What would happen if on one day more than 50 people died and over 10 times that many were harmed by an infectious disease in the United States? Likely, our nation's esteemed and highly capable public health infrastructure would gear up to care for those harmed and study the problem. There would be a rush to identify the cause, develop interventions, and refine them continually until the threat is eliminated or at least contained. In light of the risks to public health (after all, over 500 people have been harmed already!), health care professionals would sound the alarm. We would demand funding. We would go to conferences to learn what is known and what we should do. We would form committees at our institutions to plan local responses to protect our communities. The United States would spend millions or more in short order to assure public safety, and no elected officials would conceive of getting in the way. Rather, they would compete to be calling the loudest for the funds and focus required to protect our people. Americans should be proud of our prowess at and commitment to addressing public health crises.

Yet, here we are again with another editorial about the public health crisis of firearm-related injury and death following what used to be unthinkable, this time a mass murder and casualties at a concert in Las Vegas. We've written it all before. The staggering numbers killed annually. The numbers left permanently disabled. The families left to cope with the loss of loved ones or to care for those broken but not killed by a bullet. As health care professionals, we seem powerless. This public health crisis seems beyond the reach of our tools.

Is there really nothing health care professionals can do? We think there is a lot. We need to each ask ourselves what we have done to apply our knowledge and skills to help address the problem since the moment of silence that followed the last mass shooting. More silence is not the answer. Have we demanded funding to adequately study the problem and test solutions? Have we participated in such studies? Have we mobilized forces at our institutions to plan strategies to lower the risks in our communities? Have we talked to our patients about gun safety and effectively challenged policies that would enforce our silence on this matter? Some of our colleagues have. We should be proud of them, but they need all of our help. And so do our patients.

Here's a short list of how health care professionals can use our skills and voices to fight the threat that firearms present to health in the United States.

Educate yourself. Read the background materials and proposals for sensible firearm legislation from health care professional organizations. Make a phone call and write a letter to your local, state, and federal legislators to tell them how you feel about gun control. Now. Don't wait. And do it again at regular intervals. Attend public meetings with these officials and speak up loudly as a health care professional. Demand answers, commitments, and follow-up. Go to rallies. Join, volunteer for, or donate to organizations fighting for sensible firearm legislation. Ask candidates for public office where they stand and vote for those with stances that mitigate firearm-related injury.

Meet with the leaders at your own institutions to discuss how to leverage your organization's influence with local, state, and federal governments. Don't let concerns for perceived political consequences get in the way of advocating for the well-being of your patients and the public. Let your community know where your institution stands and what you are doing. Tell the press.

Educate yourself about gun safety. Ask your patients if there are guns at home. How are they stored? Are there children or others at risk for harming themselves or others? Direct them to resources to decrease the risk for firearm injury, just as you already do for other health risks. Ask if your patients believe having guns at home makes them safer, despite evidence that they increase the risk for homicide, suicide, and accidents.

Don't be silent. We don't need more moments of silence to honor the memory of those who have been killed. We need to honor their memory by preventing a need for such moments. As health care professionals, we don't throw up our hands in defeat because a disease seems to be incurable. We work to incrementally and continuously reduce its burden. That's our job.

Will yet another commentary about the ravages of firearm-related harm change anything? Probably not—our journals have published far too many following prior firearm-enabled catastrophes. The only thing that will change the world for the better is a group of people who believe that they can change the world. With regard to firearm-related injury and death, let's each be part of that group.

Darren B. Taichman, MD, PhD, Executive Deputy Editor, Annals of Internal Medicine

Howard Bauchner, MD, Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network

Jeffrey M. Drazen, MD, Editor-in-Chief, New England Journal of Medicine

Christine Laine, MD, MPH, Editor in Chief, Annals of Internal Medicine

Larry Peiperl, MD, Chief Editor, PLOS Medicine

如果一天内有50多人死亡，而美国有10倍以上的人受到传染病的伤害，将会发生什么？我们国家受人尊敬且能力强大的公共卫生基础设施很可能会做好准备，以照顾受到伤害的人并研究问题。急于找出原因，制定干预措施，并不断完善它们，直到消除威胁或至少遏制了威胁。考虑到公共健康的风险（毕竟已经有500多人受到伤害！），医疗保健专业人员会发出警报。我们会要求资金。我们将去参加会议，以了解已知的知识和我们应该做什么。我们将在我们的机构中​​成立委员会，以计划当地对策，以保护我们的社区。美国将在短期内花费数百万美元甚至更多，以确保公众安全，而且任何民选官员都不会考虑这样做。相反，他们将争夺号召最大声的资金，并集中精力保护我们的人民。美国人应该为我们在解决公共卫生危机方面的能力和承诺感到自豪。

