gun safety – PEM Currents: The Pediatric Emergency Medicine Podcast

Dr. Kit Carney and Dr. Kristen Humphrey discuss gun violence, its impact on our patients and their families, as well as practical tips on advocating for safe storage of firearms, and how we can support victims of violence.

Advocacy and education resources

Be SMART Campaign
Be SMART emphasizes the importance of responsible gun ownership and secure gun storage. Ultimately, secure gun storage prevents kids from accessing guns. When we protect our kids from the dangers of gun violence, the whole community stands to benefit.

Brady: Asking Saves Kids (ASK)
ASK (Asking Saves Kids) is a simple way to help keep kids safe and a fundamental part of our End Family Fire campaign. Parents and guardians ask all sorts of questions before they allow their children to visit other homes; they ask about pets in the house, discuss allergies and Internet access, and ask questions about supervision. As part of our End Family Fire campaign, ASK encourages parents and guardians to add one more question to this conversation: “Is there an unlocked gun in your house?”

AAP Gun Safety Toolbox

References

Council on injury, violence, and poison prevention executive committee, M. Denise Dowd, Robert D. Sege, H. Garry Gardner, Kyran P. Quinlan, Michele Burns Ewald, Beth E. Ebel, Richard Lichenstein, Marlene D. Melzer-Lange, Joseph O’Neil, Wendy J. Pomerantz, Elizabeth C. Powell, Seth J. Scholer, Gary A. Smith; Firearm-Related Injuries Affecting the Pediatric Population. Pediatrics November 2012; 130 (5): e1416–e1423. 10.1542/peds.2012-2481

Haasz, M., Boggs, J. M., Beidas, R. S., & Betz, M. E. (2022). Firearms, physicians, families, and kids: Finding words that work. The Journal of Pediatrics, 247, 133–137. https://doi.org/10.1016/j.jpeds.2022.05.029

Gifford. (2022, August 10). Child Access & Safe Storage. Giffords. Retrieved October 7, 2022, from https://giffords.org/lawcenter/gun-laws/policy-areas/child-consumer-safety/child-

Goldstick, J. E., Cunningham, R. M., & Carter, P. M. (2022). Current causes of death in children and adolescents in the United States. New England Journal of Medicine, 386(20), 1955–1956. https://doi.org/10.1056/nejmc2201761

Gun violence prevention. Children’s Defense Fund. (2022, March 18). Retrieved October 7, 2022, from https://www.childrensdefense.org/policy/policy-priorities/gun-violence-prevention/access-prevention-and-safe-storage/

Episode Transcript

[Kit] Hello! I’m Dr. Carney and I am a pediatric resident at Cincinnati Children’s Hospital Medical Center. I’m here with my co-resident, Dr. Humphrey. Today, we are going to discuss firearm safety and ways to screen for it in both the ED and clinic settings. Thank you for hosting us, Brad!

The goals of this episode are to:

Report updated statistics about pediatric firearm-related injuries and deaths in the US
Discuss and review the updated American Academy of Pediatrics’ recommendations on firearm safety
Discuss updated strategies for counseling your patients and families on firearm safety, and
Talk about how we can support patients and families who are victims of gun violence

[ Kit ] To best understand how prevalent firearm-related injuries are, let’s discuss some statistics:

Firearms are now the leading cause of death among children 0-19 years old in the United States. While gun violence is a global issue, the United States houses a disproportionate amount of these gun violence instances.
While the United States accounts for just 4% of the world’s population, it accounts for 35% of firearm suicides and 9% of firearm homicides.
Each year, 3200 children die from firearm-related injuries. This means that a child dies from a firearm every 2 hours and 45 minutes. Unfortunately, this number has continued to rise as gun sales have soared.
From 2019 to 2020, the rate of firearm related deaths among children increased by 30%. When we look more closely at these numbers, we note that prominent racial disparities exist regarding firearm injury, as well.
Black children and teens are 4 times more likely than their white peers to die by firearms.

[ Kristen ] These fire-arm related fatalities among children are due not only to homicide or accident, but also suicide.

Firearms account for the greatest number of suicide deaths. Guns are by far the greatest risk for completed suicide, because they are so lethal. Guns have a 90% mortality rate when used for suicide.
Unfortunately, of the weapons used in these suicides, as well as in school shootings and unintentional homicides, 70-90% of them came from unsecured weapons at the child’s home.
Research demonstrates that fewer than half of all gun owners store their firearms safely, and that many children have access to these guns.
Of the estimated 4.6 million children in the US who live with at least one unsecured firearm in their home, 75% of those know where guns are stored in their home and 22% have handled guns without their caregivers’ knowledge.

[ Kit ] To help address these harrowing statistics, the American Academy of Pediatrics has released updated recommendations concerning safe firearm storage practices.

