Ten Minnesota hospital systems pledged Wednesday to confront the rising problem of gun violence, including mass shootings like those at a Texas public school last month and locally at a Buffalo, Minn., clinic last year.

Chief executives of all 10 systems said gun deaths have reached "epidemic levels" that threaten communities in general but also the safety of medical facilities. Firearm-related deaths in Minnesota have risen over the past two decades from 312 in 2000 to 513 in 2020, according to the Centers for Disease Control and Prevention.

"We believe it is time to declare gun violence as a public health crisis and to work to prevent the deaths of innocent people of all ages and backgrounds," their statement said.

The group consisted of leaders of the Allina, CentraCare, Children's, Essentia, Gillette, HealthPartners, Hennepin Healthcare, M Health Fairview, North Memorial and Sanford systems. Mayo Clinic was not part of the group, having issued its own statement denouncing gun violence after the Uvalde, Texas, shooting that left 19 grade school students and two teachers dead.

Hennepin Healthcare, which operates one of three urban trauma centers in the Twin Cities, has tracked a 50% increase since 2020 in penetrating trauma injuries that include gunshot wounds. Responses have included a Next Steps outreach program to try to prevent violent injuries from prompting retaliatory assaults, but chief executive Jennifer DeCubellis said more preventive solutions are needed.

"As health systems we're in the business of saving lives and this is a place where we're seeing the numbers increase and we're alarmed and we can make a difference," she said.

Wednesday's statement offered no specific solutions, but leaders of the systems hope the unique level of cooperation among hospitals in Minnesota can produce change and inspire other industries to consider their own steps. While gun access is a politically divisive issue, firearm-related deaths also can be traced to problems such as untreated mental and substance abuse disorders.

One person died and four were injured at Allina's Buffalo clinic in February 2021 by an opioid-dependent man who had been denied more painkillers. The shooter, Gregory Ulrich, awaits sentencing and a mandatory life sentence in prison after being found guilty June 2 of 11 counts, including premeditated first-degree murder.

The timing of the hospitals' statement was coincidental to that verdict, but motivated by the recent high profile attacks that include a shooting in a medical facility in Tulsa, Okla., that left four people dead, said Lisa Shannon, Allina's president and chief executive.

"We have personally faced gun violence at Allina Health. ... I can't imagine looking past this time and not elevating our voice for something that is foundational and fundamental to health, which is safety," she said.

Safety in clinics and hospitals has been re-evaluated since the Buffalo shooting — with the challenge being that an overwhelming security presence can cause stress for patients and disrupt healing. Entrances have been redesigned by repositioning doors and front desks to inhibit attackers and buy time to call for help. Analytics and technological tools assess which facilities are most at risk and when attacks would be most likely, Shannon said.

Patients agitated by pain were behind Buffalo, Minn., and Tulsa shootings. More outreach and virtual follow-up appointments are needed so patients' medical needs are met and "somebody who is feeling desperate has a trusted resource to go to very quickly," DeCubellis said.

Gov. Tim Walz held a ceremonial bill signing Tuesday for a $93 million mental health reform package that could address these issues. The governor cautioned against "stigmatizing and demonizing" the vast majority of people with mental illnesses who aren't violent, but said more needs to be done to address the root problems that help lead people to harm others or themselves.

"What are we missing back upstream?" he asked. "What are we missing in the disconnect in schools and families and things like that?"

Minnesota hospitals have set aside competitive interests before to address urgent health problems, forming the Safest in America collaboration years ago to standardize practices such as the marking of body parts to reduce surgical errors. They placed a full-page newspaper ad in December when crowding reached crisis levels during a severe COVID-19 wave.

Firearms were the means in 46% of Minnesota's 354 suicides in 2020 and 63% of its 138 homicides that year, according to the CDC. The statement by hospital leaders avoided the thorny topic of restricting access to guns, despite public health research showing that it can make a difference — especially in preventing sudden attempts at self-harm.

Shannon and DeCubellis said the health systems can contribute research and information to the political debate, but there are other ways for hospitals to have an influence that will gain broad support. Shannon said that includes providing outreach and support to police officers and first responders to prevent burnout.

"We have absolutely no interest in eliminating appropriate, safe use and the rights of our communities," Shannon said. "This is not as much about guns but what happens when they are used improperly."