A comprehensive new review article published in the prestigious Journal of the American Medical Association (JAMA) highlights the urgent need for enhanced long-term medical care for individuals who survive firearm injuries, a persistent and growing public health crisis in the United States. With firearm-related deaths exceeding 48,000 in 2022 alone, and an additional 120,000 people suffering and recovering from gunshot wounds, the scale of this epidemic demands a paradigm shift from acute trauma management to more inclusive, sustained outpatient care strategies.
While emergency medical response protocols for gunshot wounds are well-defined and universally adopted across trauma centers, the pathways for long-term recovery remain insufficiently delineated and inconsistently implemented. This review, authored by a team of leading trauma surgeons from the University of Maryland School of Medicine (UMSOM), synthesizes current research on the multifaceted sequelae following firearm injuries—focused particularly on physical, neurological, psychological, and social outcomes—excluding injuries involving the central nervous system, such as brain or spinal cord trauma.
The neurological ramifications of firearm injuries are notably complex, especially concerning peripheral nerve damage caused by high-velocity projectiles. Such injuries can result in partial or complete loss of nerve function, profoundly impacting survivors’ quality of life and functional independence. While spontaneous recovery is possible in some cases, the review advocates for early referral to neurology or reconstructive surgery specialists and initiation of tailored rehabilitation programs to optimize functional outcomes and prevent long-term disability.
Chronic pain emerges as a dominant and debilitating consequence in survivors, with approximately 68% of patients reporting persistent daily pain between six and twelve months post-injury. This prevalence surpasses that observed in patients recovering from severe motor vehicle trauma, emphasizing unique pathophysiological challenges intrinsic to firearm wounds. The article strongly recommends a multimodal pain management approach that integrates pharmacological interventions—including opioid and non-opioid analgesics—with physical therapies and alternative modalities such as acupuncture or cognitive behavioral techniques, to effectively alleviate suffering and enhance recovery.
An often-overlooked but medically significant factor is the retention of bullet fragments within survivors’ bodies; according to the review, about 75% of gunshot wound patients are discharged harboring retained metallic fragments. This retention poses insidious risks, notably lead toxicity, particularly when fragments are lodged near joints or critical anatomical structures. The authors call for routine monitoring of blood lead levels and advocate for surgical removal of bullet remnants when clinically indicated and feasible, to mitigate potential systemic toxicity.
Psychological health is a paramount concern post-firearm injury, with over half of survivors screening positive for posttraumatic stress disorder (PTSD) within the first year following trauma. This statistic underscores the profound emotional and cognitive burden borne by patients. The review emphasizes the imperative for routine PTSD screening within primary and specialty care settings, alongside the deployment of evidence-based treatments such as trauma-focused cognitive behavioral therapy, pharmacologic antidepressants, and interventions targeting sleep disturbances, which collectively contribute to improved mental health trajectories.
Beyond the biological and psychological dimensions, survivors frequently endure profound functional decline and socio-economic disruption. Nearly 60% are unable to return to employment within one year of injury, reflecting persistent physical limitations and psychosocial challenges. Quality of life indices are significantly diminished in comparison to other trauma-affected populations, illustrating the far-reaching consequences of firearm injuries that extend well beyond physical recovery. The article advocates for integrative care models that address vocational rehabilitation, social support networks, and holistic wellbeing.
Another pressing issue illuminated by the review is the elevated risk of reinjury encountered by firearm survivors. Approximately 10% of individuals suffer a subsequent firearm injury, with young Black men constituting the demographic at highest risk. This cyclical nature of gun violence necessitates innovative interventions such as hospital-linked violence intervention programs, which combine comprehensive support services—including counseling, education, and social services—to disrupt patterns of violence and foster long-term resilience within affected communities.
The review’s authors, led by Dr. Bethany Strong, assistant professor of surgery at UMSOM, and Dr. Thomas Scalea, renowned trauma surgeon and Physician-in-Chief at the R Adams Cowley Shock Trauma Center, advocate for a transformative leap in clinical practice. They argue that mastery in acute trauma care must be complemented by proactive long-term management strategies that holistically address chronic pain, neurological impairments, mental health disorders, social reintegration barriers, and prevention of reinjury.
The broader public health implications are stark. As noted by Mark T. Gladwin, Dean of UMSOM, gun violence results in daily tragedies where 125 people lose their lives and over 200 sustain injuries nationwide each day. The economic burden eclipses $557 billion annually, representing a staggering 2.6% of the United States’ gross domestic product. The authors foreground the necessity of improving access to post-acute care and supportive services, particularly in underserved, low-income communities disproportionately affected by firearm violence, to alleviate the health disparities perpetuated by this epidemic.
This review thus serves as a clarion call for the medical community, policymakers, and healthcare systems to recognize and act upon the enduring health consequences faced by firearm injury survivors. In addition to lifesaving acute interventions, a sustained commitment to multidisciplinary, patient-centered long-term care is essential to mitigate disability, improve mental health outcomes, and reduce the cycle of violence and reinjury. By incorporating this comprehensive approach, clinicians can better guide survivors towards full functional recovery and enhanced quality of life.
Through meticulously compiling emerging scientific evidence, this JAMA article extends beyond clinical observations into actionable recommendations that transcend institutional walls. It calls for integrated healthcare delivery models, expanded research into effective interventions, and systemic policy reforms, all aimed at confronting one of America’s most entrenched public health crises. The time is ripe for aligning trauma expertise with preventive care and psychosocial support—a holistic paradigm capable of transforming survival into true recovery for gunshot wound survivors.
Subject of Research: People
Article Title: Sequelae and Care After Firearm Injury
News Publication Date: 23-Jul-2025
Web References: http://dx.doi.org/10.1001/jama.2025.10498
Keywords: Violence, Anxiety disorders, Post traumatic stress disorder
