School Nursing

The Relentless School Nurse: Join the Call to Declare Gun Violence a Health Emergency for U.S. Children

The American Medical Women’s Association (AMWA) is inviting all healthcare providers to join the call to declare gun violence a health emergency for U.S. children. You can sign this important letter to be delivered to  Secretary Xavier Becerra, JD of Health and Human Services (HHS), and Director Rochelle Walensky, MD, MPH, of the Center for Disease Control (CDC).  Death from gun violence is now the number 1 cause of death in U.S. children, surpassing car accidents.  School nurses are needed in this call for action! 

The content of the letter is provided below, to add your signature to the letter, you can click the link here, or look for the embedded link, sign on, at the conclusion of the letter.  Health and Public Health Practitioner Petition: Gun Violence is a Health Emergency for U.S. Children

Health and Public Health Practitioner Petition: Gun Violence is a Health Emergency for U.S. Children

Please sign on.
  • July 1, 2022

    Xavier Becerra, JD
    Secretary, Health and Human Services (HHS)

    Andrea Palm
    Deputy Secretary, Health and Human Services (HHS)

    Rochelle Walensky, MD, MPH
    Director, Center for Disease Control (CDC)

    Debra Houry, MD, MPH
    Director, National Center for Injury Prevention and Control, CDC

    Dear Secretary Becerra,

    As pediatricians, trauma surgeons, emergency medicine specialists, primary care physicians, subspecialty physicians, scientists, health workers, and public health practitioners across the United States, we are deeply concerned that guns have now become the number one cause of death in American children.1

    Every day, we are confronted with the unshakable yet preventable burden of gun violence on children, whether from injuries directly to themselves, or indirectly to their families, friends, and communities. Every day, we are challenged in caring for children suffering physical, emotional, and behavioral health consequences of gun violence in our rural to urban-based clinics and hospitals.

    We are disturbed by widening racial and socioeconomic disparities among children experiencing gun violence. According to the CDC, firearm-related homicide increased by 70% among Black children less than ten years of age from 2019 to 2020, with no change in other racial groups.2 The inequitable impact of gun violence on youth is further evident by non-fatal firearm-related injuries, most of which occur by assault in economically-disadvantaged communities.3, 4, 5

    We are horrified that young children are regularly required to participate in Active Shooter drills and Stop the Bleed campaign training, contrary to the recommendations of the American Academy of Pediatrics (AAP). Schools should avoid high-intensity live crisis drills which have unclear value and may cause unintended negative psychological and emotional harm from such exercises. “Resources directed to prevention efforts are more cost-effective and have wider benefits to potential victims, survivors, and society.”6

    We know the power of a comprehensive public health approach in saving children’s lives from our nation’s greatest public health threats, such as unsafe sleep and secondhand smoke.7 We support the CDC’s recent report highlighting upstream prevention strategies to address escalating firearm-related homicide amongst minoritized youth.2 We support widespread implementation of Extreme Risk Protection Order (ERPO, sometimes known as red flag laws), safe storage, and other evidence-informed child injury prevention strategies.8, 9

    We are moving in the right direction, but need to move faster. American children are dying en masse.10

    We urge the U.S. Department of Health and Human Services to consider the following 3 public health strategies:

    1. Formally declare gun violence as a health emergency for U.S. children.

    Increased awareness of gun violence as the leading cause of death in children is needed. We request the issuance of a National Action Plan for Firearm-Related Injury Prevention in Children and Adolescents in collaboration with our nation’s health and public health communities, modeled by the CDC’s National Action Plan for Child Injury Prevention.11

    2. Require equitable data practices for firearm-related injuries in U.S. children.

    Current clustering of data limits our understanding of the risk factors for gun violence among children, thereby limiting advances in equitable prevention policies and practices.12 We urge HHS to require disaggregation and more accurate reporting of data on the bases of age, race, ethnicity, gender, and intent. We also request that people from communities most impacted are engaged at all stages to guide these data practices.

    • A recent CDC report concluded that those at highest risk for firearm-related homicide are Black males ages 10 to 44 years old – an age group broadly spanning children to adults. 
    • Child victims of stray bullets are often misclassified as homicide intent in marginalized communities resulting in victim blaming, whereas their white peers are more often classified as unintentional intent (ex: playing with a firearm). 4, 10

    3. Promote a child-focused definition of gun violence.

    Scientific evidence supports the classification of exposure to gun violence as an adverse childhood experience.13 Exposure places children at increased risk for victimization, perpetration, and long-term health consequences. We call to broaden the definition of gun violence from direct victimization (injuries, deaths) to also include indirect victimization experiences (e.g. hearing gun shots, losing loved ones). We urge investment in evidence and trauma-informed treatment programs to address a broad range of experiences and improve health outcomes across the lifespan.

