Hong Kong Journal of Paediatrics [HK J Paediatr (New Series) 2016;21:127-130]

In the US, gunshots are one of the most common modes of deaths in childhood injuries, surpassing many communicable causes of mortality in children and young persons in the post-World War II era. Injuries from firearms are more frequent among young people aged 15 to 24 than in any other age group, and black males are especially vulnerable.^1,2 A gun in the home doubles the likelihood of a lethal attempt, and there is increased likelihood that a family member or friend will be killed rather than an intruder.¹ The most effective way to prevent firearm injuries is to remove guns from the home and community.² A number of horrifying paediatric shootings hit international news in recent years. US high rates of child injury and death from firearms are in stark contrast to the cities with no cases. The difference is related to firearm regulation³ (http://o.canada.com/news/politics-and-the-nation/crime-and-justice/interactive-mass-shootings-around-the-world-since-1996/).

Gun violence among children often gets major media play after some terrible events (Table 1). Toddlers as young as 2 years have been involved in shooting (Table 1).

Table 1 Notorious cases from gun violence on paediatric populations

Apr 20, 1999

The Columbine High School massacre was a school shooting. Two senior students murdered a total of 12 students and one teacher, and injured 21 additional people, with three others being injured while attempting to escape the school. The pair then committed suicide (http://en.wikipedia.org/wiki/Columbine_High_School_massacre).

Mar 10, 2010

A three-year-old Tennessee toddler mistook a loaded gun for a Wii controller and killed herself. The girl's stepfather had left the .38-calibre weapon loaded on a table in the living room where the toddler picked it up and shot herself. She was rushed to hospital but was pronounced dead later that night. Much of the gun violence is due to careless storage of firearms by owners. In this case, police did not file neglect charges on the parent (http://abcnews.go.com/Technology/toddler-dies-mistaking-gun-wii-controller/story?id=10056190).

Jan 9, 2011

The US government charged a 22-year-old man with attempted assassination of a congresswoman. The suspect opened fire with a semi-automatic pistol at point-blank range outside a supermarket. A 9-year-old girl was among the six people killed. In that incident, fourteen people were wounded (http://www.reuters.com/article/idUSTRE7071IA20110109).

Jul 24, 2011

A 32-year-old Norwegian man killed 92 people, mostly children, in Europe's worst terrorist attack in seven years. The man was alleged to have a history of hatred of Muslims and of links with rightwing extremists and Christian fundamentalists (https://terrorismbreedsterrorism.wordpress.com/norway-oslo-2011terrorist-conservative-christian-anti-muslim-crusader/).

Jul 20, 2012

A gunman opened fire at a premiere of the new Batman movie in a theater in Aurora near Denver, in Colorado theater, killing 12 people and injuring 38, including children and young persons. The suspect was reportedly wearing a gas mask and a bullet-proof vest. The gunman was arrested near his car, he had rifle and a hand gun in his possession and another firearm was found inside the theatre (http://edition.cnn.com/2012/07/20/us/colorado-theater-shooting/index.html).

Dec 14, 2012

27 were killed including children aged between 5 and 10 years in a mass shooting at Sandy Hook Elementary School in Connecticut. The autistic perpetrator's mother had taken him to a gun range to learn how to use a gun. He killed her first and then went to the elementary school and shot teachers and children. He also had a history of violent video game utilisation (http://en.wikipedia.org/wiki/Sandy_Hook_Elementary_School_shooting).

Apr 10, 2013

A 6-year-old New Jersey boy died after being shot in the head by a 4-year-old playmate in the yard. The younger boy went inside and emerged with a .22-caliber rifle and fired a single shot. The 6-year-old was shot in the head, with both children's parents nearby in the yard (http://edition.cnn.com/2013/04/09/us/new-jersey-child-shooting/).

Oct 24, 2014

A student fatally shot one classmate and wounded four others when he opened fire in the cafeteria of his Washington state high school following a fight with fellow students. All of the victims of the shooting were young people. The shooter then took his own life (http://www.reuters.com/article/2014/10/24/us-usa-washington-shooting-idUSKCN0ID25720141024).

Nov 25, 2014

An Oklahoma woman was fatally shot in the head by her 3-year-old son who came across a handgun in their home. The victim, a 26-year-old Army veteran, was apparently hit with a single shot and died as she was changing her 1-year-old daughter's diaper (http://www.reuters.com/article/2014/11/25/us-usa-oklahoma-shooting-idUSKCN0J92IU20141125).

Dec 30, 2014

A two-year-old boy shot and killed his 29-year-old mother in a Walmart store while she was shopping with her son and three other children. The boy found the gun in her mother's purse while sitting in the front of the shopping cart (http://www.theguardian.com/us-news/2014/dec/30/idaho-toddler-shoots-kills-mother-walmart).

