Moving from Crisis to Action on Gun Safety

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Four years after the first March for Our Lives rally in Washington D.C., survivors of the Marjory Stoneman Douglas High School shooting in Parkland, Florida are once again organizing student-led demonstrations around the country this weekend in response to the Robb Elementary School shooting in Uvalde, Texas. Andy speaks with Parkland survivor Samantha Fuentes and ER physician Dr. Megan Ranney about how they turned their trauma into action, and how you can, too.

Keep up with Andy on Twitter @ASlavitt.

Follow Dr. Megan Ranney and Samantha Fuentes on Twitter @meganranney and @funkpuncher.

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Andy Slavitt, Sam Fuentes, Megan Ranney

Andy Slavitt  00:18

IN THE BUBBLE, this is Andy Slavitt. Welcome to our Friday conversation. It’s Friday, June 10th. And we’ve got a great conversation, I’m going to welcome a couple of people you’re going to absolutely adore hearing from in a moment. This is a show that I think you want to dedicate to how we turn our own stories of pain into moments to transform our lives and could really transform our society. And the two people that are here today have those experiences with gun violence, one, a victim of school, a school shooting in Parkland, four years ago, and one, an emergency room physician, both of whom decided that acting to prevent this from happening in the future, was the most sensible thing they could do with their times. And you’ll really appreciate why that is. And you know, as we get into this, I think we just have to understand, we’re just now sitting in a place where the number one cause of death among kids who make it through infancy is an injury from a gun. And that means we got to give it space, we got to give it the air that needs, suicides are up by massive amounts. And then we have these things that are barely even breaking through anymore these major shootings. But this is not a show that we’re going to wallow in the politics. This is a show that I think can at least show me how, we can use anything that happens in our lives, and move us towards action and change. So I’m going to ask these two guests to actually introduce themselves to one another, because I think it is a great way to start this conversation. So Sam, point this, tell us about yourself.

Sam Fuentes  02:13

Well, it’s nice to meet you. My name is Sam Fuentes. I’m currently a 22-year old gun violence prevention activist as well as mass shooting survivor, I survived the Parkland shooting in 2018 that took the lives of 17 students and teachers. I’ve been working here within the field for the last four years or so, you know, collaborating and working with organizations like March for our lives, Moms Demand Action, the Sandy Hook Promise. And furthermore, it’s been a large part of my passion, as well as the large part of, you know, my life, my lived experience as a you know, as a trauma survivor. And, you know, I’m just here to advocate for gun violence prevention, legislation and just activism in general. And I find that the most effective way to do that is through survival leadership. So yeah, that’s a little bit about me.

Megan Ranney 

Thank you, Sam. And it’s a honor to meet you. So I’m Megan Ranney. I’m an emergency physician. Researcher. Most of my research looks at how to use technology to identify risk factors for prevent and treat the aftermath of violence and related behavioral health problems. I’m also the academic dean at the School of Public Health here at Brown University in Rhode Island. And I’ve spent the last 10 or 15 years trying to get firearm injury talked about as a health problem. Back when I did my residency in emergency medicine, I went into emergency medicine partly because I wanted to work on gender based violence. And when I finished residency, I went and did a fellowship specifically in injury prevention. So like two extra years of training in the science of injury prevention, and we can talk about this, but there was this day working in the ER, where it hit me that no one was talking about firearm injury is a preventable health problem. And so from that day in, right around 2008, up through now, with a little detour with COVID been a huge part of both my career and my mission.

Andy Slavitt  04:40

I’m so proud to have both of you in the bubble today. Either the discussion we’re going to have in this Friday conversation is something that I hope I think you can help a lot of others, which is how people move from a traumatic event or experience or realization to the place where you both moved, which is to a place of advocacy, empowerment, and as a guiding light for others. And I want to start by honoring both of your individual stories, because it’s the route for which things came. You say you describe yourself prior to the shooting. Now, four years ago, as a kid with a lot of normal things, I’m sure not everything was great. Like, it’s not for every kid, but a lot of you talked about being a kid back then. And I’m wondering if you wouldn’t mind just taking us back to your perspective today on those events, what happened and what that initial trauma was like?

