Firearm-related injury surveillance in California

Context: Although firearms are the leading cause of injury death in California, no staff resources were devoted to surveillance of firearm-related injuries until 1995, when The California Wellness Foundation funded the Firearm Injury Surveillance Program (FISP). Objective: To develop and evaluate surveillance of serious firearm-related injuries and risk factors. Design: Passive surveillance using several data sources: death records, homicide data, hospital discharge data, and Behavioral Risk Factor Surveys. To evaluate FISP, we follow the Centers for Disease Control and Prevention's Guidelines for Evaluating Surveillance Systems. Setting: State of California. Participants: California Department of Health Services, Epidemiology and Prevention for Injury Control Branch. Main Outcome Measures: Deaths and hospitalizations resulting from firearm-related injuries and presence and storage of firearms in the home. We evaluated FISP's utility, simplicity, flexibility, acceptability, representativeness, and timeliness. Results: Firearm-related injuries were the leading cause of death among children as young as 13 or 14 years of age. In 1994, more than 13,000 California residents died or were hospitalized as a result of firearm-related injuries. Except among whites, most of these serious firearm-related injuries were from assaults. The predominance of handguns as murder weapons increased with time and was more marked among younger and racial/ethnic minority victims. FISP provides data needed for setting policy and preventing firearm-related injuries. The system is acceptable and represents the serious firearm-related injury problem well, but lacks flexibility, timeliness, and detail. Conclusions: Despite the limitations inherent in passive surveillance, FISP serves many of our surveillance needs well.