Violence involving firearms is a significant problem in the United States. Handguns are used in the overwhelming majority of cases because they are easy to carry and conceal. Many criminals now use semiautomatic handguns that carry up to 15 cartridges in their clips. Funds produced in the lucrative illegal drug trade enable drug traffickers to switch from cheap revolvers (Saturday night specials) to expensive modern high-technology semiautomatic pistols. Law enforcement has followed suit in this "arms race." It is not surprising that multiple gunshot wounds are becoming more common.1 A higher percentage of patients wounded by semiautomatic pistols are dead at the scene, increasing from 5 percent in 1985 to 34 percent in 1990 in Philadelphia County. 1 In that study, the percentage of firearm homicide victims with criminal records increased from 43 percent in 1985 to 67 percent in 1990. Of all the 1990 Philadelphia firearm homicide victims, 61 percent were intoxicated at the time they were killed, and 39 percent were using cocaine at the time of death compared with 9 percent in 1985.

Between 1983 and 1992, a total of 37 million handguns, rifles, and shotguns were produced in the United States. These were added to the pool of existing firearms. This figure does not include guns imported into the United States during the same period. In 1992, a total of 3 million handguns, rifles, and shotguns were produced in the United States, and 2.85 million more were imported.2

When tracing the ownership history of a firearm for a crime investigation, the record often stops at the point of the gun's first private sale. Except where expressly outlawed by individual states, anyone who owns a firearm is free to sell it without demanding identification and without keeping any record of the sale. The Brady law does not apply. Like most federal gun-sale laws it regulates only the transactions of federally licensed gun dealers.

Each day in the United States, there are 65 murders.3 At least 68 percent of these are committed with firearms. Many of these murders and much of the urban gun violence result from disputes between criminals, so criminals are often the victims. The medical literature regarding the epidemiology of firearm-involved trauma is often misleading and sometimes outright false.45

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