Giving Clinicians the Tools They Need to Prevent Firearm Injury in Their Patients

The BulletPoints Team December 11, 2020

Clinicians are on the front lines of the firearm violence epidemic. We care for many of the nearly 40,000 people who die from firearms annually, and tens of thousands more who are injured.1

We stop the bleeding, repair injured organs and broken bones, treat PTSD in survivors, and help them and their loved ones deal with the long-term physical and psychological effects of their injuries. We pronounce the deaths. We tell the families.

Firearm violence is a major public health problem in the United States. The US suicide rate has been climbing for the last 15 years, with firearms consistently accounting for over half of those deaths.1 The daily toll of firearm homicides continues, causing nearly 15,000 deaths annually, and disproportionately affecting young men of color from disadvantaged communities.1

And clinicians overwhelmingly believe that preventing firearm injury is within their scope of practice. Many major health professional societies, including the American Medical Association, the American College of Physicians, the American Academy of Pediatrics, American Academy of Family Physicians, the American College of Emergency Physicians, the American College of Surgeons, the American Public Health Association, and the American Psychiatric Association, recently have published or renewed statements on the medical community’s role in reducing firearm injury.2 For example, in 2019, the consensus statement from the inaugural Medical Summit on Firearm Injury Prevention included that “healthcare providers should be encouraged to counsel patients and families about firearm safety and safe storage,” noting that “educational and research efforts are needed to support appropriate culturally competent messaging.”3

Yet firearm injury prevention remains largely absent from training programs for clinicians. The result? Clinicians don’t feel they have adequate knowledge about risk factors for firearm injury, nor do they feel equipped to initiate conversations about firearms and health, or to make appropriate recommendations to keep patients and their families safe.4

In the fall of 2018, a tweet by the National Rifle Association—that “someone should tell self-important anti-gun doctors to stay in their lane”—inadvertently helped pave a path forward.5 Medical professionals responded with personal and graphic accounts about how firearm injury and death affect their practice of medicine. The resulting #ThisIsOurLane rallying cry united clinicians nationwide in their belief that preventing firearm injury was very much within their purview.

The impact of #ThisIsOurLane reached to California Assemblymember Mark Berman, who was tired of battling the gun violence epidemic with small legislative patches and of watching bills fuel partisan battles over Second Amendment rights. He saw an opportunity: train clinicians to talk to their patients about firearm injury and death before harm occurred.

Providing clinicians the tools to assess risk and talk with patients in an informed, acceptable way seemed like a cost-effective, non-partisan approach to reducing firearm deaths in California.

In early 2019, Assemblymember Berman enlisted our team at the University of California Davis Firearm Violence Research Center (UCDFC) to help draft a bill to create this clinician education. The team drew on research about how clinicians perceive their role in preventing firearm injury and how patients react to these discussions to design a proposal for the project.6 The language was then incorporated into the California Legislature’s Assembly Bill 521, which was adopted by votes of 71-2 in the Assembly and 31-6 in the Senate.7 The 2019-20 state budget included $3.85 million over 3 years for the project.

This effort, the BulletPoints Project, is creating, implementing, and evaluating curricula for clinicians to prevent firearm-related harm in at-risk patients. The educational content includes the epidemiology of firearm injury and death, individual and social determinants of risk, the basics of firearms, the risks and benefits of having firearms in the home, best practices for talking with at-risk patients about safety, safe storage counseling, other intervention tools for clinicians, and relevant California policies.

The educational material is being made available to clinicians at all levels of training through online resources, continuing education courses, online videos, webinars and lectures, journal club guides, and case-based learning modules.

The BulletPoints Project is an example of how clinicians, researchers, educators, and policy makers can collaborate to create change.

We know clinicians want to play a bigger role in preventing firearm injury and death, both at the patient and the public health levels, but they need knowledge, training, and resources. Policymakers can supply funding through legislation, clinician-educators can develop such a program, and researchers can tell us what works.

There are people at risk for firearm-related harm whom trained clinicians won’t reach. It’s one part of a multi-faceted solution for reducing firearm deaths comprised of evidence-based policy, personal practice, and cultural change. We still need effective ways to keep weapons out of the hands of dangerous people, and improvement in the social, psychological, and economic factors that contribute to firearm homicide and suicide. Educating clinicians won’t put an end to all firearm deaths, but it’s a good place to start.

 

The BulletPoints Team

Clinical tools for preventing firearm injury

References

  1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS).
  2. Weinberger, S. E., Hoyt, D. B., Lawrence, H. C., 3rd, et al.(2015). Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Annals of Internal Medicine.
  3. Bulger, E. M., Kuhls, D. A., Campbell, B. T., et al. (2019). Proceedings from the Medical Summit on Firearm Injury Prevention: A Public Health Approach to Reduce Death and Disability in the US. Journal of the American College of Surgeons.
  4. Roszko, P. J., Ameli, J., Carter, P. M., et al. (2016). Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related Injury. Epidemiologic Reviews.
  5. Ranney, M. L., Betz, M. E., & Dark, C. (2019). #ThisIsOurLane - Firearm Safety as Health Care's Highway. The New England Journal of Medicine.
  6. Pallin, R., Spitzer, S. A., Ranney, M. L., et al. (2019). Preventing Firearm-Related Death and Injury. Annals of Internal Medicine.
  7. CA AB-521. Physicians and surgeons: firearms: training. Retrieved from https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB521
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