Sam Fuentes

Sure, that’s a great question. I grew up in a generation that recognized and witness, you know, countless amounts of shootings that hit the headlines and were catastrophic, right? And I was so desensitized and so numb to those events at that point in my life to a point where it had almost became normal to me. But it’s What’s interesting, though, right, is that my definition of normal now is entirely different. I’m, you know, more than I’m just aware to these, these circumstances, right? It’s become inherently personal to me. And so, for me, my interest isn’t just raised from a place of, you know, sympathy, and this is terrible, I would never want this to happen to anyone of my family, or my children to sort of, you know, lose sympathy that people feel when they witness it, it becomes embedded within my identity, because it’s a part of my trauma now, and I’m here not by choice I was this was something that I was pushed into something that was, you know, birthed out of a really, really traumatic event that completely, you know, devastated. Not just myself, but my entire community of people. So for me, my motivations come from a place of real pain and a real yearning, of trying to bring justice and light to not just what happened to me, but what happens to, you know, hundreds and 1000s of Americans every year.

Andy Slavitt 

Are you able to describe to somebody who hasn’t been through a school shooting, but can only imagine it, sitting in a class, studying the Holocaust as matter of fact. And the moments that followed, you caught shrapnel, you were covered in blood, you got hurt, and you watch people in front of you lose their lives. How does that experience run through you? And what are the stages you go through? And just even just adjusting to all of those things coming at you.

Sam Fuentes  08:12

One thing is that it completely reshapes your reality and like your perspective on it. As a sever of PTSD, I, not only do I have nightmares and flashbacks, I fear for my life in very normal everyday occurrences in which, you know, I have a level of paranoia of people that I didn’t have before I’ve created myths for myself that I have to constantly debunk every day, which is that there’s someone out to get me and there’s someone out to hurt me. And additionally, not just like having to live with the psychological repercussions, right? I’ve got like the physical, you know, normally that’s happening with my body that I’m still learning to try to understand. I, you know, I was shot just above my left knee and then I sustained a bunch of injuries with additional shrapnel in my legs and my face and my arm, I had to get multiple surgeries that I had never heard of one being laser surgery to sort of reconstruct my face to look like what it used to look like. You know, having bits of metal pulled out of my body because they become dangerous to myself, you know, in the future, I have the potential of suffering from literal lead poisoning. These are just things besides that there’s just the daily everyday chronic pain which I don’t have the same, you know, range of motion and stamina that my body once had. And that’s what fuels my fire. Personally, I think it’s my own frustration with myself and then also the frustration that I see when you see this everyday gun violence that Americans are facing, you know, whether that’s the 60% that’s, you know, suicide, whether that’s police brutality, whether that’s, you know, like hate crimes or mass shootings or the cases of, you know, White nationalism, like, these are experiences that are not unique to myself, right? There’s a nation of people who beaks understand to an extent, even though mass shootings are a very unique thing, right. But everyone who’s experienced gun violence have these common, you know, denominators here, and it’s that trauma.

Andy Slavitt  10:39

Well, yeah, you didn’t choose it, it chose you. It’s foundationally formed, what you’re doing now. And as you say, it’s sparked you. And Megan, something clearly spark you as well. You know, we know you from this podcast, you’ve been on a couple of really groundbreaking episodes, you’ve been very generous to share the experience that trauma surgeons and physicians and emergency room doc’s have. And I’m wondering if, you know, we’re used to hearing about the experience of gun violence. In some particular ways, I think the lens we almost never get is the lens of the person working in the emergency room when somebody gets brought in. Who has been a victim of gun violence, whether it’s self-harm, or whether it’s from someone else, whether it’s from a mass shooting an individual shooting, whether it’s from a small caliber weapon, or from an AR15, that shows up to you as a life at risk. And I’m wondering if you can just take us back to the experience you’ve had, maybe even with one or two cases, so we could try to understand what that experience is like.