    In summary, we, as health and public health practitioners across the nation, call upon the U.S. Department of Health and Human Services to swiftly adopt and act upon our targeted public health recommendations. By addressing gun violence as a health emergency for children, we can improve the health and quality of life of our nation’s children and families, now and for generations to come.  

    Thank you for your consideration.


    Nina Agrawal, MD FAAP, Chair – Gun Violence Solutions Committee
    American Medical Women’s Association

    Alyssa Besser, MPH Candidate
    Columbia University Mailman School of Public Health

    Special acknowledgments to our colleagues for their important contributions:  Eileen Barrett MD MPH, Alice Chen MD, Eliza Chin MD, Eric Fleegler MD MPH, Jennifer Grad MD, Bill Jordan MD MPH, Maya Haasz MD, Lois Lee MD MPH, Sonali Rajan PhD MS. 

  • References:

    (1) Goldstick, J. E., Cunningham, R. M., & Carter, P. M. (2022). Current Causes of Death in Children and Adolescents in the United States. The New England Journal of Medicine, 386(20), 1955–1956.

    (2) Centers for Disease Control and Prevention. (2022). Firearm Deaths Grow, Disparities Widen: Comprehensive Strategies Can Prevent Violence and Help Reduce Racial and Ethnic Disparities. CDC Vital Signs. Retrieved from

    (3) The Educational Fund to Stop Gun Violence. (2020). Nonfatal Gun Violence. Johns Hopkins Center for Gun Violence Solutions. Retrieved from

    (4) Lee, L. K., Chaudhary, S., Kemal, S., Kiragu, A., Sheehan, K., & Fleegler, E. W. (2022). Addressing the Void: Firearm Injury Prevention in the USA. The Lancet Child & Adolescent Health.

    (5) Hughes, B. D., Cummins, C. B., Shan, Y., Mehta, H. B., Radhakrishnan, R. S., & Bowen-Jallow, K. A. (2020). Pediatric Firearm Injuries: Racial Disparities and Predictors of Healthcare Outcomes. Journal of Pediatric Surgery, 55(8), 1596–1603.

    (6) Schonfeld, D. J., Melzer-Lange, M., Hashikawa, A. N., Gorski, P. A., Krug, S., Baum, C., Chung, S., Dahl-Grove, D., Davies, H.D., Dziuban, E., Gardner, A., Griese, S., Needle, S., Simpson, J., Hoffman, B. D., Agran, P. F., Hirsh, M. P., Johnston, B. D., Kendi, S., Lee, L. K., Monroe, K. W., Schaechter, J., Tenenbein, M., Zonfrillo, M. R., Council on Children and Disasters, Council on Injury, Violence, and Poison Prevention, & Council on School Health. (2020). Participation of Children and Adolescents in Live Crisis Drills and Exercises. Pediatrics, 146(3): e2020015503.

    (7) Centers for Disease Control and Prevention (2022). The Public Health Approach to Violence Prevention. CDC Violence Prevention. Retried from

    (8) Johns Hopkins Bloomberg School of Public Health. (n.d.). Solutions: Firearm Removal Laws. Johns Hopkins Bloomberg School of Public Health. Retrieved from

    (9) Morral, A.R. (2022). The Gun Laws That Work, and the Gun Laws That Don’t. The Rand Corporation. Retrieved from

    (10) Montgomery, D., Zraick, K., Fausset, R., Healy, J., Medina, E., Morales, C., Peck, J., Robertson, C., Sandoval, E., Traub, A., & Yoon, J. (2022). ‘She Was My Sweet Girl’: Remembering the Victims of the Uvalde Shooting. The New York Times. Retrieved from

    (11) Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2012) National Action Plan for Child Injury Prevention. CDC – NCIPC. Retrieved from

    (12) The White House. (2022). The Release of the Equitable Data Working Group Report. The White House Briefing Room Press Releases. Retrieved from

    (13) Rajan, S., Branas, C. C., Myers, D., & Agrawal, N. (2019). Youth Exposure to Violence Involving a Gun: Evidence for Adverse Childhood Experience Classification. Journal of Behavioral Medicine, 42(4), 646–657.

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