Analysis of the factors increasing the mortality in emergency department following firearm injuries

Firearm injuries (FAI) can be observed in all the societies. However, they are more common in underdeveloped societies, especially where acts of violence are prominent. The influencing factors in the prevalence of mortality due to firearm injuries are sociocultural factors, socioeconomic state, insufficient legal regulation, immigration, mafia, and acts of terror (1,2). However, FAIs are considerably common in countries where the firearm usage is enabled through legislation, such as the United States of America. FAIs are the second most common cause of death among 15-19 year-olds (3). The rates of homicide in the US are seven times higher compared to the other developed countries. Only in the year 2014, 33.700 people were killed due to FAIs, and approximately 81.000 people received non-fatal injuries (4) . Recent studies indicate that the mortality rates due to FAIs are high (5,6). FAIs still cause a considerable number of deaths and disabilities in Turkey. In Turkey, about 3.000 people die due to firearm injuries every year. According to the autopsy reports of the Forensic Medicine Institution, the rate of FAI range between 8 to 13% (7). The main reason why the incidences of FAIs are high is because the acts of terror resume in this region and the local population react violently to these incidents. The extent of the damage that occurred within the organs and the subsequent results are closely associated with the area of injury and the properties of the firearm/bullet. If the vital organs or blood vessels are damaged, the patients usually die before they can reach the healthcare center. In the cases of the patients that come to the emergency rooms, the morbidity and mortality values indicate lifethreatening injuries (depending on the region of the injury). Mortality rates are very high in vital organ injuries. The injuries can cause health and labor force losses for the patients that recover from death, together with important health problems. Our purpose is to determine the factors that influence morbidity and mortality in FAIs and to provide suggestions for preventive measures to decrease mortality rates.