Megan Ranney  12:05

So this sounds horrible, but gunshot wounds are part of the bread and butter of Emergency Medicine in the United States. There is not an emergency physician working who has not taken care of a GFW, it is what we train on in our major trauma centers. And for some people, that kind of adrenaline rush of taking care of victims is one of the things like resuscitating a cardiac arrest patient that draws them to this field, it’s this idea of there is an acute problem that is so time sensitive, and you have the potential to fix it. When someone gets shot by a gun, what happens is either that person gets driven to the ER by their friends, or they die, where they’re shot, or someone calls police or an ambulance. And they get brought in one way or another at some point. If they survive that initial wound, they roll through the doors of my and others emergency departments, sometimes with some notice, sometimes without any notice. If we have notice, we have a whole process for getting set up ahead of time, we actually have different levels of trauma activation, depending on what type of gunshot wound we think is coming in. We’re we think someone has been shot we’re on the body, and how many people we expect to be getting. Sometimes we locked down the ER if we know that it’s part of a larger kind of string of gang violence or if we expect there to be drama at the doors of the ER, we call. In addition to our ER team, we bring down our trauma surgeon, our radiology techs, our social workers, med students, respiratory therapists, we bring out all the equipment, our ultrasound, our thoracotomy tray in case we have to crack someone’s chest, our big central lines, these huge IVs that we put in in order to put in blood or fluids very quickly, we get blood in the room, we bring our ultrasound so that we can look at what’s going on. And we prep, we have a series of steps that we prep for and we train for over and over again. So that by the time that person rolls in the room again, if we have a little bit of notice, but sometimes even if we didn’t have notice, we know what everyone’s role is, and what it is that we have to do to have the best possible chance of saving that person’s life. And we each play that role for as long as we can until we either stabilize the person in the emergency department until we stabilize them just enough to roll off to the or, or until we call the code and say that it was a non-survivable injury.

Andy Slavitt  14:57

In medical terms and I wanted to just probe a little bit further, because you’re talking about this as a public health crisis, and I think we often, at least I often kind of don’t think about this very real part of what this is doing to somebody’s body just heard Sam talk about, physically, she’ll never be the same, let alone emotionally and psychologically. But I think about like the caliber of these weapons, these fast moving bullets, these bullets didn’t move in rapid array, these bullets that can do the kind of damage that caused parents to need to use DNA to identify their children. But can you give us a sense of what maybe a young person damage from these kinds of guns? Can do? What  you how it presents itself physically?

Megan Ranney 

Yeah, so I’ll say I mean, honestly, as you know, from the statistics, the majority of gunshot wounds that we see in the emergency department are handguns, right? We have seen an increasing number of AR15’s and the like, causing injuries over the past decade or so. But regardless, that type of injury can range from a great use. I mean, I’ve taken care of people who literally had the tiniest sliver of skin off of their scalp or their arm, but were emotionally traumatized, right? Because they thought they were understandably thought they were about to die, through people who were so riddled with bullets whose organs were so shredded, that there was literally no chance of survival. I’ve also taken care of people who had a single wound to the head to the heart, that just destroys a vital organ in in a second.

Andy Slavitt 

Sam, I can imagine, you know, going through what you went through, and finding it very, very hard to cope, let alone turn, what you’re experienced into the power of survivorship and the kind of spoken leadership that you have represented. How did you go from that experience? To the place where you decided to do what you’ve decided to take on?

Sam Fuentes 

Yeah, well, firstly, it was it was certainly not a graceful or you know, as heroic as it may be portrayed as, if anything, it was very reckless and irresponsible of me to throw myself under the circumstances. So soon. I mean, I was standing on stage, you know, four years ago, at the March For lives, you know, march with stitches still in me fresh black, I, you know, metal in my face, in my cheek. And I was still raw, it was only a month after. And I was public speaking, I was traveling, I was I was putting a lot of pressure on my freshly injured and traumatized body.

Andy Slavitt  18:36

How did your family feel about that, Sam?

