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Last week, when I told my friends and family that I was heading to Milwaukee to attend the National Violent Death Reporting System Conference, I was met with some version of the same response: “That doesn’t sound fun.” Who could blame them? The name doesn’t exactly conjure happy thoughts.
But the National Violent Death Reporting System, or NVDRS, is actually a noteworthy success story. It tracks all kinds of violent deaths — from gunshots to poisonings — in incredible detail, serving as the foundation for some of the best public health research and prevention efforts across the country. The Milwaukee gathering was the first hosted by the Centers for Disease Control and Prevention, which runs the NVDRS — a delayed celebration of the system’s 20th birthday.
“NVDRS has just put us heads and shoulders above where we were in the past,” Catherine Barber, a senior researcher at the Harvard School of Public Health’s Injury Research Center who helped lead the effort to design the NVDRS, said in Milwaukee.
While the NVDRS serves as a gold standard for data on fatal injuries, it doesn’t come without limitations. The database contains most violent deaths in the U.S. and hundreds of variables about the circumstances that led to and surrounded those deaths, which is valuable but time-consuming to produce. It takes between 16 and 18 months for state health officials to collect death investigation records, process them, and upload them to the system. For violence prevention efforts on the ground, that delay can be a hurdle. One former public health official at the CDC once described using systems like the NVDRS to inform prevention as “trying to hit a tennis ball last seen two years ago.”
Moreover, the NVDRS doesn’t track nonfatal injuries. The system was never intended to, but for prevention efforts, that information is just as important. After all, the difference between a fatal and nonfatal shooting often comes down to where a bullet happened to penetrate and the distance to a hospital. And despite firearms’ lethality, there are far more people who survive gunshot wounds than those who die. This lack of basic data makes trying to get a handle on violence, and responding to it, that much harder.
That’s the main reason why I traveled to Milwaukee: to see how researchers were making use of the system, where it was falling short, and to learn more about a new effort, known as FASTER, or Firearm Surveillance Through Emergency Rooms, that could help fill in some of the remaining gaps in U.S. gun violence data. For the past three years, FASTER has been running in 10 states to assess whether it can accurately track emergency room visits for gun injuries in near-real time. Because most gunshot wounds — upward of 90 percent — result in a hospital visit, such an effort is likely to catch most nonfatal shooting injuries.
FASTER, which provides grants to state health departments, builds on another federal-state partnership that has been used to track infectious diseases and other public health threats using data from ER visits. That system, known as the National Syndromic Surveillance Program, or NSSP, has served as an early warning system for the flu, the Zika virus, COVID-19, overdose clusters, and even lung injuries from vaping products.
The goal of FASTER is to enable and encourage state and local health agencies to rapidly track emergency department-treated firearm wounds, classify them by intent, share that data with the CDC, and then use the information to help their local communities respond. State health departments, for example, could help cities target resources or develop violence prevention programs.
“We can support local and state health departments to respond more quickly to upticks, or abnormal patterns of firearm injury ED visits in their jurisdiction,” Marissa Zwald, of the CDC’s National Center for Injury Prevention and Control, told me. “And that’s really the most important piece of FASTER — that data-to-action component.”
As part of the grant agreements, participating state health departments share more detailed data, allowing the CDC to examine information down to the level of individual visits, which goes far beyond the aggregate data that the federal agency currently has. And that data is typically available within one to two days.
“There’s more granularity, and we can see patient demographics and understand some of those trends by demographic characteristics, and empower our funded state health departments to look at and examine these data in that way, too,” Zwald said.
The new approach is less likely to suffer from the shortcomings of some of the CDC’s other efforts to estimate nonfatal shooting injuries, which have relied on small samples of hospitals. But, as with the NVDRS, it does have its own limitations that again come down to a trade-off between detail and timeliness. While FASTER is, well, faster, and will improve our overall understanding of nonfatal shootings, it will be nowhere near as detailed as the NVDRS. On top of that, researchers cautioned it was likely that the intent of injuries would be miscategorized — an assault might be coded as an unintentional shooting, for example.
Another issue: Some emergency rooms don’t yet submit data to the surveillance system. About 75 percent of ERs currently participate, but thanks to a 2021 federal rule change, that number is on an upward trajectory and is likely to get close to 100 percent soon.
FASTER is in its third and final year of the pilot, which wraps up in August. The effort has produced new mechanisms for logging details about firearm injuries into the NSSP system that will be made available to other state health departments. Going forward, it will also be incorporated into a broader initiative to improve surveillance of all violent injuries, not just those from firearms.
The system shows promise for improving national-level data, but getting truly accurate statistics will still take time. Nevertheless, FASTER is already providing benefits in states where it is operating. New Mexico used the data to inform a statewide strategic plan to address gun violence. In Oregon, legislators used it to pass a bill that provides consistent funding for hospital- and community-based violence intervention programs. And in Georgia, the state health department developed a data dashboard — with detail down to the neighborhood level — to support violence intervention efforts in Atlanta that it plans to soon make public.
“It obviously is more timely,” said Elizabeth Blankenship, an epidemiologist focusing on violence at the Georgia Department of Public Health, during a presentation in Milwaukee. “We really have just a great picture of both the morbidity and mortality side of things, and hopefully FASTER will be able to evolve outside of just firearm incidents.”
News You Can Use
Can Philadelphia End Gun Violence Using Its Sports Teams’ Strategies? In The Philadelphia Citizen, Luqman Abdullah lays out a plan to get violence prevention programs in the city on the same page and working toward the same goals. “So much of the anti-violence work being done right now is taking place in silos, without any organized collaboration,” Abdullah writes.
Red Flag Laws: Which States Have Gun Violence Restraining Orders? Since Parkland, more than a dozen states have passed laws that allow law enforcement to seize guns from people deemed a danger to themselves or others. We’ve been tracking these laws since 2018. The latest: Michigan just became the 21st state to do so, days after Minnesota got its own law on the books.
Can a Renowned Hospital Keep a Boy From Being Shot Again? The Washington Post goes inside one of the country’s top children’s medical centers to profile a hospital-based violence intervention program. The effort, at Children’s National Hospital, is aimed at keeping kids and teenagers from falling victim to gun violence again after they’ve been shot.