The most effective measure caregivers can take to prevent fire-arm related injuries is to remove them from the home.
For those families who do have guns in the home, these firearms should be unloaded and locked, with ammunition stored and locked separately.
Cable locks, trigger locks, and lockboxes are all safe ways to store firearms.
A Cable lock is a looped wire that works similarly to a bike lock. This mechanism allows you to loop one end of the wire through the handgun to prevent the gun from being fired or loaded, and then connect that end of the wire to the lock at the end of the loop. You can purchase these for about $10 at local retailers.
A trigger lock is a two-piece mechanism. The two pieces fit over the trigger guard so that the gun’s trigger cannot be released and allow the gun to fire. These trigger locks come with either a key and lock; a keypad, or a combination lock. One can purchase these for about $10 at local retailers.
Finally, a Gun lock box is a combination-protected box that is similar to a safe but is small enough to house just a gun. You can purchase these for about $25-100.
Studies demonstrate that utilizing one of these storage methods can reduce the suicide and unintentional gun deaths in children by up to 54%.

[ Kristen ] Great question.

In our current environment, it can feel overwhelming as a healthcare provider to discuss firearms. The encouraging news is that the majority of parents report that they would feel comfortable discussing firearm safety with their pediatrician. Nonjudgmental communication is key to this conversation. Healthcare providers need to be aware of and manage their biases concerning this topic, and that starts by ensuring that we ask all families about it.
Firearm safety can be discussed in any setting, but ideally it is a preventative, rather than a reactionary, conversation.
It helps to first frame this conversation as one about safety, perhaps in the context of discussing car seats, water safety, or bike helmets because optimizing a patient’s safety is often a common goal of both caregivers and healthcare providers.
For example, you might say “I like to talk about firearm safety with all of my patients because we know firearms can pose a safety risk to children. Research has shown that the safest way to store firearms is to store them locked, unloaded, and separately from ammunition.”
While the AAP continues to emphasize that the most effective measure to prevent firearm-related injuries is their absence in the home.

New studies demonstrate that families respond best to a normative statement. This means that the clinician normalizes that many people have firearms in the home. An example of this normative statement would be “for any firearms in the home, or other homes your child may visit, are they stored locked and unloaded?” Asking about both their home and other homes they visit allows families to talk about this subject without having to disclose a gun in their own house.

After asking this question, you can also ask if families would like to hear more information about safe storage practices, such as cable locks and lockboxes.
When discussing firearms, it is important to keep in mind the age of the patient.
- In younger children (ages 1-9), firearm injuries are typically related to unintentional injury, as children as young as 2-3 are capable of pulling a trigger.
- However, In adolescents, (ages 10-19), nearly 97% of firearm injuries are related to intentional homicide or suicide. In this patient population, especially if there are significant mental health concerns, discussion about removing firearms from the home temporarily and voluntarily may help promote the patient’s safety.

[ Kit ]

It is important that both the adolescent and the parent be engaged in these discussions, as adolescents are prone to more impulsivity and need to understand the dangers for themselves, as they are able to get access even without a caregiver’s knowledge.
To help caregivers keep their adolescents and younger children safe, I often refer families to the ASK (or asking saves kids) campaign to provide them with the tools to ask their children about the presence of firearms in both new and familiar circumstances. These new circumstances can include a new babysitting job, a new roommate, or a new playmate.
The Be SMART campaign is another excellent resource for both parents and healthcare providers for modeling firearm safety conversations. S stands for secure all guns in the home and vehicles; M stands for model responsible behavior around guns; A stands for ask about presence of unsecured firearms in other locations; R stands for recognize the role of guns in suicide T stands for tell peers to be SMART. Check out the references section of this PEM currents episode for links to the ASK and Be SMART websites, as well as for other links for learning how to talk to children about gun violence.

[ Kristen]

Because those impacted by gun violence often experience trauma and are at higher risk for suicide, we as healthcare providers need to ensure that families get early access to mental health support. National support groups for families and patients who have experienced gun violence include: Trauma Survivors Network, Survivors Empowered, and the Gun Violence Survivors Foundation. There are also local survivors groups through Cincinnati’s chapter of Mom’s Demand Action and Every Town.

[Kit] Let’s review what we talked about today:

[Kit] Gun sales and violence have increased since 2020, and firearms are now the leading cause of death for those aged 0-19
[Kit] While younger children are more likely to become injured 2/2 unintentional use, adolescents are more likely to become injured due to intentional homicide or suicide attempts
[Kit] Many caregivers are open to discussing firearm safety with their healthcare provider in the context of other anticipatory guidance
[Kristen] The American Academy of Pediatrics states that discussing with ALL families that firearms should be unloaded and locked, with locked ammunition stored separately, would significantly decrease the rate of firearm-related injury among children
[Kristen] Victims of firearm related injury and their families are at higher risk for mental health crises; providing them with support is essential to ensuring their ongoing well-being

[Kristen] If you are interested in becoming involved at a legislative level, Moms Demand Action is a national organization that provides information for local, state, and national advocacy around gun safety.

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Advocacy and education resources

Resources for gun violence survivors

Talking to children about gun violence

Ohio specific resources

References

Episode Transcript