Sam Fuentes 

Ah, I mean, ultimately, they’re worried for me, you know, there’s so much there’s so much that they can’t understand and cannot relate to which makes talking about trauma very difficult, because trauma doesn’t just put you in the dark, it puts everyone else if you don’t know how to process your emotions, how the hell is anyone else going to. And so it was a very awkward stage of feeling like I had to convince people that I was strong enough to do it. And even convincing myself that I was strong enough to do it. But at the end of the day, it just seemed like a huge ultimatum for me it was either, you know, coward, fear and lock myself in my house and be afraid of the world, just as this person intended me to be, or fight against the very systems that put me in that situation in the first place. And it was easy for me to choose that because I was full of so much emotion, I was so charged. And it was easy for me to fall into activism because you know, what makes most of this community are survivors and ultimately, we were the children that were faced with this you The responsibility of making a movement and then sustaining it. Were there days where I was burnt out and couldn’t feel any emotion except go to sleep? Absolutely. Like these were real realities that were very brutal for me. And I think that’s one thing that people don’t usually acknowledge is like, yeah, you see these, these real trailblazers, these young people out on the grounds doing this grueling work, but I don’t think people ever really acknowledged that, if not all, but most of us were kids who were traumatized by something that was much bigger than ourselves. And that’s how we coped was to bite I suppose. Right? And I mean, I’m still doing it now. So I feel like that says a lot about just how I’ve been working through all of it, which is literally by working through it.

Andy Slavitt  20:57

Do you ever talk to, sadly, this growing community of kid survivors that’s getting bigger from these, from more recent shootings about that experience?

Sam Fuentes 

Yeah, I’ve met, it makes me really sad to think about it, but I’ve met so many people. And I’ve seen them literally grow up too, which is the crazy part, I became really good friends with somebody who survived Sandy Hook. And I met her when she was 11. She’s like 16 now, sophomore in high school. And, you know, I was out in, in Colorado, after they got devastated by that King Soopers supermarket shooting. And I met with lots of people from there. And it’s where your summons, your summons where your people are. And that’s like, it’s unfortunately, it’s like a club that you join. And really, the only people who get it are in it. And it makes a lot of different facets of your life really difficult. Because you know, you don’t want people to pity you, you don’t want people to feel bad for you. And the last thing that you want to do is feel misunderstood.

Andy Slavitt  22:13

You guys have made a couple of choices. I don’t know whether they were explicit, or implicit choices in how you in March for our lives began to get organized. One was very much in reaching out to communities that weren’t involved in the big headline grabbing mass school shootings, but who lived with the threat of day to day violence to an even greater extent in Black and Brown communities around the country. One of the events that my wife, Lana, who is a part of Moms Demand Action, and I went to and participated in, we were talking to David and some others. And you guys insisted that there be equal representation in the conversation among people from different types of shootings. And that was very powerful. The other thing I noticed was that it was really important that you all got to talk to other kids, and get to speak with your own voices. There were a lot of politicians who just let’s say, I would describe as wanted to draft on the coattails it will meeting people who wanted good gun reform efforts. But he wanted to give speeches in the back of your visits to different communities in your marches. And it was something that I think was very important to protect your voices for. I’m just wondering if maybe you reflect on the decision of how you chose to want to represent yourselves after this experience?

Sam Fuentes 

Well, at the end of the day, the conversation of gun violence prevention or gun violence in general is an inherently intersectional one, because gun violence affects a large variety of people within a large variety of different you know, socio-economic standing certain neighborhoods, states, etc, etc. So this idea that, you know, like the conversation of gun violence is a strictly Parkland conversation or strictly mass shooting conversation is just very false in in authentic to what gun violence actually affects. And I mean, we’ve seen it time and time again, gun violence disproportionately affects people of color, you know, like, this is something that is a daily occurrence for a lot of, you know, POC peeps. And that’s just the reality. And so if you don’t have these people at the forefront of the conversation, then you’re not accurately telling the stories of everyday gun violence. And that’s why representation does matter. Because my feeling is the people who understand gun violence the most are those who are affected by it. Those who have lived experience and that’s why I think it’s phenomenal that we have the pairing of talking about gun violence as a national health crisis, because it is.

Andy Slavitt 

So making on that point, tell us about what you decided to do, in addition to every day just expecting more and more gunshot wound victims to show up and just doing your very best to make people as whole as you possibly could at that moment. What did you decide to do? And tell us what it means to think about this as a public health issue? Because I think it’s very interesting what that lens actually means to thinking about this problem.

