Last week's mass shooting in San Bernardino brought the total number of Americans killed by guns so far this year to 12,225, which is actually a significant drop from when gun violence was at its height in the 1990s. Fewer people in the US are dying from guns than in years past, but this doesn't mean gun violence has gone down — we're just getting better at treating gunshot wounds.
Gun deaths have dropped by about half since their peak in the 1990s, falling from an average of about seven firearm homicides per 100,000 people in 1993 to 3.8 by 2011, according to data from the Centers for Disease Control analyzed by Pew Research Center. The numbers of nonfatal gunshot injuries also dropped between 1993 and 2000 — by about 63 percent — and have remained relatively stagnant since then.
When most people talk about the decrease in gun violence, they point to the plummeting number of gun deaths as evidence. But if you look more closely at the kind of gun violence happening in the US, the numbers show something very different, says Dr. Bindu Kalesan, a professor of surgery at Columbia University's School of Public Health.
"The truth is is that gun violence has not been constant," says Kalesan. "What we found is that hospitalizations [for gunshot wounds] are increasing tremendously. Those who would have died are actually surviving because of the better care they receive in the hospital."
According to the most recent survey data available from the CDC, the rate of nonfatal gunshot injuries has risen about 20 percent since 2001, from 22 incidents per 100,000 people to 27 incidents in 2013. Even more striking is that the rate of gunshot wounds that require hospitalization (rather than treatment and release from an emergency center), has gone up by more than 50 percent since 2001. In other words, people are now surviving from many of the more dangerous wounds that would have killed them in previous years. There were roughly 9.4 hospitalizations per 100,000 people for nonfatal gun injuries in 2001, compared to more than 14 per 100,000 in 2013, according to the CDC.
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The fact that more people are surviving from increasingly severe gunshot injuries comes with substantial long-term side effects, Kalesan said. More people are getting discharged from the hospital into long or short-term nursing care, or getting re-admitted over and over again, which means that the rates of post-traumatic stress, medical costs, and long-term disability are all rising.
Experts say there are several possible explanations for the rise in gunshot victims survival rates, the mostly likely being that trauma care has dramatically improved in recent years. For one thing, there are more trauma centers than ever before, allowing first responders to quickly reach victims and bring them to emergency rooms. And once patients get to a trauma center, the likelihood that they survive is also far greater due to improved emergency medicine and triage services.
"If they don't die at the scene and get to the hospital, their probability of death is lowered now because of the better treatment," Kalesan said.
Many of the improvements in treating gunshot injuries were developed alongside the US military, according to Dr. C William Schwab, a trauma surgeon and director of the Firearm Injury Center at University of Pennsylvania. Military doctors learned trauma care from residencies in urban hospitals after the Gulf War in the early 1990s, when gun violence in the US was at its peak, says Schwab.
Especially since the wars in Iraq and Afghanistan, Schwab added, there has been a "tremendous exchange" between military and civilian trauma medicine tactics in both emergency response care (i.e. paramedics and ambulances) and surgery.
'Those who would have died are actually surviving because of the better care they receive in the hospital.'
One example of the crossover between military and civilian trauma care is a sponge-like device that was recently developed at the request of the Department of Defense that stops the bleeding from gunshot wounds. The tool is currently in the hands of military medics on the battlefield, but RevMedx, the medical company that made it, plans to expand to civilian use for law enforcement and first responders, according to CNN.
The decline in gun deaths is especially remarkable in light of the fact that the Americans now have greater access to deadlier types of weapons. After Congress passed a law in 1986 that eased restrictions on gun sales and inter-state transfers of weapons, Schwab said semi-automatic handguns, particularly 9mm pistols, flooded the streets of cities through both legal and illegal markets. A semi-automatic weapon allows a shooter to fire more rounds than an old revolver, leading to multiple wounds with greater tissue damage and blood loss. Schwab says this has forced him and his fellow trauma surgeons in Philadelphia hospitals to change how they treated bullet wounds.
"All of us have learned the ballistics of [the 9mm semiautomatic gun], the wounding patterns of it," said Schwab. "We've adapted our surgical responses to treating multiple bullet wounds and the competing priorities to control bleeding and multiple injuries that need treatment."
There are also more guns in the US than ever before. In 2009, guns outnumbered the population for the first time in history, according to data from the Congressional Research Service. In 2013, there were an estimated 357 million firearms in the US, or about 40 million more guns than people.
So far this year, about twice as many people have been injured than have died from being shot, according to Gun Violence Archive, an organization that tracks gun violence in the US. As doctors get better at treating gun violence, the chances of dying from being shot will likely continue to go down. But judging by the numbers on gun violence since the beginning of the century, this doesn't mean your chances of getting shot will too.
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