FASTER, which provides grants to state health departments, builds on another federal-state partnership that has been used to track infectious diseases and other public health threats using data from ER visits, reported The Trace. That system, known as the National Syndromic Surveillance Program, or NSSP, has served as an early warning system for the flu, the Zika virus, COVID-19, overdose clusters, and even lung injuries from vaping products.
The goal of FASTER is to enable and encourage state and local health agencies to rapidly track emergency department-treated firearm wounds, classify them by intent, share that data with the CDC, and then use the information to help their local communities respond. State health departments, for example, could help cities target resources or develop violence prevention programs.
“We can support local and state health departments to respond more quickly to upticks, or abnormal patterns of firearm injury ED visits in their jurisdiction,” Marissa Zwald, of the CDC’s National Center for Injury Prevention and Control, told me. “And that’s really the most important piece of FASTER — that data-to-action component.”
As part of the grant agreements, participating state health departments share more detailed data, allowing the CDC to examine information down to the level of individual visits, which goes far beyond the aggregate data that the federal agency currently has. And that data is typically available within one to two days.
“There’s more granularity, and we can see patient demographics and understand some of those trends by demographic characteristics, and empower our funded state health departments to look at and examine these data in that way, too,” Zwald said.
The new approach is less likely to suffer from the shortcomings of some of the CDC’s other efforts to estimate nonfatal shooting injuries, which have relied on small samples of hospitals. But, as with the NVDRS, it does have its own limitations that again come down to a trade-off between detail and timeliness. While FASTER is, well, faster, and will improve our overall understanding of nonfatal shootings, it will be nowhere near as detailed as the NVDRS. On top of that, researchers cautioned it was likely that the intent of injuries would be miscategorized — an assault might be coded as an unintentional shooting, for example.
Another issue: Some emergency rooms don’t yet submit data to the surveillance system. About 75 percent of ERs currently participate, but thanks to a 2021 federal rule change, that number is on an upward trajectory and is likely to get close to 100 percent soon.
FASTER is in its third and final year of the pilot, which wraps up in August. The effort has produced new mechanisms for logging details about firearm injuries into the NSSP system that will be made available to other state health departments. Going forward, it will also be incorporated into a broader initiative to improve surveillance of all violent injuries, not just those from firearms.
The system shows promise for improving national-level data, but getting truly accurate statistics will still take time. Nevertheless, FASTER is already providing benefits in states where it is operating. New Mexico used the data to inform a statewide strategic plan to address gun violence. In Oregon, legislators used it to pass a bill that provides consistent funding for hospital- and community-based violence intervention programs. And in Georgia, the state health department developed a data dashboard — with detail down to the neighborhood level — to support violence intervention efforts in Atlanta that it plans to soon make public.
“It obviously is more timely,” said Elizabeth Blankenship, an epidemiologist focusing on violence at the Georgia Department of Public Health, during a presentation in Milwaukee. “We really have just a great picture of both the morbidity and mortality side of things, and hopefully FASTER will be able to evolve outside of just firearm incidents.”
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