Megan Ranney 

Yeah. So what I decided to do way back in the late early 2000s, was to try to think about firearm injury, the same way that we think about any other health problem, which is something preventable, yes, I try to stop the bleeding and to save a life after a gunshot wound has happened. There’s also a heck of a lot that we can do before someone ever picks up that gun and pulls the trigger. And the analogy I use is it’s like with heart attacks, or with COVID. Where Yes, I will take care of you if you come through my doors with a massive EMI with low oxygen because you have severe COVID. But I’m also going to try to work to identify what got you there in the first place, and to try to change it. And that’s really the essence of what this public health approach is. I will say, Andy, it has been a long road as Sam knows, right? So if I go back to 2010, nobody talked about firearms as being anything other than a criminal justice problem or a political issue. Nobody talked about the actual damage that’s done by a firearm to the human body, to the human psyche, or to the communities around it. And nobody saw this as anything that was preventable in any way other than talking about, you know, DOJ, ATF, right, there was no discussion of this larger network of science and prevention that we apply to so many other problems. The analogy that I often use in addition to heart attacks and COVID is car crashes. If we go back, right?

Sam Fuentes 

No, seriously, like I’ve had the exact ongoing thought for the longest time is that we will put so much research and time and energy into things that are preventable, just as an adjacent to gun violence. And I use the analogy of car accidents or cigarettes or things like that where we have preventatives, we have labels on cartons we have you know, these particular routines that people can practice that will lower the chances of something occurring and I cannot emphasize how invaluable all of that information is and infuriates me to all hell that we have. We can only have people working within the field hands on dealing with gunshot wounds and injuries that know this, this isn’t public knowledge that that’s being funded for in the CDC, we almost we almost put it away no money for that in comparison to things like diabetes or you know, things that but and that’s the thing is that guns affect more people than some of these ailments that we invest so much more money towards And sorry to go on a tangent. I just I couldn’t agree with you.

Megan Ranney  28:25

No, Sam, I appreciate it. And I mean, I couldn’t agree more. It’s ridiculous. And I will say so when I first started doing this back in, you know, the 2008-2010 I was actually told not to talk about firearms as a health problem, because in 1996, this thing called the Dickey Amendment was passed, which was passed by this junior representative from Arkansas, a guy named Jay Dickey, who in response to a research study led by an emergency physician, a guy named […], that showed that having a firearm in the home increased your chance of dying from a gunshot wound. Right? This is not surprising having a pool in your house increases your chance of drowning having cars on the road increases the chance of a car crash. That’s just the first step in a much longer line of how do we prevent it. But they did this study, and in response, Jay Dickey passed this amendment that prohibited the CDC from using its funds to promote or advocate for gun control. Now, let’s be clear the CDC cannot promote or advocate for any policy. That’s not the CDC is role. But when this amendment was passed, all the money that the CDC had been spending on firearm injury prevention was removed. And from that time, up until 2020, after the work of a large group of us over many years, including of course, this is our […] campaign in 2018. We finally got a small amount of money refunded to the CDC. Over the last two years, the CDC has had $25 million NIH has had another 25 million, this sounds like a ton of money. But think about how much was spent on operation works. be to create COVID vaccines in one year alone, right the amount of money spent on firearm injury prevention pails, as Sam said, in comparison to the scope of the problem. And the irony is towards the end of J. Dickey’s life, he died about 5 years ago, 5-6 years ago. Towards the end of his life, he actually went on record and said that he was wrong, that we could have done research on firearm injury the same way we do research on car crashes, which PS was also originally led by coalitions of physicians, survivors and activists to make the actual mechanism safer, to identify policies that reduce the risk of harm, and to educate. And it’s through that combination of data, identifying risk and protective factors, identifying things that we can do that can make a difference, and then putting them in place. And recognizing that firearm injury, just like any other health problem, it’s that same Swiss cheese model that Andy, we’ve talked about for COVID. Right? It’s that there is no single thing that is going to stop all gun injuries in this country. But there are a lot of things we can do to bring that number down and put together one by one, we start to make a dent. And we make it so we don’t have 44,000 deaths a year, we have 36,000, or we have 20,000. And each of those is a life saved, a family saved, and a community saved.

