EPs should educate patients about gun safes, trigger locks, and storing bullets away from guns
It feels daunting to broach the subject of firearm injury prevention because guns are so polarizing in our country. We love our guns. Forty percent of us, myself included, have firearms in our homes. (Boston Globe. July 21, 2022; http://bit.ly/3ZOfHNp.)
I am married to an avid waterfowl hunter, and we have five guns locked in a gun safe in the attic. The number of civilian-owned firearms in this country actually outnumbers our population—393 million to 326 million. (Boston.com. July 11, 2022; http://bit.ly/3TcMf1f.) Guns are so extensively woven into our political discourse that any mention of gun safety policy can push peoples' political buttons. Sadly, responses too often seem intended to fight against opposing political camps than greater gun safety.
It's time for a new approach. The American gun violence epidemic is a public health emergency that won't be solved by politicians alone. Trust me, political agendas are trivial when you're watching a mom bury her son like I did a few weeks ago, a story I shared in my last article. (EMN. 2023;45:10; http://bit.ly/EMN-ERGoddess.) We need multipronged public health solutions that go beyond politicians to include educators, physicians, law enforcement, community organizations, and gun owners.
Much like we did for motor vehicle safety, we must use public health tools to create preventive infrastructures for gun safety. As Megan Ranney, MD, MPH, a practicing EP, researcher, and national advocate for decreasing gun violence, put it, “This isn't about being pro- or anti-gun any more than doctors are pro- or anti-cars. It's about applying that basic public health approach to reduce the number of gun injuries and gun deaths, the same way that we've effectively decreased car crash injuries and deaths by more than 70 percent over the last 50 years.” (Boston Globe. July 21, 2022; http://bit.ly/3ZOfHNp.)
Firearms have surpassed car collisions as the leading cause of death among children and teens in the United States (N Engl J Med. 2022;386:1955; https://bit.ly/3lJg3Wp), so we must find more measures to stop shootings before they happen, the same way we have found measures to avoid motor vehicle crashes.
No Funds for Research
Importantly, we can improve gun safety and protect our communities without infringing on Second Amendment rights. Distinguishing firearm injury prevention from gun control is critical. A public health approach to firearm injury will allow us to research risk factors, develop and test interventions, and find the best ways for interventions to be implemented, all while respecting our history of gun rights.
Unfortunately, we are behind the curve when it comes to research. The Pickney Amendment in 1996 blocked the Centers for Disease Control and Prevention and the National Institutes of Health from using funding for firearm injury prevention research (Boston Globe. July 21, 2022; http://bit.ly/3ZOfHNp), so no money was appropriated to the CDC for any public health approaches to firearm injury from 1996 to 2020. (AMA. May 5, 2021; https://bit.ly/3YLKsSO.)
The truth is that most firearm injuries are preventable. The American Medical Association has already proposed more than 30 policies to help prevent gun violence. Even most gun owners would get behind background checks, waiting periods, and a higher minimum purchasing age. But we also need to restrict assault weapons and ghost guns, those untraceable firearms made from unserialized parts that can be bought online without a background check and assembled at home. (If you can't pass a background check, you shouldn't be allowed to build a gun in your basement!) We also need gun manufacturers to acknowledge that firearm injury is an escalating problem and to come to the table with solutions.
We also need to teach our youth nonviolent strategies for handling conflict. Kids have always scuffled, but now they have access to guns that leave behind bodies, not bruises. Dismantling harmful norms about masculinity by not celebrating violence will go a long way too. Enhancing access to resources to prevent mental health crises will go even further.
Red flag laws that allow law enforcement to temporarily seize guns from those believed to be a threat to themselves or others may also save lives. (Mental health emergencies allow emergency custody orders for people, so why not guns?) I believe there are additional and better preventive measures for reducing firearm injuries, but we need more researchers and better research funding to identify them.
One Bullet After Another
Stopping firearm injury for nonacademic community physicians who fix one bullet hole only to be faced with another and another and another feels like trying to plug a dam with a finger. Nonetheless, even if we're not able to do research or large-scale advocacy, we can still help mitigate risk through patient interactions.
The general public's lack of awareness about responsible gun ownership and safe storage has gotten to the point that a 6-year-old boy was able to take his mother's gun to school and shoot his teacher. (New York Times. Jan. 6, 2023; http://bit.ly/3JFXjke.)
We educate patients about smoking cessation and seatbelt use. It's time to start asking and educating about gun safes, trigger locks, and storing bullets away from guns. St. Louis Children's Hospital in Missouri has a basket filled with gun locks in its waiting room along with pamphlets about properly storing firearms. (CNN. Jan. 22, 2023; http://bit.ly/3ZLmUO9.) We should all take a page from their book.
Gun owners and non-gun owners are more inclined to trust physicians about gun violence. (Penn Medicine News. July 7, 2022; http://bit.ly/3lcuaDM), perhaps because our motives are patient-centered, not political. It may feel daunting to broach the subject, but our white coats give us some street credibility with our patients. As health care professionals who witness the toll of the gun violence epidemic, no matter whether we're conservatives or liberals, each of us is in a privileged position to promote firearm injury prevention.
We can make a difference by promoting gun safety one patient at a time and by supporting public health measures that create greater firearm safety for all.
Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns athttp://bit.ly/EMN-ERGoddess.