Apr 4, 2015

Angry protests erupted in Rio De Janeiro after a 10-year-old boy was shot dead at his home in the Complexo Alemao shantytown by police who were carrying out a raid on drug gangs (http://www.ibtimes.co.uk/brazil-10-year-old-boy-shot-dead-police-raid- drug-traffickers-1494945).

Apr 6, 2015

In Indianapolis, someone using an assault rifle fired inside an apartment unit, injuring five people including three small children. The youngest victims are boys, ages six, four and two (http://www.wthr.com/story/28726043/at-least-2-shot-on-nw-side).

Oct 19, 2015

In Georgia, a handgun fell to the floor and discharged, striking a woman and her 8-year-old daughter while the mother was brushing her daughter's hair. The child died and the mother was injured (http://www.11alive.com/story/news/local/dallas-paulding-county/ 2015/10/19/accidental-child-death-under-investigation-paulding-co/74237268/).

The gun laws of 4 nations and Hong Kong were compared (Table 2). Contrasting differences among these nations are evidenced. Firearm legislation and policy vary greatly around the world (http://en.wikipedia.org/wiki/Overview_of_gun_laws_by_nation).

Table 2 Comparative legislation in selected countries

Countries

Legislation

USA

General Gun policy: general legislations

Primary goal: to "[keep] firearms out of the hands of dangerous and irresponsible persons." In other words, the central objective has been to enact an inchoate offense of gun possession for members of ineligible groups.
National Firearms Act of 1934 and the Federal Firearms Act of 1938 prohibited the transfer of firearms to fugitives and persons convicted or under indictment for a violent crime.

The Gun Control Act of 1968, the Firearms Owners' Protection Act of 1986, and the Brady Handgun Violence Prevention Act of 1993:

The list of persons banned from gun ownership has grown over time.
List expanded by adding minors, all felons, illegal aliens, illicit drug users, adjudicated mental incompetents, persons dishonourably discharged from the military, anyone who renounces his citizenship, and those under a restraining order for domestic violence.

Sources: Law & Philosophy 2004, Guns and drugs: case studies on the principled limits of the criminal sanction, Douglas N. Husak

Firearms Act 1968 c. 27

Brought together all existing firearms legislation in a single statute.
The possession and use of firearms are controlled by the Firearms Acts 1968 to 1997. These comprise seven statutes: the Firearms Act 1968, the Firearms Act 1982, the Firearms (Amendment) Act 1988, the Firearms (Amendment) Act 1992, the Firearms (Amendment) Act 1994, the Firearms (Amendment) Act 1997 and the Firearms (Amendment) (No. 2) Act 1997 (referred to in this chapter as "the 1968 Act").
Controls introduced for long-barreled shotguns, in the form of Shotgun Certificates that, like Firearm Certificates, were issued by an area's chief constable in England, Scotland, and Wales. While applicants for Firearms.
Certificates had to show a good reason for possessing the firearm or ammunition; this did not apply to Shotgun Certificates. Firearms had to be locked up, and ammunition stored and locked in a different cabinet.
The Act also prohibited the possession of firearms or ammunition by criminals who had been sentenced to imprisonment; those sentenced to three months to three years imprisonment were banned from possessing firearms or ammunition for five years, while those sentenced to longer terms were banned for life.

Sources: Firearms Act 1968 c. 27

Canada

The Criminal Code of Canada in 1892

Owners of pistols were obliged to obtain government permits, and handgun vendors were required to keep detailed client records.

Bill C-150 1969

Established the strict categorization of firearms and prohibited all fully and semi-automatic rifles as well as many types of handguns.

Bill C-17 1991

New firearms owners were obliged to take a gun safety course and submit themselves to a criminal background check.
Under the bill, gun buyers obtained Firearms Acquisition Certificates after a 28-day application process.

The Act, or Bill C-68 in 1995

Expanding the grounds for warrantless searches, reducing restraints on issuing warrants, and requiring people to testify against themselves.
The bill stipulated new, harsher penalties for gun crimes, a licensing program for acquiring and possessing firearms, and the registration of all firearms within Canada's borders.

Sources: Evaluating Gun Policy In The USA And Canada: The Impact Of Political Institutions On Bill C-68 And Brady's Bill, Banerd, Nicholas. Michigan Journal of Political Science 3. 1/2 (Spring 2009): 6-18.

Australia

1996 National Agreement on Firearm

Enacted after the tragedy: a man using a semi-automatic rifle killed 35 people and injured 18 at Port Arthur in Tasmania.
Became extremely strict
Anyone wishing to possess or use a firearm must have a Firearms License and be over the age of 18 with somewhere to securely store their firearms. All of this stemmed from the gun violence and murders that took place the previous year.

