Health Systems Interventions to Prevent Firearm Injuries and Death: Proceedings of a Workshop

by National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, Alexis Wojtowicz, Melissa French

Overview

Firearm injuries and death are a serious public health concern in the United States. Firearm-related injuries account for tens of thousands of premature deaths of adults and children each year and significantly increase the burden of injury and disability. Firearm injuries are also costly to the health system, accounting for nearly $3 billion in emergency department and inpatient care each year.

The National Academies of Sciences, Engineering, and Medicine convened a workshop to examine the roles that health systems can play in addressing the epidemic of firearm violence in the United States. This publication summarizes the presentations and discussions from the workshop.

Product Details

ISBN-13:	9780309488396
Publisher:	National Academies Press
Publication date:	05/17/2019
Pages:	142
Product dimensions:	6.00(w) x 9.00(h) x 0.40(d)

Table of Contents

Acronyms and Abbreviations xv

1 Introduction 1

Organization of the Proceedings 4

2 Why Do Health Systems Have a Role? 5

Gun Violence: A Complex Biopsychosocial Disease Requiring a Strengthened Health Care System Response 6

3 The Toll on Individuals and Communities 11

A Pediatric Victim and Opportunities the Health System Had to Intervene 11

The Psychological and Social Burden of Firearm Violence on Communities 15

Discussion 21

4 Identifying Individuals at Higher Risk for Firearm Violence 27

Identifying Survivors of Domestic Violence Who Are at High Risk for Firearm-Related Violence 28

Applying a Medical Model of Disease to Identify Those at Risk of Firearm Violence 29

Factors to Consider When Thinking About Identifying Risk of Firearm Violence 30

Discussion 31

5 Developing Health System Interventions 37

Developing a Firearm Storage Decision Aid to Enhance Counseling on Access to Lethal Means 37

Creating Consensus: Developing a Firearm Injury Research Agenda 41

Discussion 44

6 Key Issues from the Workshop's First Day 47

Getting Health Systems Involved 48

Helping Providers with the Aftermath of Gun Violence 50

Helping Health System Leaders Act 51

Shifting the Paradigm 51

Discussion 52

7 Programs and Research 55

Project Ujima 56

Helping Individuals with Firearm Injuries Clinical Trial 59

SafERteens: An Evidence-Based Youth Violence Prevention Program 61

Participatory Approaches to Implementing Firearm Safety Promotion in Pediatric Primary Care 66

State of the Science for Hospital-Based Violence: Research and Policy Implications 69

Discussion 71

8 Developing Networks and Sharing Information 75

Building a Learning Health Care System for Suicide Prevention 75

Violence Intervention and Collaboration 79

Discussion 81

9 Developing a Culture of Health Care Providers as Interveners 85

Hospitals Against Violence Initiative 85

Consensus-Based Firearm Injury Prevention Strategy 87

The Cure Violence Approach 89

Discussion 91

10 Closing Remarks 97

References 99

Appendixes

A Workshop Agenda 105

B Speaker Biographical Sketches 113

Editorial Reviews

Reviewer: Sally Kuykendall , RN, BSc, PhD (Saint Joseph's University)
Description: In 2016, firearms accounted for 38,500 deaths and more than 85,000 injuries. The cost of emergency department and inpatient care is estimated at $3 billion per year. This public health crisis affects youth and other highly vulnerable populations. This book is the proceedings of a workshop that brought together pediatricians, emergency room physicians, and policy and injury experts to discuss and share best practices in treating and preventing firearm injuries and deaths. Workshop sessions covered the role of health systems, health and social impact on individuals and communities, at risk populations, interventions, programs, research, and future steps.
Purpose: The purpose is to document information and formal collaboration by experts in order to reduce firearm injuries and deaths in the U.S. Despite the human and financial cost of firearm injuries, research into mechanisms to prevent or reduce gun violence has been stymied. The National Academies of Science, Engineering, and Medicine convened a two-day workshop to frame current knowledge and potential gaps for future investigation.
Audience: The audience includes pediatricians, emergency department staff, medical residents, healthcare practitioners, healthcare administrators, violence and injury prevention specialists, social workers, and researchers. The book describes current evidence on healthcare-based interventions, foundations for best practices, and suggestions for future research and practice. Members of the planning committee, the presenters, program moderators, and the attendees are well known in the field of injury prevention. For example, Dr. Joel Fein, Professor of Pediatrics and Emergency Medicine, University of Pennsylvania Perelman School of Medicine, is codirector of Children's Hospital of Philadelphia Violence Prevention Initiative. Dr. Fein has published more than 70 peer-reviewed research papers on violence prevention and mental health.
Features: This book focuses on primary prevention through trauma care, primary care, specialty care, and behavioral health systems. The workshop aims to change the debate on firearms from political to medical and preventive. Content is organized from general background (the role of health systems and epidemiology) to programs, research, and next steps. Statistics and information are relevant and up to date. The presenters weave clinical experiences into informational content, providing immediate practical relevance. The workshop suggests new ways to investigate gun violence. For example, Dr. Richmond of University of Pennsylvania School of Nursing presented Haddon's Matrix as a framework to understand environmental and individual factors contributing to firearm injury. Haddon's Matrix was originally used to understand and prevent motor vehicle crashes. The matrix is credited with making our roads significantly safer. The book offers many unique approaches to the public health issue of gun violence.
Assessment: This book is packed with useful information for injury prevention practitioners and researchers. There are currently several popular books on gun violence, but there are not many scholarly books, and those tend to be older. For example, Reducing Gun Violence in America: Informing Policy with Evidence and Analysis, Webster and Vernick (John Hopkins University Press, 2013), brought together gun violence prevention experts to focus on public policy. These workshop proceedings instead focus on health systems and health professionals. Some may remember the ire the National Rifle Association raised in November 2018 when the organization tweeted, "Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves." That tweet got 21,000 comments, many from emergency room doctors who shared pictures of their "lanes": blood-stained floors, trauma rooms littered with bandages and discarded equipment, gory scenes witnessed regularly in emergency rooms across the nation. The National Academies moderators, presenters, and attendees present evidence-based practices in order to close the lanes of gun violence in America.

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