Rampage shootings: an historical, empirical, and theoretical overview

Comparison of rampage and non-rampage mass shootings in the U.S.: A 5-year demographic analysis

BACKGROUND

Rampage mass shootings (RMS) are a subset of mass shootings occurring in public involving random victims. Due to rarity, RMS are not well-characterized. We aimed to compare RMS and NRMS. We hypothesized that RMS and NRMS would be significantly different with respect to time/season, location, demographics, victim number/fatality rate, victims being law enforcement, and firearm characteristics.

STUDY DESIGN

Mass shootings (4 or more victims shot at a single event) from 2014-2018 were identified in the Gun Violence Archive (GVA). Data were collected from the public domain (e.g. news). Crude comparisons between NRMS and RMS were performed using Chi-squared or Fisher's exact tests. Parametric models of victim and perpetrator characteristics were conducted at the event level using negative binomial regression and logistic regression.

RESULTS

There were 46 RMS and 1626 NRMS. RMS occurred most in businesses (43.5%), whereas NRMS occurred most in streets (41.1%), homes (28.6%), and bars (17.9%). RMS were more likely to occur between 6AM-6PM (OR=9.0 (4.8-16.8)). RMS had more victims per incident (23.6 vs. 4.9, RR: 4.8 (4.3,5.4)). Casualties of RMS were more likely to die (29.7% vs. 19.9%, OR: 1.7 (1.5,2.0)). RMS were more likely to have at least one police casualty (30.4% versus 1.8%, OR: 24.1 (11.6,49.9)) or police death (10.9% versus 0.6%, OR: 19.7 (6.4,60.3)). RMS had significantly greater odds that casualties were adult (OR: 1.3 (1.0,1.6)) and female (OR: 1.7 (1.4,2.1)). Deaths in RMS were more likely to be female (OR: 2.0 (1.5,2.5)) and White (OR: 8.6 (6.2,12.0) and less likely to be children (OR: 0.4 (0.2,0.8)). Perpetrators of RMS were more likely to die by suicide (34.8%), be killed by police (28.3%), or be arrested at the scene (26.1%), while more than half of perpetrators from NRMS escaped without death or apprehension (55.8%). Parametric models of perpetrator demographics indicated significant increases in the odds that a RMS shooter was White (OR: 13.9 (7.3,26.6)) or Asian (OR: 16.9 (3.7,78.4)). There was no significant difference in weapon type used (p=0.35).

CONCLUSION

The demographics, temporality, and location differ between RMS and NRMS, suggesting that they are dissimilar and require different preventive approaches.

An Analysis of Motivating Factors in 1,725 Worldwide Cases of Mass Murder Between 1900-2019

Mass murder, particularly mass shootings, constitutes a major, growing public health concern. Specific motivations for these acts are not well understood, often overattributed to severe mental illness. Identifying diverse factors motivating mass murders may facilitate prevention. We examined 1,725 global mass murders from 1900-2019, publicly described in English in print or online. We empirically categorized each into one of ten categories reflecting reported primary motivating factors, which were analyzed across mass murderers generally, as well as between U.S- and non-U.S.-based mass-shooters. Psychosis or disorganization related to mental illness were infrequently motivational factors (166; 9.6%), and were significantly more associated with mass murder committed using methods other than firearms. The vast majority (998, 57.86%) of incidents were impulsive and emotionally-driven, following adverse life circumstances. Most mass murderers prompted by emotional upset were found to be driven by despair or extreme sadness over life events (161, 16.13% within the category); romantic rejection or loss, or severe jealousy (204, 20.44% within the category); some specific non-romantic grudge (212, 21.24% within the category); or explosive, overwhelming rage following a dispute (266, 26.65% within the category). Results suggest that policies seeking to prevent mass murder should focus on criminal history, as well as subacute emotional disturbances not associated with severe mental illness in individuals with poor coping skills who have recently experienced negative life events.

The COVID-19 pandemic and its impacts on mass shootings in six major US cities

BACKGROUND

The COVID-19 pandemic has significant impacts on the US socioeconomic structure. Gun violence is a major public health issue and the effects on this area have not been well-elucidated. The objective of this study was to determine the impacts of the pandemic on mass shootings in six major United States cities with historically high rates of gun violence.

METHODS

Mass shooting data were extracted from an open-source database, Gun Violence Archive. Mass shooting was defined as four or more people shot at a single event. Data from six cities with the highest incidence of mass shootings were analyzed in 2019 versus 2020 (Baltimore, Chicago, Detroit, New Orleans, Philadelphia, and St. Louis). Geographic data were examined to assess changes in each city's mass shooting geographic distribution over time. Quantitative changes were assessed using the Area Deprivation Index (ADI), and qualitative data were assessed using ArcGIS.