Andy Slavitt 

You know, when you start to talk about this in those terms, for some of us, the light bulb goes off. And it stops being this call it Black and White issue where it says gun rights owner versus someone who believes in gun control, and actually becomes, as you say about this model that we become more familiar with this model, which says that there are a lot of things we could do, this swiss cheese bottle. I don’t know if you saw that our friend Katelyn Jetelina, did you see that she published..

Megan Ranney  32:02

I did. I looked at it. Last night before she put it up. It was terrific.

Andy Slavitt 

It just was cheese. It made me think of you so not surprised at all, that you’re about the same. I’ll just read it to you. And for audience sake. This is just I call it a partial list that she publishes. And we’ll have a link to it in our show notes. And things that can be done right now. Number one, safe storage. Mentoring children who are particularly isolated, hear something say something, the data around people who are going to use a weapon or feeling suicidal or homicidal is that most of them let people know, monitor media consumption, voting advocate, community level change and support it, it goes on and on. And you can of course, you can add things like mental health and school safety. And you can add all the things you want to because what you’re really trying to do is prevent the number of people that have to come into your emergency room, or that Sam has to go get on an airplane and visit because of their traumatic experience. You would do all of those things, and only a small portion of them require Congress. And I don’t want to take any pressure away from Congress. Congress could do an awful lot and needs to do an awful lot here. And then we’re monitoring conversations that are going on this week here. But I think it’s a different type of thinking. Still, are you finding resistance? Are you finding people saying well, we don’t even like talking about it in those terms.

Megan Ranney 

Every day, I get resistance from folks who have never heard of the idea of thinking as a health problem, who think that there is one solution, who fear that by talking about it as a health problem that I’m either coming to take away their guns, which let me be clear and not. Or saying that the firearms don’t matter, which to be clear, I’m also not saying right, it is about both the mechanism that is used to cause harm, and all of the steps that lead up to that point of misuse. It’s about changing the structure and the societal mores that allow this to happen, as well as reducing access at that moment. But gosh, there is resistance. I mean, you wouldn’t […] sometimes you should see some of the blog posts. I joke that I like cut my teeth for COVID on doing firearm injury work because there are things out there.

Andy Slavitt 

Sam, let’s turn the conversation to which of the things you think are most important to do. Right now, if people want to get activated, if they are feeling radicalized, energized, they want to, they don’t want to feel helpless, they want to do something, they feel in alliance with you, what are the things that you think are most important, as ideas or places to go that are that people could get into, that should start them on that journey?

Sam Fuentes 

Yeah, one thing that people will neglect to do is actually just take a look in their backyard, which is, you know, becoming familiar with your local community, and its relationships with gun violence and guns in general. You know, whether you’re in a community who’s been devastated by, you know, a mass shooting, you know, a police shooting in, you know, a small arms robbery, whatever it might be, these people ultimately need help and resources, just like anyone else who goes through a disaster. And that’s where I always tell people to, you know, take a look at your community and see what resources and advocacy groups you can put together to support the people you are around. This is also goes as far as obviously, like voting in your state elections, you know, voting for legislation, obviously, you know, calling and submitting to your congressman to your senators, advocating for, you know, things like red flag laws that have literally prevented 1000s of situation situations in Florida since passing in 2018. You know, these are all things that are accessible right now, I cannot emphasize the importance of voting. But I understand that not all people can vote. And that’s why I always, you know, emphasize the importance as well as social media, you know, uplifting stories that don’t make the headlines that don’t get big GoFundMe is and people who often get their, their backs turned, especially in communities, largely of people of color, I think that’s a big thing. You know, supporting organizations like that supporting organizations like March For Our Lives and Moms Demand Actions, and the Giffords campaign, and you know, all these people who are putting countless and countless hours on the ground, advocating for change, the list goes on and on supporting, you know, teachers supporting physicians, supporting research. One thing is, I will always chalk it up as being like three columns, which is obviously show up show out on the ground, you know, activism, which you’re marching, you’re lobbying, you’re going and you’re protesting, research and education, and, you know, practicing your right to vote and, you know, making sure that you’re filling out those ballots, and those are certainly the three columns that I, people can bounce between and whatever is most accessible to use, the one I always recommend.

