation to suffer from mass shootings; however, the problem is far worse here than anywhere else in the world.  A comparative study of 171 countries showed a close correlation between the availability of firearms and the rate of mass shootings.  Americans own 89 guns per 100 persons, compared with a worldwide average of 14 per 100 (these are not evenly distributed – 66% of households have no gun, and 3% have more than 25).  Between 1966 and 2012, the international per-country average for mass shootings (defined as episodes in which 3 or more people were killed by the same shooter) was 1.7.  In that time, the U.S. had 90.

As physicians and public health experts, we’re accustomed to tackling tough, seemingly intractable problems.  Polio once ravaged the nation in recurrent epidemics.  Now it has all but vanished in the Western Hemisphere. Automobile fatalities have dropped more than 90% since the 1950’s due to research and implementation of motor vehicle safety measures.  Cancer is a devastating condition of enormous biological complexity; yet we can now prevent or effectively treat the majority of common malignancies.

Mass shootings have been increasing in frequency and severity over the past decade.  The easy, legal availability of powerful guns and ammunition greatly facilitates these attacks.

No single law or action would completely eliminate the possibility of a mass shooting.  However, we would like to propose several entirely constitutional and feasible measures that, taken together, could substantially reduce their frequency and severity.

Eliminate legal access to the types of guns and ammunition that facilitate long-duration, high-fatality mass shootings.

The weapons used in the Las Vegas shooting were semiautomatic rifles.  Combined with a high-capacity magazine, these weapons can shoot hundreds of bullets as fast as the user can pull the trigger.  In Las Vegas, the shooter appears to have modified the rifles using a legal device called a bump-stock, which essentially turned them into machine guns, bypassing the trigger altogether to fire continuously.

Semiautomatic weapons have been used in 14 mass shootings in the past 10 years, including Columbine, Sandy Hook, Aurora, San Bernardino and Orlando, and their use has increased over the past two years.  Semiautomatic weapon use has been shown to raise the injury rate in mass shootings by 157% and the fatality rate by 47%.   Attraction to these weapons is a major motivator for those who attempt to commit such acts.  Semiautomatic weapons were illegal in the United States from 1994 to 2004, and remain so in several states.

During the U.S. ban, the number of semiautomatic weapons used in crimes and recovered from criminals fell each year.  In Australia, where a ban on rapid fire long guns was combined with a government buyback program, there have been no mass shootings (none!) and the number of firearm deaths has diminished from 1.6 to 1.0 per thousand since 1996, when the ban was implemented.

Eliminating the legal public and private sale of semiautomatic weapons would not, in itself, guarantee against their use in mass shootings.  An individual planning a rampage might acquire assault weapons illegally.  However, it is notable that most of the mass shooters of recent years have acquired their guns legally and have no criminal history.  In fact, studies of the intended perpetrators of aborted mass shootings indicate that they study past shooting events and use that information to plan their own.  The standard modus operandi – and part of the attraction for the individuals who plan mass shootings – is the legal stockpiling of weapons.  Thus, it is not certain that potential mass shooters, if denied legal access to semiautomatic weapons, would have the motivation or means to acquire them illegally.

Shootings could also be carried out with weapons that were in the possession of the perpetrator before the ban went into effect.  The protective impact of an assault weapon ban would be incremental over time, as existing weapons were recovered, damaged or otherwise inactivated.  The fact that a ban might benefit future generations more than our own is an argument for, not against, such a ban.  The short-term impact could be augmented by a buyback program, such as the one implemented in Australia.

Ensure that guns are not sold legally to those who are at risk to use them harmfully.

Federal law prohibits purchase and ownership of guns by persons who have been convicted of violent misdemeanors, have a history of drug or alcohol abuse, or have been convicted of juvenile offenses.  This law is enforced through mandatory background checks that take place at the time of gun purchase from a licensed dealer.

However, the law permits the sale of guns without a background check by unlicensed dealers.  As a consequence, persons prohibited from owning guns can buy them from private sellers at gun shows and over the Internet.  In one study, 96% of persons convicted of gun offenses had purchased their guns through unlicensed dealers.

