Firearm safety advocacy: Practice Gap discussion at Update Course 2018

What number are we on now? Does anybody know? Nothing controversial anyway, 10-year-old boy shoots himself in the chest at home with a gun hidden beneath the couch cushions. After resuscitation, the emergency department resident mentions that while in medical school in another state, she noted a much lower incidence of pediatric gun-related injuries. So the state laws that have been found to be most effective in reducing pediatric firearm injuries hold adults criminally liable for negligently stored firearms, penalize adults who intentionally, knowingly, or recklessly provide firearms. Require background checks, ban the sale of military-style assault weapons, or regulate the concealed carrying of handguns. So this is a gap in knowledge simply because it's a very important issue and at least in this country right now and it's constantly in the news and Uh, and most of the major surgical organizations have come out in favor of some sort of gun regulation of one form or the other. So once you go to the uh Answer. So we go to the answer on this one. So these are things called cap laws. The answer in this case is that the most effective state laws in reducing pediatric firearm injuries are those that hold adults criminally liable for negligently storing firearms. And there's a little bit of a thing here. I put that. I'll answer that way because I knew the other 4 weren't right. Yes, I didn't know if it was right, but the other 4 I know aren't effective. You're a good test taker, a tried and true approach. So strong child access prevention laws, the cap laws, require adults to safely store guns. They hold them liable for injuries suffered when the children get. get at the guns and they are associated with a significant reduction in self-inflicted and unintentional pediatric firearm injuries. They don't really reduce the teenager who gets a gun and goes out and robs a liquor store and shoots another child or themselves, but they do. Decreased suicide and accidental injuries, which are a significant problem in children in the United States. The following are not effective at decreasing pediatric firearm injuries, and those are weak cap laws that provide less stringent penalties for adults who let their kids get access to the guns. Background check laws and concealed carry laws don't really affect pediatric injuries. They may affect adults, but not pediatric. Banning military style assault weapons has been effective in reducing mass shooting fatalities in other countries. But the number of overall people injured in that is small compared to the to the big pool of of firearm injuries. So, so there have been several papers on this, and I think it's 27 laws 27 states have uh. Cap laws and others do not, so there's no federal law regarding storage of guns, but in the states that have significantly stringent laws they've seen a decrease uh in some of these injuries. So I think that there's, there's two issues. One is, um, again this is a little out of the box for a practice gap, but is, you know, if we're gonna be true advocates for our patient and injury prevention is part of what pediatric surgeons do, then this is important, and you should become active politically or let your voice heard or whatever it is. Let me ask the panel, when a patient comes into your office for an inguinal hernia repair, how many of you ask the parents if there are guns in the home? Not me. I don't think I've ever crickets. Why not? I mean if we think injury prevention is a big deal, then this is the way to get it, and this is, if they say yes, I do, this is apolitical, then you then you make sure that they have trigger locks or you make sure that the ammunition is stored separate from the weapon or you make sure that the gun is locked away and there's no key. There are ways to educate our parents. To prevent stuff like this from our hospital supplies trigger locks for any family that asks for them or wants them, and there are multiple signs around the hospital to that effect. I'm curious if we have anyone international. I we have Ken Wong on here still or Giovanna by text. I know David stepped away for a little bit, um, but Ken, is he on there? Ken, do you have this problem there in Hong Kong? Uh, not really. You don't see very many gunshot injuries in kids, I'm assuming. Not really, it's uh very unheard of. I won't ask you why you think that is. So I, I don't want this to turn into, uh, a political thing. I, I do agree with you. One thing that you said, and I posted this on Facebook, uh, about, uh, six months ago is that. I do believe that gunshot injuries are just like safe kids did with seatbelts and bike helmets. I think that as pediatric surgeons, it is our actual job to do injury prevention. Now how that's done is going to differ on all the different pediatric surgeons because not everyone agrees. Uh, um, I'm, I personally am gun prevention, but I am totally understanding of those who, who feel differently. So what we're