Where the Scalpel Meets the Statute: A PhD Student Studies Red Flag Laws to Save Lives.
Annie Buck poses in front of the Talbot Building. PHOTO: MEGAN JONES
Where the Scalpel Meets the Statute: A PhD Student Studies Red Flag Laws to Save Lives
Annie Buck (GMS’20), a PhD student in health services and policy research, discusses how the same decisive instincts that guide trauma care in the aftermath of gun violence can translate to policies that prevent gun violence before it occurs.
From the moment someone sustains a gunshot wound, every passing second counts. Trauma surgeons race to stop the bleeding and prevent tragedy. Annie Buck (GMS‘20) once aspired to wield the scalpel herself, intervening quickly and decisively in the operating room to save lives. But while pursuing a Master of Science degree in clinical research at BU, Buck discovered another tool—statutes like red flag laws—that, when applied with similar timeliness and precision as a scalpel, can prevent firearm injury before it occurs. Now a fourth-year PhD student in health services and policy research at the School of Public Health, Buck studies how these laws, also known as extreme risk protection orders (ERPOs), which allow courts to remove firearms from individuals who pose a risk to themselves or others, can enable clinicians to save more lives.
As a master’s student, Buck spent hours at Boston Medical Center observing teams of clinicians converge upon critically ill patients in a finely choreographed flurry of activity. Inspired by their urgency, she would then return to her computer to wrestle with datasets populated by surgical intensive care unit patients who were frequently survivors of gun violence. One day, while working on a clinical trial under former chief of acute care & trauma surgery Peter Burke, Buck expressed her frustration over their patients’ poor health outcomes to a passing surgical resident, now attending trauma surgeon, Megan Janeway.
“We got in this whole conversation about the social determinants of health and socioeconomic inequalities, and then, [Janeway] said, ‘Do you want to do something about it?’” says Buck. “She told me, ‘We have this group [we] started four years ago—it’s called Socially Responsible Surgery [SRS]. Come to the next meeting.’”
Two weeks later, Buck recalls, she was sitting in the living room of the current chief of acute care & trauma surgery, SRS cofounder, and now, a member of her dissertation committee, Tracey Dechert, drinking wine, eating pizza, and talking with a handful of other students and residents about all the research and policy advocacy work they hoped to do to advance surgical equity and reduce healthcare disparities.
“And that was it—boom, I found my place,” says Buck. “And [SRS] has grown since then. There are now 18 chapters at medical schools across the country. We have our 501(c)(3) […] The amount of policy change and advocacy we have done, I will forever be proud that I’m a part of that.”
Buck discussed her motivations for pursuing a career in health policy, her ongoing dissertation work, and her advice for other students seeking to make a difference.
Q&A
With Annie Buck (GMS’20), a PhD student in health services and policy research at SPH, an academic program manager for BU’s Master of Science in Clinical Research program, and an instructor in research ethics
SPH: Your research sits at the intersection of trauma surgery and social justice, and you are completing your dissertation on gun violence prevention. What drew you to these subjects in the first place?
Annie Buck: I’ve always been very drawn towards trauma surgery, and there was that crossroads where I reached, at one point, where I had to decide, did I want to do an MD? Do I want to do a PhD? I was doing my undergrad work in Georgia, and I was doing some work with the CDC, and before there, I was doing some bench research at the Scripps Research Institute in San Diego. I got to work around a lot of the trauma teams, and I was really fascinated by not just the nature of the work, but also the flow, and how it’s just such a finely choreographed, well-oiled machine. People make comparisons to an F1 pit crew. You arrive in the trauma bay, and…everybody knows what they’re supposed to be doing and where they’re supposed to be doing it and how they’re supposed to be doing it for the benefit of one person.
But of course, in trauma surgery, especially in this country, you see a huge preponderance of firearm injury, unfortunately. We’re one of the only countries in the world where you see that. There’s just this huge burden of firearm injury, and it’s hard to ignore, it’s hard to turn away from, and as a country, we shouldn’t be turning away from it. So, fast forward, I was unfortunately in a relationship where there was firearm violence, and as somebody who experienced that personally, never thinking that that would be something that was a part of my life, I immediately said, I need to do what I can with my skills, and my ability to help others in this situation.
SPH: Your dissertation specifically focuses on Massachusetts’ red flag laws. For those who are not familiar, what are red flag laws, and what do you hope to achieve at the state level with your dissertation work?
Annie Buck: Massachusetts has always been a leader in effective, responsible gun policy, and is frequently among the lowest two states in the country for gun deaths. We’ve done a really good job of that historically, but there’s still work to do. Back in 2018, in response to the Parkland shooting in Florida, a lot of states came out with red flag laws, also known as extreme risk protection orders or ERPOs. It is a civil order that, if you feel that somebody is at risk to themselves or the community, you can go to a judge and you can file, just like a restraining order, except it’s for firearms. You can get an emergency one where there’s a judge on call 24/7, and there’s an immediate response. It’s a civil order, it’s not criminal, so law enforcement would then show up and seize the weapons regardless of whether they’re owned legally or not.
The law in Massachusetts was very specific in that these orders could only be filed for people who already had a firearms license in Massachusetts. To own a gun in Massachusetts, you have to have a license first. Then, the only people who could file were law enforcement officers, family members, or household members; nobody else, so if I didn’t have a current Massachusetts firearms license, but I was at risk and my roommate was worried about me, they wouldn’t be able to file for me, and I would still be able to drive to New Hampshire or Maine, walk in a store, purchase a firearm, and be back to Boston in say 50 minutes—that’s a problem. And yet, between 2018 and 2022, there were only 48 orders filed—a silly low number. [It was] wildly underutilized.
My team and I decided to investigate. It was the right time, too, because in Massachusetts, in response to the Bruen decision, a Supreme Court decision in 2022, a lot of gun laws had to be updated, especially in the Northeast. In April 2024, we sent out a survey to BMC clinicians to see what they knew about ERPO laws and to ask them, as clinicians, what would prevent them from using this legislation if it became available to them. At BMC, 9% of those who responded to the survey said that they see somebody daily who they feel would be eligible for an ERPO. It really gave us pause and showed that this is a way bigger problem than anybody anticipated. We then had this data to share in testimony as the state weighed a gun omnibus bill H.4885 in response to the Bruen decision, and when the law passed later that year, it included an ERPO refresh to expand petitioners to include licensed clinicians, so not just MDs, but any NPs, PAs, licensed mental health clinicians, social workers—anybody who’s got a license in Massachusetts and has seen a patient in the last six months.
I never thought that I would be focusing my doctoral education and my dissertation on just this one law, but it’s the perfect marriage of supporting both clinicians and effective policy change. Unfortunately, with a highly politicized topic like firearm injury and gun policy, it’s challenging, but it’s really rewarding.
SPH: What advice would you give to a current or prospective student who expresses interest in your career?
Annie Buck: The first thing I would ask them is, what keeps you up at night? What’s going to be the topic that keeps you up at night, that you’re really passionate about? Because it’s not always going to be easy. There’s going to be some times where it’s going to be really tough, and unfortunately, in today’s environment, really defeating at times. There has to be that thing that you’re so interested in and you’re so passionate about that you just have to keep chasing. That’s the niche that you have to find, and then find mentors. Especially as a woman in any kind of academic sphere, clinical sphere, political [sphere], find a mentor and hold onto them. Mentorship is so important, and good mentorship is hard to find. I’m really grateful for the good mentorship that I have, and the people who are incredibly invested in me. Regardless of whether you want to go into firearm injury or do a PhD or clinical research or bioethics or any of that, just find a mentor whom you click with—that’s going to take you further than anything.