From
StayCurrentMD
Update Course Rewind: Pediatric Surgeon and Firearm Injury Prevention 2022
With Dr. Peter Masiakos
Chapter 1 of 5 · Fundamentals
Crisis overview
Introduction: Firearm Injuries Now Exceed Motor Vehicle Crashes in Children
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What the experts said
Trauma nurse practitioners at one institution talk about safe gun storage and there is a program in the community with gun locks.
Safe gun storage programs exist in Atlanta and Akron.
Cincinnati is developing standardized teaching for trainees on counseling for firearm storage as part of an institutional firearms task force.
The Injury Prevention Coalition has resources for gun locks, but they are not widely available enough that families can access them when asked.
The AAP requires pediatricians to ask patients whether there are firearms in the house and whether they are appropriately locked.
When pediatricians ask about firearms and families say yes, the pediatricians are often not sure what to do next.
The Ohio AAP has a statewide initiative around lock box availability and gun locks.
In 19 days after the Uvalde shooting, there were 2,300 firearm deaths in America, tantamount to a public health crisis.
Most pediatric firearm deaths are assault/homicide related, but a large proportion of injuries are due to self-harm or unintentional injuries.
In a review of 80,000 medical charts across medicine, neurology, OBGYN, orthopedics, psychiatry, and surgery, documentation of firearm access was woefully small compared to documentation of alcohol and tobacco use.
In 2018, only 5% of children presenting to the MGH emergency department with suicidal or homicidal ideation were asked about access to lethal means in the home.
Since 2019, each incoming intern at MGH receives a 30-minute didactic on gun violence in Massachusetts plus two 30-minute sessions with a standardized patient using a resident-developed curriculum.
After implementing the resident curriculum, there were no opt-outs, no concerns about comfort, and no issues about whether it was the right thing to do.
One year after implementing the curriculum, documentation of firearm access screening increased from 5% to 32%.
MGH is collaborating with Cincinnati Children's Hospital (Joe Real and Matt Zakov) to develop virtual reality, artificial intelligence-generated avatar-based curricula for firearm counseling training.
Massachusetts is the safest state with Boston having approximately 40 firearm deaths per year.
Boston PD data shows 1,000 to 2,000 911 calls for shots fired annually, with most occurring between 8:00 PM and 11:00 PM.
The problem of gun violence must be reframed from counting only deaths to including injuries, shots fired, and community fear.
MGH partnered with Emerson College film school to create a program where community educators are paid to present their experiences of gun violence to students who will write future narratives about gun violence.
Three classes per semester at Emerson College bring community educators into the classroom to share their lived experiences with gun violence.
For the first time in recorded history, firearm injuries in children have exceeded motor vehicle crashes as a cause of death.
Deaths from suicide and homicide in children are both on the rise, particularly in the very young.
Primary prevention matters most; avoiding stress and injury at the primary level is better than secondary prevention.
Hospital-Based Violence Intervention Programs (HVIPs) are multidisciplinary programs that identify patients at risk of repeat violent injury and link them with hospital and community-based resources aimed at addressing underlying risk factors for violence.