A surgeon, who survived being shot, is studying why patients aren’t making it to the hospital.

For victims of gunshot and stab wounds, the ability to get to a hospital quickly can mean the difference between life or death.

But victims of violent injuries are increasingly not surviving long enough to get to the hospital.

A new study published in The Journal of Trauma and Acute Care Surgery analyzed national trauma data and found that individuals were four times more likely to die from gunshot wounds and almost nine times more likely to die from stab wounds before getting to a hospital in 2014, compared with 2007.

“Over around a decade or so, we’ve seen an increase in prehospital deaths when it comes to penetrating trauma. And I think that’s fascinating, because it begs the question as to why is that happening,” Dr. Joseph Sakran, director of emergency general surgery at Johns Hopkins Hospital and lead author of the study, told Healthline.

The issue is one that’s close to Sakran’s heart: He’s a survivor of violent crime. In 1994, at the age of 17, Sakran was shot in the throat when a member of a gang opened fire at a high school football game at a park in Burke, Virginia.

Since then, he’s saved hundreds of gunshot victims’ lives.

Sakran and his team examined the records of 437,398 patients of penetrating trauma. They were separated into an early period (2007 to 2010) and a late period (2011 to 2014). Half of the patients suffered stab wounds, the other half gunshot wounds.

Despite equal representation in injuries, gunshot wounds accounted for almost all deaths at 88 percent, compared with just 12 percent from stab wounds.

In addition to a surge in prehospital deaths in the later period of their study, researchers also observed an equally disturbing rise in the severity of injuries. Patients from the later period were more likely to have received gunshot wounds to the face and spine. The amount of stab injuries to the spine also increased during this time.

Researchers theorize that this could signal a rise in “violence intensity.”

“The pattern of injury is more lethal. So, if the pattern is more lethal, is it because they are getting shot numerous times? Is it because they are being shot with more high-power rifles, or are they being shot at closer range?” Sakran said.

The answer is unclear.

And there’s a whole host of potential complications that arise from using large datasets, admit the authors.

Access and distance to trauma centers, differing geographic areas (urban vs. rural), and prehospital interventions are all important factors in trauma death that weren’t accounted for in this study.

“I think an article like this is very valuable, but it only scratches the surface. It requires a lot more study into why this is happening,” Dr. Adam D. Fox, section chief of trauma at Rutgers New Jersey Medical School, told Healthline.

“Because this is such a broad sweep, it’s very hard to make any conclusions about whether or not the world is getting more violent or whether inner-city people are using larger capacity clips,” he said.

But Fox admits that these sorts of statistics are excellent in helping create a conversation around what’s otherwise a complex and difficult topic.

Some studies have looked at the possibility of whether bystander intervention can help save the lives of trauma patients in prehospital scenarios. One study from 2017 concluded that bystander intervention is often a “missed opportunity” to improve outcomes.

Fox has worked closely with an initiative called “Stop the Bleed.” The campaign teaches the general public basic skills to deal with severe bleeding injuries in the face of mass shootings and gun violence.

“Unequivocally, having the public understand the basics of bleeding control which is potentially life-threatening would be beneficial in many scenarios,” he said.

While it’s a good, practical step to help save someone’s life, it’s by no means a solution to gun violence in America.

“It’s sort of like Narcan for opioid overdoses. There is an underlying public health problem that needs to be fixed… but Narcan is a Band-Aid for a significant and broad health problem,” Fox said.

Sakran notes that bystander intervention is also limited to a handful of scenarios.

Suicides using a firearm actually make up about two-thirds of all gun-related deaths in the United States. There’s also a correlation between gun ownership and firearm suicide, which Healthline has previously reported on.

Mass shootings account for very few gun deaths each year.

While neither Sakran or Fox specifically frame the results of the study as a “gun control” issue, it’s hard to ignore the elephant in the room. Framing gun violence as a public health problem, rather than a law enforcement or political issue, is an important distinction that can lead to a solution, according to the experts.

“We have a gun violence problem in this country, without a doubt. In fact, I could sum it up in three words: It’s a public health crisis that we are facing. We’ve seen in other studies that this is significant, especially within urban areas like Baltimore and Chicago, New Jersey and so forth. These are happening every day on a daily basis,” Sakran said.

That sentiment is shared by Dr. Howard Bauchner, the editor-in-chief of JAMA, who, along with other JAMA editors in December 2017, penned an editorial titled “Death by Gun Violence — A Public Health Crisis.”

There, they describe treating firearm deaths “like any epidemic.”

Sakran’s study doesn’t provide any easy answers on how to do that. But it does add to a growing body of evidence about what’s unequivocally a gun violence epidemic in the United States.

“Right now I feel like we’re at a tipping point in this country. I’ve said this before and I’ll say it again: This is not a Democratic problem or a Republican problem. This is an American problem that we are facing,” Sakran said.