doing in our lab is working on innovations to keep the kids safe. Um, uh, uh, Maria Libertine is a, a medical student. She's working on using the, um, fingerprint sensor of an iPhone on a gun so that the kids can't activate it. Um, can we, uh, do facial recognition, uh, like as on, on the iPhone. So. So trying to, to, while while the legislation is working its way out, can we as pediatric surgeons redirect some of our labs on protecting the kids in innovative ways as well. So, so like a couple of things. First off, this is a public health issue and we need to treat it as that. It, it really, I understand it becomes a political issue, but it's a public health issue and And pediatric surgeons need to address it as such, and John Petty and Marion Henry of ABSA have have drafted and it's going to move through a, you know, our, our stance if you will, on, on this issue and cap laws are very strong in there and it's and the approach is not one around Second Amendment or politics or anything else. It's about children. Being shot and children being safe and how do we make this public health issue just like like you said, car seats we have children that are are injured in cars. We have cars that are unsafe and we as a country decided we were going to make them safe and the number of automobile deaths has decreased steadily. And in both adults and children, and the same thing with firearms we need to make sure as pediatric surgeons that our children are safe. It's a great and so David, David, you're there, right, because I want to ask you a question. Um, I think Vanderzee is here. Yeah, go ahead. All right, so, so I, I had, I, I was in the Netherlands last month and I heard a fact that. First of all, everyone rides their bikes. And I was told by Gerda that in the United States, and I might be messing these numbers up, there are 30,000 kids that are injured by guns a year and there's a certain number, but in the Netherlands, there's, it's the inverse. They have 30,000 spoke injuries but almost no gun injuries, so it's it's it's a different pattern because of the culture there. Tell me what's going on with gun injuries there. There are, of course, gun injuries, but they are much less than you see them in the United States. Principally, it's a very strict law to have a gun, to own a gun. You're screened, and I think in general, it's only in the criminal atmosphere that you will find guns and very little in the whole situation. So the, the chance of the risk of getting gun injuries for kids unless they, they get involved in including on the streets, uh, is very low. On the other hand, we are a cycling society, so we have more head injuries because still many parents don't want to have their children wear helmets, which they should actually. Interesting. So, um. When, uh, when we're done with this, so because we're not gonna have, we have an hour left. And so I think we're gonna be able to get to everything, but, um, there are questions, and this might happen a few times. There are questions on the last case that I wanna hit on before we go to the next question. So, um, There were a bunch of, so first, for those of you, I guess Ron and Craig, whoever is doing this non-operative appendicitis, how long do you keep them in the hospital on antibiotics? 24 hours, 24 hours, even if they're still having symptoms. Yes, 24 hours of antibiotics and they need to have. Their symptoms resolve and then they go home. All right, they go home on antibiotics. You go home on antibiotics for a week. I think it's a week, but that second view, they have to be getting better. They have to be responding to antibiotics. So if in fact, if those patients are getting worse, then there's an arm where they will go off to the operating room. Gavin Falk, who's in Montana, says that he is not going to send a kid home on antibiotics with the risk of recurrence and not being able to reach a surgeon. So it might depend on your region and how you manage it as well. OK, I think that, I think that's absolutely true. I mean, I think, you know, there, it's, it's not unlike somebody that comes in with a bleb on their lung and they're going to be going to another country somewhere remote and you make decisions as a surgeon based on those social influences, if you will, OK. Yeah, so there were other questions that I think we addressed most of. So before we move off this question, so one other factoid from some of the papers are that 1 in 3 US households has a gun in it, and out of those 1 in 3 households, about 3 to 5% of them, the gun is not kept in a safe situation. So is the instance of pediatric firearm injuries higher in those households? In in the states without good cap laws it is, I, uh, I don't know in those without good cap laws, it helps. I don't cap laws reduce the injuries, the, um, to children from, from firearms. This is actually kind of a personal injury because one of my brothers shot one of my other brothers when we were kids. So then all of a sudden the guns became it's very controlled scenario. Wow.