Update Course Rewind: Firearm Screening 2023

Globalcast MD along with Cincinnati Children's Hospital sharing knowledge to improve child health around the globe. Hello pediatric surgery family. I'm M Gotti, a research fellow from Cincinnati Children's Hospital Medical Center. Our 11th annual update course in pediatric surgery was held past August. In this video series, we'll recap the sessions and share the main highlights with you. We are seeing a lot of penetrating trauma in the US, and there are more and more firearm injuries, even in younger kids. Sadly, firearms are now the leading cause of death in all children and adolescents in the US, overtaking motor vehicle crashes in 2019. And today, Doctors Mira Koral and Katie Russell will help us understand what to do for firearm screening and prevention of firearm injuries. Firearm injuries leading cause of death for kids unfortunately in the United States now, luckily not necessarily the same around the world. So, this is an eight-year-old who's got a gunshot wound to the abdomen. He was playing with his four-year-old brother and he was unintentionally shot. What might you have done to prevent this? What are people doing in your hospital routinely in the room around firearm safety and education. What we as physicians and surgeons that take care of all these kids in partnership with our ED colleagues and pediatricians and others is, how do we improve safety? And how do we reduce firearm injuries? Some of which is about safety and some of which is about social determinants and community level violence, both being really important. There are really great examples and toolkits out there of things you can use in your own hospital, so you don't have to reinvent the wheel of understanding how to do firearm counseling. The bullet points project is a great source of information in Ohio. The AAP chapter in Ohio has a program called Store It Safe, um which can be used and there's material and you can literally just transfer them um into your institution. Cincinnati Children's Hospital started a firearm related injury task force to try to address this problem in community, recognizing that it includes both a focus on safety and education and suicide prevention, as well as community level violence prevention. So we're doing stuff all across the board and this is actually going to become part of the committee on trauma, using this as a foundation to think about how we could share resources across the institutions and how hospitals and individual institutions might take a role. We know now that it's the leading cause of death in kids. Do we know where and how the majority of those are being shot? Is it in schools or is that a tiny percentage? So the American College of Surgeons did a non-fatal firearm study out of the committee of trauma and that data has just been finalized and collected and so the first pediatric paper will come out. The schools are a tiny part. When we look at percentages, it's something between 50 and 60% are assault related. A lot of them are bystander injuries. And then about 30% are unintentional. So kids who are playing with firearms or otherwise engaging with them at home because they're not safely stored, and then the remaining are self-inflicted. Mike Nash has published a study in JAMA that the majority are self-inflicted. coming out of rural communities. We continue to see that the rural urban divide is very different. In the rural population, we are much more likely to see self-inflicted injuries, both in adults and kids. In the urban population, assaults remain the predominant source. And I think we have to recognize that one size doesn't fit all for all communities in terms of how we reduce injury, but recognizing that we have to both do the safety part. But if you live in a community where you don't feel safe, walking up to you and tell you, it will be really great if you could store your guns separately from the bullets, locked in a safe, is not going to be an effective strategy. You have to think about how we do community violence reduction by targeting drivers of community level violence, the biggest of that is poverty and economic opportunity. This is work being done by some of our pediatric colleagues in Cincinnati, Matt Zaf and Joe Real and they're doing virtual reality counseling and screening and providing opportunities for folks to get training in that. VR counseling is something that's going to continue to develop and grow. But it's a strategy by which we can help people become comfortable with these conversations, but in a virtual reality way. Really cool work that's happening and I think will continue to grow and be widely available. The more we know where they're getting shot, we can actually do point of location measures. Are there innovations we could do in the schools? Are there innovations we could do if it's bystanders, is there some way we can forgetting all the prevention stuff to stop people actually getting hit by bullets. In our lab, we had talked about what kind of innovations can we do to just stop people getting shot even if you can't control the guns. The data that we have is poor and part of what you'll see in these papers that come out from the ACS firearm study is that we don't actually collect that data very well. So the amount of missingness in terms of the data is huge. And that is a reflection of how we collect data when these kids come in. We don't actually know as much as we should because we're not really asking people, did it happen at the school? Were you close to home? What kind of weapon? Did you know the person? All of those things are pieces of information that we continue to need in order to make interventions. It's a topic that really can't be done on a national basis. It can to give us the big picture, but everybody's local environment for this is going to be so different. Like my environment, I can tell you 100% is suicide in rural environments, right? So what I have to work on is locking the guns and getting the ammunition separate. That's what I have to work on. Now, Mira's situation is probably very different than mine. In summary, firearm injuries are the leading cause of death for children in the US. Prevention measures including firearm safety education in hospitals are crucial. There are available tool kits for firearm counseling such as the Bullet Points project and the Store It Safe program from Ohio's AAP chapter. While school shootings gain attention, the majority of incidents involve assaults, bystanders, unintentional injuries, and self-inflicted wounds. Rural areas see more self-inflicted cases, while urban areas experience assaults. Virtual reality counseling is an emerging strategy to facilitate firearm safety conversations. Interventions require a thorough data, which is currently lacking, and regional differences should be considered. Thank you for watching this video. Don't forget to subscribe to the Stay Current MD YouTube channel. Follow our social media channels and download the Stay Current MD app for tons of content in pediatric surgery. Globalcast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.