Andy Slavitt  38:19

So let’s narrow the list a little bit, you’ve established, we got a long list of stuff we can do. And I want to just help people not feel lost in that make into some extent, there are policy things to do and efficacy things to do. But it sounds like there are also things to do if you are a homeowner, in a neighborhood where people keep guns, there might be things to do if you’re working in a hospital or physician, there might be things to do if you’re working. As an employer, there might be things to do if you’re in a school, there might be things to do if you do counseling for kids, like help us maybe with some of the real significant things you can do that make a difference, that aren’t necessarily about changing the laws we should start to get after.

Megan Ranney 

Yeah, so I think one of the biggest things, as Sam already outlined is to know the facts about firearm injury in this country to know that an average year not last year, but on an average year, two thirds of deaths are suicides. To know that mass shootings are horrific never events that are only the tip of the iceberg. The leading cause of death for a victim of domestic violence is being shot. And the top reason that women are killed in this country is that it’s a domestic violence homicide. We also know that one of the biggest predictors of whether or not someone is murdered is whether the perpetrator of domestic violence owns or has access to a firearm. The last really tough part, Andy is when you look at the data around people who perpetrate mass shootings. There is a narrative out there that says oh, it’s mental health. They’re crazy. So first of all, it’s not mental health, right? People who are mentally ill are more likely to be victims or to hurt themselves than to hurt someone else. But also when you actually look at the risk factors, being a perpetrator of domestic violence is one of the most significant. The second thing is to share stories, to destigmatize firearm injury as a health problem. Studies have suggested that as many as 95% of us have either been involved in a shooting or personally know someone who has been shot. And I think that’s important, because it makes it clear that this is not an us versus them issue. And then the third thing is what can you do so there are a few actions, advocate for safe storage, it is far and away the biggest thing that a firearm owner can do, in order to reduce the risk of misuse of a firearm, whether it is a parent making sure that that firearm is under lock and key so that their kid can’t use it to hurt themselves or hurt someone else. Most kids who hurt themselves or someone else do so with a parents or family members gun, two, preventing your gun from being stolen, to potentially protecting yourself, if you’re going through a moment of depression, or you’re someone in your family is experiencing dementia. Safe storage is the first and biggest thing that you can advocate for. The second thing is being involved in your community. Sam mentioned some terrific community groups, there are so many out there that are making a difference. And they absolutely shift patterns of violence, as well as anxiety, stress, depression in communities on a scale, you know, things ranging from Big Brothers Big Sisters to violence interruption programs.

Sam Fuentes 

I was in Big Brothers and Big Sisters.

Megan Ranney

It is an awesome program. Right? And then there’s structural stuff, right? Sam, you talked about kind of going to communities. And I think that providing that emotional support, there are things a colleague of mine at Penn, a woman named Gina South, fellow emergency physician is doing research showing that putting gardens in to vacant lots reduces gun violence around where those gardens have been put in. So gardening, nature can make a difference. And the last thing is allowing ourselves time to grieve. I think it’s okay to be angry and sad, and sometimes numb or hopeless. Those are all normal emotions right now. We’ve been through a lot. And it just keeps coming. And, you know, Sam, you’ve learned this in your life and gosh, knows I have in mind to get to the other side of trauma, it’s not by pushing down the pain, it’s by letting yourself feel it and then using that in channeling it for action. And I think when I watch people get stuck in being angry or being hopeless, and like, man, you got to let yourself feel, feel that emotion and then channel it, you know, action. And a sense of control is the biggest predictor of resilience. And I will say that those few actions that I outlined, as well as all the ones that Sam did, those do make a difference. Even if they feel small.

