One year later: A trauma director’s reflections on the Danforth shooting

July 22, 2019 marks one year since the Danforth shooting, an evening in which two young girls were killed and thirteen others injured in a mass shooting while enjoying a beautiful summer evening in Toronto. For victims and loved ones, this day marks a year of grief, pain, and unfathomable loss with so many lives now significantly and permanently changed. As a paediatrician and trauma director, and as a citizen of Canada, my heart, thoughts and prayers are with everyone who has been affected by the Danforth shooting, or any other violent injury.

While it took less than 30 minutes to unleash hell on the Danforth that evening, it is and will be a very long process to recover from it. The ripple effect from trauma is long-term and far-reaching.   

I think often of the injured and their families and friends, reflecting on how they are now coping and progressing through life with a suddenly altered family architecture or a vanished friend.  Like many who have suffered trauma, these family members and friends are smart, strong and thoughtful advocates for their own families, their personal experiences and for our society, striving to and succeeding in making positive change in this world.

I also think about the harrowing and excellent work of the first responders and hospital staff across the city who were on duty that evening, working tirelessly to mitigate damage and save lives. I hope they recognize how valuable they are, and have received any care they may need to cope with this experience.

Canada’s national homicide rate from firearm-related injury is now at its highest rate since 1992, with many cities (not just Toronto) deeply impacted by this rising epidemic. Suicide/self-inflicted injury by firearm, however, still accounts for the vast majority of firearm-related mortality in Canada. Unintentional injuries remain ever-present, and recent data depict that the murder of women and girls, known as “femicide”, now occurs every 2.5 days in Canada, with the majority of these cases involving shootings.  

Where do children and youth fit into this tragic but preventable societal travesty?

Uniquely vulnerable to gun-related injury because of age, size and developmental characteristics that put them at risk, children and youth are impacted by firearms – both directly and indirectly – via suicide, homicide, and unintentional death or injury, usually but not always, in the home.  Canadian youth are involved in gang violence, and our nation has unfortunately experienced several school shootings, most recently in 2016. The majority of injuries in children, however, are unintentional, and related to inappropriate access to guns.

Our Trauma Program at SickKids has noted a trend in increasing violent injury, and in 2018 our hospital cared for the same number of children with gunshot wounds as the previous five years combined. The absolute numbers remain small in comparison with our partner adult trauma centres, but are a marker of a significant societal problem. Despite strong prevention efforts and great success in many injury domains, society often implicitly allows for the acceptance and normalization of life-ending or life-altering injury. With regard to guns, it’s already “normal” to hear of daily occurrences of shootings in Toronto; it must never become “normal” for children in their daily lives – be it school, playgrounds or otherwise – to be at risk.  

Gun-related injury is a complex public health issue for which there is no single magic answer, but harm reduction efforts have been proven to be effective. Addressing root causes of violence, poverty and intersecting socioeconomic factors, while specifically reducing the availability of guns in society, has dropped mortality rates in countries that more strictly regulate firearm access.

For children, removing access to firearms is lifesaving. The Canadian Paediatric Society (CPS) along with many medical and paediatric organizations, agrees with a ban on handguns and assault weapons; additionally the CPS strongly advocates for safe storage and removal of guns from the home in families with active mental illness. They also support the proper regulation of air and BB guns with velocities high enough to cause serious injury or death, and argue these should be classified as firearms. Expanding research programs to obtain robust data needed to guide policy is absolutely essential.

One year out from the Danforth shooting, we have seen impressive community engagement: providers working with families and friends in a long-term capacity, individuals working within systems to further prepare for this kind of trauma and/or mass casualty event in the future, and those advocating for societal change to reduce the everyday burden of trauma and the likelihood of tragic events such as this one.  Our shared collaborative goal is to see this type of tragedy prevented and eliminated from our future.