Health Systems Interventions to Prevent Firearm Injuries and Death

Health Systems Interventions
to Prevent
Firearm Injuries and Death

Firearm injuries and death are a serious public health concern in the United States. According to the Centers for Disease Control and Prevention (CDC), nearly 40,000 people were killed by firearms in 2017. Injuries related to firearms also come at large cost to health systems, accounting for roughly $3 billion in emergency department and inpatient care each year.[1]

With support from Kaiser Permanente and the American Hospital Association, the National Academies of Sciences, Engineering, and Medicine hosted a workshop to look at the role that health systems can play in addressing firearm injury and death in the United States. Scroll down to read what participants at the meeting had to say.


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Why health systems?

Health systems see millions of patients each year in emergency departments and hospitals and in primary care and specialty practices. They conduct research and engage in quality improvement work to translate research findings into day-to-day care for people they serve. And, "they have a track record of…implementing best practices based on good science. " (GEORGE ISHAM)

Health professionals routinely treat patients injured by firearms. There are many touch points and settings in which health systems may encounter firearm-related injuries and death. (BECHARA CHOUCAIR)

Hospitals and health systems serve as anchors for communities that can think about broader upstream issues, provide leadership and partner with governance, and take a community health needs approach. (JAY BHATT)

Gun violence…is a defining public health issue of our time.”

—Victor Dzau, President, National Academy of Medicine

Firearm deaths fall into 3 categories:

Intentional and directed at another person (e.g., intimate partner violence)

44 percent of female homicide victims are killed by an intimate partner, and half of those incidents involved a firearm. [2]

Intentional
and self-directed (e.g., suicide)

Of the 36,658 firearm-related deaths in 2016, 59 percent were suicides, and 50 percent of all suicides are by firearm.[3]

Unintentional

An estimated 110 children under 14 are killed each year by unintentional firearm injury.[4] Children unintentionally killed or injured by firearms are more likely to be male and shot by another child.[5]

We must move away from political and social debates to constructive discussions to advance complex biopsychosocial disease management and prevention, supporting research all along the way, just like we do for other disease processes.”

—Stephen Hargarten, Medical College of Wisconsin

Opportunities for Health Systems

Health systems can:

build networks and collaborate with communities, local organizations, and nonprofits to open doors to new approaches to preventing firearm injury. These efforts can create natural opportunities for sharing the results of experiments, spreading best practices, and benefitting from experience that other programs have gained in their communities. (LINNEA ASHLEY)

serve as drivers of opportunity to create community partnerships and a community-based research agenda that promotes trauma-informed, evidence-based prevention programs. (JAY BHATT)

work to address the social determinants of health and understand the policies that create conditions tied to firearm injury (e.g., the link between redlining and poor quality housing). (PATRICK CARTER, DANIEL WEBSTER)

recognize the impact of treating firearm injury on providers and then create a safe space for providers to talk about their feelings and experiences. (JOSEPH SIMONETTI)

support providers by developing clinical guidelines and providing training on preventing firearm injury. ( MEGAN BAIR-MERRITT, DAVID GROSSMAN)

"When you partner with somebody else and look at the work that they are doing, it can expand your idea of what is both possible and also where your work might fit in with somebody else’s work."

–Linnea Ashley, Youth ALIVE!
"After [shootings], I…take care of my colleagues. I take care of nurses, I take care of paramedics that were traumatized."

–Christopher Barsotti, American Foundation for Firearm Injury Reduction in Medicine (AFFIRM)
"I think for our system to change, we have to build supports for our workforce as well."

–Megan Bair-Merritt, Boston Medical Center

Opportunities for Practitioners

Health care practitioners can:


discuss firearm injury as a public health problem, removing politics from the equation. (STEPHEN HARGARTEN)

use respectful, neutral language not intended to change a person’s identity as a firearm owner but to "help them be safe and then encourage behavior change."(MARIAN BETZ)

counsel parents of adolescents at risk of suicide, which can change how firearms are stored. (RINAD BEIDAS, MARIAN BETZ)

Opportunities for Programs and Research

Workshop speakers discussed different programs and research projects that seek to prevent firearm injuries and death. These efforts work to identify people and communities at higher risk and implement interventions that offer protective factors or disrupt the momentum towards firearm-related injury and death.



Some programs and research projects identify higher-risk individuals based on high injury rates in their communities, or based on a prior visit to the emergency room or hospital for a firearm-related injury. These programs can focus on hospital- or community-based interventions that provide social and psychological support. (SHANNON COSGROVE, REBECCA CUNNINGHAM, MICHAEL LEVAS, ALI ROWHANI-RAHBAR )

Other programs and research projects provide screening tools that allow clinicians to identify higher-risk individuals in their practices and offer interventions tailored to the type of risk (e.g., safer storage for firearms in homes with children). (RINAD BEIDAS, MARIAN BETZ, GREGORY SIMON)

Workshop speakers also highlighted collaboration and sharing of best practices between providers and systems. (LINNEA ASHLEY, MEGAN RANNEY, GREGORY SIMON)

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Want to learn more? Read the full Proceedings of a Workshop at nationalacademies.org/PreventFirearmDeath.

SOURCE: NASEM. 2018. Health Systems Interventions to Prevent Firearm Injuries and Death: Proceedings of a Workshop.

Statements, recommendations, and opinions expressed are those of the individual participants. They are not necessarily endorsed by the National Academies of Sciences, Engineering, and Medicine and should not be construed as reflecting any group consensus.