This loophole should be closed by requiring universal background checks for all gun sales. In combination with an assault weapon ban, this would make it considerably harder for someone planning a mass shooting to acquire assault weapons.

The so-called “Charleston loophole,” which allows a gun sale to go through if an FBI check cannot be completed in three days, must also be closed. This is the legal loophole that allowed Dylan Roof to kill nine people in Charleston, S. C.  despite a drug possession charge which should have prevented him from buying a weapon.

The group Ohioans for Gun Safety is planning a ballot initiative that would require all gun sales in Ohio to be completed with a background check. This is particularly important because buying a gun at a Ohio gun show is the most prevalent form of gun transaction in the state. Ohio gun show distributors face little regulation.  No state license is required to sell a gun, there is no mandatory record keeping, there is no communication with the state, and police inspections are not allowed. As a result, Ohio remains a top source of interstate crime guns, according to the Bureau of Alcohol, Tobacco and Firearms.

Allow law enforcement officials to keep modern, searchable records of firearm and ammunition purchases.

Tracking the purchase of guns and ammunition electronically would provide law enforcement officials with a powerful tool to spot the weapon stockpiling that precedes a mass shooting.  Analysts might pay particular attention to stockpiling preceding a large public event in a given location.  Cross checking this against other databases such as the terrorist watch list would enhance the ability to spot and investigate suspicious behavior before a mass shooting takes place.

The creation of an efficient database has been vigorously opposed by the gun lobby on the basis that it constitutes an invasion of privacy.  We feel that the public safety argument in favor of gun tracking outweighs privacy concerns.  In our own field, which highly values privacy, we have accepted that for the health and safety of a community, it is important to report certain communicable diseases to public health departments. When treating gun violence like an public health issue, this same approach should apply.  It is not unreasonable to require someone who wishes to own a highly dangerous weapon to provide data such as name and address in the interest of preventing that weapon from being used for violent crime and mass murder.

Allow and fund research into gun violence prevention, including mass shootings

As physicians, we have seen how public health research has led to laws that save lives, such as the prohibition of drunk and distracted driving, the requirement for seat belt use, and the universal installation of airbags in cars.  All of these have all measurably and substantially reduced unnecessary deaths.

Congress should end the ban on public funding of research on gun violence.  The Centers for Disease Control should be fully funded to investigate the epidemiology of gun violence and to propose practical, science-based measures to address it. Objective data is the only logical way to have a conversation and enact laws that reduce gun violence.

If private individuals are to have a role in responding to mass shootings, they should be trained and licensed

The effect of concealed carry has been studied thoroughly in the past few years, with the conclusion that there is no discernible relationship between the number of concealed carry permits issued in a state and the crime rate.  Of 160 active shooting incidents from 2000 to 2013, according to an FBI analysis, only one was stopped by a concealed carry permit holder.

Nonetheless, the idea that an experienced person such as a military veteran with a firearm could disable a shooter before law enforcement arrives is often put forward as a rationale for concealed carry laws and unrestricted gun access.

Mass shootings are chaotic events.  In the absence of training, there is a high probability that a random individual using a gun with the intention of “taking down” the shooter would increase the injury rate and interfere with the response by law enforcement officials.  We would suggest that, if the “good guy with a gun” model is to be effective, private individuals allowed to carry concealed firearms should undergo extensive mandated training in managing shooting incidents and should be licensed as voluntary first responders.


The accelerating problem of mass shootings in this country demands a vigorous response.  When fighting to preserve our right to free speech and our right to bear arms, we neglect the fact that they do not exist in isolation. When the simple act of being in a public space places people at risk of being shot and killed, no citizen can fully exercise his or her right to move and speak freely.  We find it implausible that this is the situation our Founding Fathers hoped for when they wrote the Bill  of Rights.

We believe that we are never helpless in the face of death, disease and disorder.  With a sustained national commitment to public health and a methodical scientific approach, we can absolutely prevent the sort of terrifying mass shootings we have seen in the last 30 years and overcome the epidemic of gun violence that afflicts our country.  The solutions are there.  We call upon Americans to raise their voices, and on public officials to act.


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