RESULTS

In 2020, the overall percentage of mass shootings increased by 46.7% though there was no change in the distribution of these events when assessed quantitatively (no change in average ADI) nor qualitatively (using ArcGIS). In the six cities analyzed, the total proportion of mass shooting events was unchanged during the pandemic (21.8% vs 20.6%, p = 0.64). Chicago, the US city with the highest incidence of mass shootings, did not experience a significant change in 2020 (n = 34/91, 37.3% vs. n = 53/126, 42.1%, p = 0.57). Baltimore had a significant decrease in mass shooting events (n = 18/91, 19.8% vs. 10/126, 7.9%, p = 0.01). The other four cities had no significant change in the number of mass shootings (p>0.05).

CONCLUSION

This study is the first to use ArcGIS technology to describe the patterns of mass shooting in six major US cities during the COVID-19 pandemic. The number of mass shootings in six US cities remained largely unchanged which suggests that changes in mass shootings is likely occurring in smaller cities. Future studies should focus on the changing patterns of homicides in at-risk communities and other possible social influences.

Communication of Intent to Do Harm Preceding Mass Public Shootings in the United States, 1966 to 2019

IMPORTANCE

Understanding the motivation of a mass shooter's intent to do harm can help practitioners and policy makers develop more effective intervention strategies.

OBJECTIVE

To examine the prevalence of communication of intent to do harm, known as leakage, in a sample of 170 mass public shooters from 1966 to 2019; the characteristics of perpetrators who do and do not leak their plans; and whether leakage is a form of fame-seeking behavior or a cry for help among individuals who are in crisis or suicidal.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included perpetrators who killed 4 or more people in a public space from 1996 to 2019 and were included in a comprehensive database of US mass shootings. That database was built from August 2017 to December 2019, and analysis took place from January to May 2021.

MAIN OUTCOMES AND MEASURES

Leakage was identified and coded using publicly available records. Any communication to a third party of an intent to do harm prior to the shooting was coded as leakage. Logistic regression models were used to examine the risk factors associated with leakage. Models estimating leakage were examined to assess the 2 hypothesized pathways to leakage (the cry-for-help model and the fame-seeking model).

RESULTS

The 170 participants in this sample included 166 (97.7%) male perpetrators and 3 (2.3%) female perpetrators, with a mean (SD) age of 34 (12) years. Overall, 161 participants had known race and ethnicity: 11 (6.8%) Asian individuals, 35 (21.7%) Black individuals, 14 (8.7%) Latinx individuals, 7 (4.4%) Middle Eastern individuals, 3 (1.9%) Native American individuals, 89 (55.3%) White individuals, and 2 (1.2%) individuals with other race and ethnicity. Overall, 79 mass shooters (46.5%) leaked their plans. Of perpetrators who leaked their plans, 35 (44.3%) leaked specific plans about a mass shooting, and 44 (55.1%) leaked nonspecific plans about generalized violence. The study findings indicate that leakage was associated with receiving counseling (odds ratio, 7.0; 95% CI, 2.0-24.8) and suicidality (odds ratio, 3.7; 95% CI, 1.0-13.6), suggesting that leakage may best be characterized as a cry for help from perpetrators prior to their act.

CONCLUSIONS AND RELEVANCE

In this study, nearly half of the perpetrators of mass shootings leaked their plans. Leakage was associated with receiving counseling and suicidality. Leakage is a critical moment for mental health intervention to prevent gun violence. Opportunities to report threats of violence need to be increased. Traditional threat assessment models focused on specific threats of violence may miss critical opportunities for intervention.

Gender-Based Mass Shootings: An Examination of Attacks Motivated by Grievances Against Women

This study provides a quantitative examination of gender-based mass shootings in America from 1966-2018. Gender-based mass shootings refer to attacks motivated by grievances against women, divided into four categories based on a specific woman or women in general, as well as whether they directly target the source of their grievances. Findings indicate that specific woman-targeted shooters were the most common and significantly different from their counterparts in their domestic violence history, racial diversity, and engagement in spree attacks. When comparing all gender-based attacks against other mass shootings, significant differences include relationship status, children, domestic violence history, substance abuse history, and suicide. This investigation provides implications for gender and mass shooting scholars, as well as practitioners developing strategies for intervention and prevention.

