Research is also needed on the ways in which individuals of varying ages, sizes, and strengths use guns, locking devices, and bullets; the resulting information can guide product design toward measures that may reduce the risk of injury and death. Recent engineering innovations designed to increase safety include magazine interlocks that prevent firing when a pistol's magazine is removed but a bullet remains in the firing chamber, and multiple approaches to gun personalization that would limit firing to one person (Robinson et al., 1996). Evolving approaches to the design of guns, such as personalization and increasingly sophisticated automatic safety locks, require real-world testing to allow an understanding of the net effects that these will have on gun ownership, storage, misuse, and injury morbidity and mortality incidence and severity patterns. The biomechanics of gun injuries has been well studied in war situations but should be studied as well in civilian settings that involve wider variations in the age of victims, types of weapons and bullets, and social crowding contexts. Research is also needed on alternative personal protection devices and their risks and benefits, individual perception of the risk of injury from firearms, assessment of various approaches to risk communication, and the effective ways to convey safety information.

Studies are necessary on the effectiveness of current acute medical treatments and on ways to improve such treatment so as to reduce death and permanent disability due to firearm injuries. The role of EMS personnel in clarifying injury circumstances and initiating psychosocial—as well as cardiorespiratory—treatment remains to be fully explored.

One of the puzzles still to be solved in firearm research is the identity of the most informative measure of exposure. For example, one possible analogue of vehicle-miles traveled would be time in the presence of a person with access to a firearm (as compared with time in the presence of people), but such a measure is not empirically feasible. In the aggregate, number of licensed drivers and number of licensed firearm owners would be functionally equivalent exposure measures if licenses were required of gun owners (and if possession of a firearm without a license were as rare as driving a vehicle without a license), but this is not now the case. Presence of a firearm in the home has been used as an exposure measure, but its usefulness is limited to incidents in the home. It is conceivable that no single exposure measure can be utilized for firearm injuries in all locations and contexts. For unintentional injuries, presence of a gun in the home may be a suitable measure, but this does not work as well for intentional injuries. For assaultive injuries, including firearm injuries, one possible measure of exposure would be violent interactions, occurrences that are theoretically measurable through survey interviews. In the committee's view, further attention to this problem, both conceptually and empirically, is needed.

This is a robust multidisciplinary research agenda that must be developed and implemented to identify optimal interventions for the reduction of firearm injuries. Two of the most pertinent lessons from motor vehicle safety research that can be applied to firearm safety research are that a comprehensive approach



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