Using EMS data to examine firearm-related injury: Implications for surveillance and preventive intervention

Background: Gun violence is a major threat to US public health. Information systems are needed to improve population surveillance of violence and inform preventive intervention. Emergency medical services (EMS) system data is an understudied potential source for incident-based surveillance of shootings and examination of personal correlates of violent injury. Methods: We reviewed Baltimore City 9-1-1 call dispatch data and Baltimore City Fire Department EMS patient records in a 23 months period 2008-10. We coded health data based on a prior schema, and compared numbers of firearm related incidents to police report data in a similar period, and examined associations with patient demographics, repeat use of EMS, and behavioral (substance use and mental) health problems. Results: We identified 954 gunshot wound incidents linked to EMS patient data, representing 13.3% of violent trauma incidents in the study period. Compared to the city and to the EMS patient population, young Black males were over-represented among gunshot victims. Compared to police reports of shootings in a comparable period, EMS records contained 19.5% fewer shooting incidents. Patients with gunshot wounds had below average levels of EMS utilization and evidence of substance abuse or mental health problems in their EMS records. Conclusions: Our findings suggest that while EMS records undercounted gunshot wound incidents in the city, EMS data may be an important source of real time incident level data to complement current data sources for firearm related injury surveillance. Future research should assess and promote the validity of EMS records on violence-related injury.