Andy Slavitt 

That’s really helpful. Well, that, you know, this is a tough topic. And there’s difficult stuff. And I appreciate everybody going through this and you guys leading us through this conversation. But I have to tell you, I find increasingly, the more I know, I find the barrier to entry to do something to be lower and lower and lower. This isn’t one of those issues. Like some issues like you know, when I was growing up nuclear, the threat of nuclear war, it felt very much out of your control. To some people climate feels like an issue of such great substance that it’s hard to know how to be able to make a difference. And we’ve tried to dispel that myth a little bit too. But this feels like an issue where if you approach it through the lens of both of you are talking about it, which is I’d never just say that every shooting is preventable, but that we can reduce it through these actions and that these actions have so many places. And, you know, think about the last time that any one of us on this call had a conversation with somebody we visited say, hey, do you have a gun and do you keep it locked up? If you got kids in the home, it feels like there is a road. I want to leave you guys a chance for the last words. You’ve honored us with your stories. You’ve taken us through your journey. I know that I would be remiss if I wasn’t saying to you, specifically, Sam, that the people who listen this episode are sitting here saying they wish you well, and happiness in the midst of all that you’re fighting for. But I wonder if you could tell us what you want to leave us with.

Sam Fuentes  44:41

Yeah. Thank you. I appreciate that. And, you know, having these conversations are important because ultimately what I want is you know, I will never make a claim of wanting to eradicate guns or you know, prevent people from getting them you know, if your someone who is a avid believer of the Second Amendment, and that’s your ride or die, you know, mantra, then, you know, go for it. But I like to make a society in an America that, you know, recognizes gun violence as a, you know, as a public health crisis, and also recognizes that gun violence prevention is not the same thing as gun control, and that, as gun owners, and just as general citizens, we can, you know, take steps that make atrocities that happen, you know, across the board, at a rate that’s reduced, that’s lessened. And that has almost nothing to do with taking people’s guns like these are all very accessible actions that we can take as the ones that we’re describing, that have nothing to do with infringing on what people believe is their God given rights. And we can all be a participant in this change. And it’s all about sort of, you know, breaking down these systems and these norms that we’ve accepted that have been the consequence, and has been the, the very reason that these deaths keep happening. And there are things that we can do, that we need to continue having conversations about, to make, having guns in America be a safer phenomenon for people that in it can, we can coexist with these machines, these mechanisms without being detrimental by them. And we can create a society that respects and understands both ideas. And so, you know, thank you so much for having me, and I’m glad that we were able to sort of talk about that intersection between, you know, not just the activism part, but the value of education and understanding it in a more precise and more preventative manner. I have so much respect for, you know, physicians, specifically EMTs, and those who work in the ER, I was patched up on the sidewalk, on the side of the road by the school, and was put in with so much care and so much respect, it’s my body. And these are the people that we need to be talking to first. And hopefully, these will be the voices that lead the conversation, lead the research, lead the funding, lead the movement. And I can, you know, just continue doing what I do best, which is, you know, fight,

Andy Slavitt 

Megan, to give you the final few moments. You are in an early chapter in the book of contribution that you’re making to this world and this country. Tell me where you’d like those next chapters to be where we ought to be going next.

Megan Ranney 

The first and biggest thing is for the entire country to recognize that firearm injury is a health problem. Just as we do any other injury or illness. The second thing is for us to have accurate data, we didn’t even have time to get into that, right. But we don’t know how many firearm injuries there are in a year in this country, much less, who suffers them or why. And the third thing is that we have community coalition’s that are able to put in place these effective preventive solutions, these things that can change the course of a person’s life. And we have those not just in blue states, not just in red states, but across the entire fabric of our nation. It is a long journey to get there. But I’m also really confident we can do it. So I look forward to working with folks like Sam and you, Andy you know, 1000s and 1000s of others across the country who are stepping up every day to help change these patterns of injury. And then after effects.

Andy Slavitt  48:56

Thanks for leading the path. Thanks to both of you. We got through the entire conversation on guns without mentioning the NRA. And I think that just says this issues. There’s a lot more here. Have a great weekend, folks.

Sam Fuentes 

Thank you.

Megan Ranney 

Thank you, Andy. Thanks for making space for this.

Andy Slavitt

All right, well, that’s conversation that I think should get us ready for our weekend. It is actually one that I view. And I hope you did as one that is full of possibility. Full of urgency for sure. full of promise. I’m so inspired by both of them to be frank. Monday show is going to be a great one. It’s Larry Summers. And what you do you know about the economy and what’s going to happen next. We’ve got other ones up ahead. But I think what we should do now is just wish you Happy weekend. Enjoy yourself. Enjoy the summer and listen in on Monday. Thanks so much for being here


Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.

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