然而，在这里，我们又有了另一篇社论，讲述了过去难以想象的枪支相关伤害和死亡的公共健康危机，这次是在拉斯维加斯的一场音乐会上的大规模谋杀和人员伤亡。我们之前都写过。每年都有如此惊人的数字被杀。号码永久禁用。这些家庭留下来应付亲人的损失或照顾那些被子弹打碎但未被杀死的人。作为医疗保健专业人员，我们似乎无能为力。这场公共卫生危机似乎超出了我们的工具范围。

医护人员真的无能为力吗？我们认为有很多。自上次大规模枪击事件发生后的沉默时刻以来，我们每个人都需要自问，我们已经做了些什么来运用我们的知识和技能来帮助解决问题。没有更多的沉默不是答案。我们是否要求资金来充分研究问题并测试解决方案？我们参加了这样的研究吗？我们是否已动员机构中的力量来计划降低社区风险的策略？我们是否已经与患者讨论了枪支安全问题并有效地挑战了政策，这将迫使我们对此事保持沉默？我们的一些同事有。我们应该为他们感到骄傲，但是他们需要我们的所有帮助。我们的患者也是如此。

以下是医疗保健专业人员如何利用我们的技能和声音来对抗枪支对美国健康造成的威胁的简短列表。

教育自己。阅读医疗保健专业组织的背景材料和明智的枪支立法建议。拨打电话并写信给您的当地，州和联邦立法者，告诉他们您对枪支管制的感觉。现在。不要等 并定期重做一次。参加与这些官员的公开会议，并以医疗保健专业人员的身份大声说出来。要求答案，承诺和后续行动。去集会。加入，志愿服务或为争取明智的枪支法规而奋斗的组织捐款。要求候选人担任公职，并投票支持那些具有减轻枪支相关伤害的立场的人。

与您自己机构中的领导人会面，讨论如何利用组织在地方，州和联邦政府中的影响力。不要因为对政治后果的担忧而妨碍倡导患者和公众的福祉。让您的社区知道您的机构所处的位置以及您在做什么。告诉媒体。

教育自己有关枪支的安全性。询问您的病人家里是否有枪支。它们如何存储？是否有儿童或其他人有伤害自己或他人的危险？将它们引导到资源上以减少枪支受伤的风险，就像您已经对其他健康风险所做的那样。询问您的患者是否相信在家中持枪会让他们更安全，尽管有证据表明他们会增加凶杀，自杀和意外事故的风险。

不要沉默 我们不需要更多的沉默片刻来缅怀那些被杀害的人。我们需要通过避免这样的时刻来纪念他们的记忆。作为医疗保健专业人员，我们不会屈服于失败，因为疾病似乎是无法治愈的。我们致力于逐步增加其负担。那是我们的工作。

关于与枪支有关的危害肆虐的另一条评论会改变吗？可能不是—在先前的启用枪支的灾难之后，我们的期刊发表了太多文章。唯一能够使世界变得更好的是一群相信自己可以改变世界的人。关于与枪支有关的伤害和死亡，让我们每个人都属于该组。

Darren B. Taichman，医学博士，博士学位，内科学年刊执行副主编

霍华德·鲍赫纳（Howard Bauchner）医学博士，《美国医学会杂志》（JAMA）和《美国医学会杂志》网络的主编

医学博士Jeffrey M. Drazen，《新英格兰医学杂志》主编

克里斯汀·莱恩（Christine Laine），医学博士，公共卫生硕士，《内科学年鉴》总编辑

医学博士Larry Peiperl，PLOS Medicine总编辑