Marlene Busko

October 19, 2016

LAS VEGAS — Clinicians working in the emergency department can play an active role in counseling patients about the safe storage of firearms, which could help reduce the number of gun-related injuries and deaths, according to experts here at the American College of Emergency Physicians 2016 Scientific Assembly.

Emergency physicians might not "prevent every mass shooting, and we're not going to prevent every suicide or every homicide, but we can make a dent" in these occurrences, said Megan Ranney, MD, associate professor of emergency medicine at Brown University in Providence, Rhode Island.

"Two-thirds of firearm deaths are suicide, and the vast majority of those are preventable," Dr Ranney told Medscape Medical News.

Emergency room clinicians are well placed to counsel patients and their families about safe gun storage, said session codiscussant Marian Betz, MD, from the University of Colorado Denver.

Although mass shootings garner a lot of public attention, they result in only a small fraction of firearm deaths. In 2013, there were close to 33,000 firearm-related deaths from suicide or homicide in the United States, and 70% of homicides and 50% of suicides involve guns, Dr Ranney reported.

Gun-Related Suicides and Homicides

In the emergency department, "the suicide attempts we see are mostly medications and other survivable cases," said Dr Betz. Unfortunately, 85% to 90% of people who attempt suicide using a firearm die.

The storage of guns in locked boxes can help. "If we can get people to live through a crisis, they can go on to live long lives," she said. Studies have suggested that counseling delivered by physicians in the emergency department does affect the storage of firearms in the home, and patients want individualized, nonjudgmental, respectful, empathetic education.

 
If we can get people to live through a crisis, they can go on to live long lives.
 

About one-third of firearm deaths are the result of homicides, especially among youth and black males, said Patrick Carter, MD, from the University of Michigan in Ann Arbor, who presented findings from urban youth populations.

"For inner-city urban youth, the emergency department tends to be the place where they intersect with the public health system," he said. "We know if they come in for assault, that's a marker for future firearm violence."

Prevention messages have to be delivered by credible messengers from the community. Programs should focus on mentoring rather than scare tactics, and should be delivered 3 to 6 months after an injury, Dr Carter added.

A safer teens program in Flint, Michigan, decreased violent crimes and assaults, and a program of stepped care for people with PTSD in Seattle decreased weapon-carrying.

In the past 50 years, drunk driving laws and seatbelts have dramatically decreased the number of motor vehicle deaths, even though the number of cars on the road has increased exponentially. But in the same time period, the number of firearm deaths has remained virtually unchanged, said Dr Ranney.

Gun Violence Research Funding Freeze

A funding freeze has led to a lack of research into risk factors for firearm-related deaths, intervention strategies, and preventive programs, Dr Ranney explained.

The ban on funding for research to prevent gun violence began in 1996, when former Rep Jay Dickey (R-Arkansas) inserted a rider into a federal spending bill, with support from the National Rifle Association, that stipulated that no funds from the Centers for Disease Control and Prevention "may be used to advocate or promote gun control." By 2011, this had been extended to cover the National Institutes of Health, Dr Ranney reported.

But in January 2013, in response to the shooting at Sandy Hook Elementary School in Newtown, Connecticut, President Obama released a plan to reduce gun violence, and directed government agencies to "conduct or sponsor research into the causes of gun violence and the ways to prevent it."

Even though the ban has been lifted, there are 957 current grants for opioid research and only 13 grants for firearm research, said Dr Ranney. "There's a disparity between the impact of the problem and the amount of money we have to do research."

Nevertheless, emergency physicians can access information about ways to counsel patients to help prevent gun-related injuries and deaths. In a recent report, she and her coauthors outline "how to ask suicidal or homicidal patients about firearm access and how to appropriately counsel them in a way that respects their right to bear arms and also keeps them and their families safe" (Ann Intern Med. 2016;165:205-213).

Although none of the speakers own guns, all had family members who did. "It's estimated that 40% of emergency physicians own guns," Dr Betz reported.

Dr Ranney, Dr Betz, and Dr Carter have disclosed no relevant financial relationships.

American College of Emergency Physicians (ACEP) 2016 Scientific Assembly. Presented October 16, 2016.

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