Sources: http://www.ic-wish.org/WiSH%20Fact%20sheet%20Firearms%20registration%20in%20 Australia.pdf

China

Since 1966, the government has prohibited the private manufacture, sale, transport, possession and import or export of bullets and guns.
Possessing a single gun can yield a three-year prison sentence, while perpetrators of gun crimes are often executed.

Sources: CHINA: Strict Gun Control Laws Fail to Curb Violent Crime, by Mitch Moxley (Beijing) Tuesday, June 22, 2010 Inter Press Service http://www.globalissues.org/news/2010/06/22/6073

Hong Kong

Firearms And Ammunition Ordinance (Cap. 238)

Possession by exempted person Section 4(3)
- The Commissioner may in writing exempt any person from the prohibition in section 13 in respect of the possession of specified arms and any specified quantity of ammunition therefore, or in respect of specified ammunition, or in respect of specified arms and ammunition.
Carrying arms or ammunition or imitation firearm with Criminal intent Section 18(1)
- A person commits an offence who has with him any arms or ammunition or imitation firearm with intent to commit an arrestable offence, or to resist arrest or prevent the arrest of another, in either case while he has the arms and ammunition or imitation firearm with him.

Sources: http://www.legislation.gov.hk/blis_pdf.nsf/6799165D2FEE3FA94825755E0033E532/34B108CF0F217
C6F482575EE00512A29?OpenDocument&bt=0

Unlike many other cities where guns and automatic weapons are readily available in the homes of their citizens, this is not the case in Hong Kong where there has been no gunshot accidents in children since World War II.^4-6 There are extremely strict gun laws in Hong Kong (see Table 2). Since 1960, even fireworks have been forbidden in Hong Kong. It is accepted by the public that there should be no place for guns and firearms in Hong Kong. The results of this are that the paediatric intensivists and surgeons had little experience in dealing with these events.

Psychosocial effects of playing with a toy gun (or any weapon) are often neglected. The death of the three-year-old Tennessee toddler mistaking a loaded gun for a Wii controller served as a good reminder of this risk (Table 1). No concept of mercy is built into these computer games. Presumably, the player has a sense of achievement and excitement as he guns down more opponents.

In any civilized nations, there is no need for civilians to possess weapons of massive destruction under any circumstance. Some owners see it as self-defence. They have been highly influenced by fear of home invaders. However, a person is much more likely killed by a family member with a gun than a home invader.²

In December 2013, the President of the American Academy of Pediatrics (AAP) expressed concerns that gun safety is a public health issue that profoundly impacts children and adolescents. Paediatricians are uniquely suited to help raise awareness about gun violence in the lives of children. The President concludes that children deserve to feel safe wherever they live, play, and learn, which should not be too much to ask. Following Sandy Hook, however, the US National Rifle Association and its allies argued that arming more adults is the solution to protecting children, be it from deranged mass shooters or from home invaders (http://www.motherjones.com/politics/2013/12/children-killed-guns-newtown-anniversary).² Meanwhile, Candidacy for president in the 2016 election, Donald Trump vowed to "unsign" President Barack Obama's plans to tighten gun control via executive action, telling a packed rally in Biloxi, Mississippi, that he would protect the right to bear arms (http://edition.cnn.com/2016/01/02/politics/donald-trump-obama-guns/). Even with the honorable intentions of AAP, paediatricians and child advocates would have difficulty winning this battle against their gun allies.

KL Hon¹*
WYJ Poon²
LK Fung³
AK Leung⁴
¹The Chinese University of Hong Kong;
²LL.B. Graduate, The Chinese University of Hong Kong;
³Barrister-at-Law, Hong Kong;
³University of Calgary, Canada

*Correspondence to: Prof. KL Hon

References

1. Firearm-related injuries affecting the pediatric population. Committee on Injury and Poison Prevention. American Academy of Pediatrics. Pediatrics 2000;105(4 Pt 1):888-95.

2. Anglemyer A, Horvath T, Rutherford G. The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis. Ann Intern Med 2014;160:101-10.

3. Leventhal JM, Gaither JR, Sege R. Hospitalizations due to firearm injuries in children and adolescents. Pediatrics 2014;133:219-25.

4. Hon KL, Leung TF, Cheung KL, et al. Severe childhood injuries and poisoning in a densely populated city: where do they occur and what type? J Crit Care 2010;25:175.e7-12.

5. Hon KL. No guns at children: not even a toy one! Indian J Pediatr 2011;78:1556-7.

6. Hon KL, Poon TC, Wong W, et al. Prolonged non-survival in PICU: does a do-not-attempt-resuscitation order matter. BMC Anesthesiol 2013;13:43.