The current status of disaster preparedness in Canadian trauma centers

Mass casualty incidents (MCIs) put substantial stress on loco-regional resources, and trauma centers are critical to responding to these events. Our previous evaluation of Canadian centers helped to identify several weaknesses in disaster responsiveness. In this analysis, we determined the current state of MCI readiness across Canada and how this has changed over time. A multinational cross-sectional survey-based study on MCI preparedness was performed, including 24 Canadian trauma centers. Surveys were completed anonymously online by representatives of each facility. Responses from Canadian centers were examined and compared to previous findings to assess temporal changes in institutional capacity. Fifteen (63%) trauma centers responded, 100% of which had a disaster committee. Sixty percent had a single all-hazards emergency plan, and 71% performed a practice drill in the last two years. Sixty-two percent had communications systems designed to function during an MCI. Ninety-two percent had a triage system in place, and 54% of centers could monitor surge capacity. Half (54%) reported back-up systems for survival essentials, but the capability for prolonged operation during a disaster was limited. A minority (15%) had a database denoting staff with emergency training, although half (54%) had disaster training programs. Comparison to past data showed an increased prevalence of committees dedicated to disaster preparedness and disaster drills but worsened external stakeholder representation and poor ability to provide a prolonged response to crises. Our results demonstrate that MCI preparedness is a growing focus of Canadian trauma centers, but that there are deficiencies that remain unaddressed. Future efforts should focus on these vulnerabilities to ensure the provision of a robust disaster response. LEVEL OF EVIDENCE: Level 3b (prevalence study, limited population).

Gendered Massacres: Examining the Effects of Cultural and Structural Gender Inequality on the Incidence of Mass Public Shootings

With nearly 97% of incidents within the past 40 years committed by men, mass public shootings are a gendered social problem. Yet, empirical research on this phenomenon largely neglects gender hierarchy and cultural factors as predictors, in favor of individual- and event-level characteristics. Despite calls from scholars to place masculinity and threats to patriarchal hegemony at the center of analyses, no empirical studies to our knowledge have examined the role of gender inequality in mass public shootings. The findings indicate that gender inequality, structural and ideological, are important predictors of mass public shootings and that future research should continue to investigate such violence from a gendered lens.

The Multiple Casualty Scenario: Role of the Anesthesiologist

Purpose of Review

Mass casualty disasters (natural and man-made) present an acute, critical situation that taxes healthcare resources and clinician acumen. This review summarizes the characteristics and management skill sets that anesthesiologists possess that make them valuable clinicians during mass casualty events and why we as anesthesiologists must continually educate ourselves on this important topic.

Recent Findings

Anesthesiologists should be involved in all aspects of emergency preparedness—mitigation, planning, response, and recovery. The anesthesia department should have a plan for how it will deal with managing patients during natural and man-made (unintentional or intentional) disasters, one that takes into account a risk hazard analysis and institutional goals. Unfortunately, most practicing anesthesiologists have not had training and ongoing education for such events, and few academic centers train anesthesiology residents and staff to prepare for mass casualty scenarios.

Summary

The everyday clinical practice of anesthesiologists involves the utilization of some of the skills (vascular access, tracheal intubation) commonly required to successfully manage mass casualty scenarios. Anesthesiologists’ knowledge of anti-cholinesterases makes them subject matter experts on nerve agent poisoning, and their experience managing trauma patients will serve them well, depending on the nature of the mass casualty event. Practicing anesthesiologists however need to continually educate themselves on their role during mass casualty events. and current anesthesiology residency programs should develop a curriculum and incorporate simulation training to better prepare future generations of anesthesiologists.

Mass School Shootings in the United States: A Novel Root Cause Analysis Using Lay Press Reports

School shootings comprise a small proportion of childhood deaths from firearms; however, these shootings receive a disproportionately large share of media attention. We conducted a root cause analysis of 2 recent school shootings in the United States using lay press reports. We reviewed 1760 and analyzed 282 articles from the 10 most trusted news sources. We identified 356 factors associated with the school shootings. Policy-level factors, including a paucity of adequate legislation controlling firearm purchase and ownership, were the most common contributing factors to school shootings. Mental illness was a commonly cited person-level factor, and access to firearms in the home and availability of large-capacity firearms were commonly cited environmental factors. Novel approaches, including root cause analyses using lay media, can identify factors contributing to mass shootings. The policy, person, and environmental factors associated with these school shootings should be addressed as part of a multipronged effort to prevent future mass shootings.

The Effect of Large-Capacity Magazine Bans on High-Fatality Mass Shootings, 1990-2017

Objectives. To evaluate the effect of large-capacity magazine (LCM) bans on the frequency and lethality of high-fatality mass shootings in the United States.Methods. We analyzed state panel data of high-fatality mass shootings from 1990 to 2017. We first assessed the relationship between LCM bans overall, and then federal and state bans separately, on (1) the occurrence of high-fatality mass shootings (logit regression) and (2) the deaths resulting from such incidents (negative binomial analysis). We controlled for 10 independent variables, used state fixed effects with a continuous variable for year, and accounted for clustering.Results. Between 1990 and 2017, there were 69 high-fatality mass shootings. Attacks involving LCMs resulted in a 62% higher mean average death toll. The incidence of high-fatality mass shootings in non-LCM ban states was more than double the rate in LCM ban states; the annual number of deaths was more than 3 times higher. In multivariate analyses, states without an LCM ban experienced significantly more high-fatality mass shootings and a higher death rate from such incidents.Conclusions. LCM bans appear to reduce both the incidence of, and number of people killed in, high-fatality mass shootings.