Abstract
IntroductionFirearm injury and death is increasingly prevalent in the United States. Emergency physicians (EP) may have a unique role in firearm injury prevention. The aim of this study was to describe EPs’ beliefs, attitudes, practices, and barriers to identifying risk of and counseling on firearm injury prevention with patients. A secondary aim was assessment of perceived personal vulnerability to firearm injury while working in the emergency department (ED).MethodsWe conducted a cross-sectional survey of a national convenience sample of EPs, using questions adapted from the American College of Surgeons’ Committee on Trauma 2017 survey of surgeons. Descriptive statistics and chi-square tests were calculated as appropriate.ResultsA total of 1901 surveys were completed by EPs from across the United States. Among respondents, 42.9% had a firearm at home, and 56.0% had received firearm safety training. Although 51.4% of physicians in our sample were comfortable discussing firearm access with their high-risk patients, more than 70% agreed or strongly agreed that they wanted training on procedures to follow when they identify that a patient is at high risk of firearm injury. Respondents reported a variety of current practices regarding screening, counseling, and resource use for patients at high risk of firearm injury; the highest awareness and self-reported screening and counseling on firearm safety was with patients with suicidal ideation. Although 92.3% of EPs reported concerns about personal safety associated with firearms in the ED, 48.1% reported that there was either no protocol for dealing with a firearm in the ED, or if there was a protocol, they were not aware of it. Differences in demographics, knowledge, attitudes, and behavior were observed between respondents with a firearm in the home, and those without a firearm in the home.ConclusionsAmong respondents to this national survey of a convenience sample of EPs, approximately 40% had a firearm at home. The majority reported wanting increased education and training to identify and counsel ED patients at high risk for firearm injury. Improved guidance on personal safety regarding firearms in the ED is also needed.
Highlights
Firearm injury and death is increasingly prevalent in the United States
51.4% of physicians in our sample were comfortable discussing firearm access with their high-risk patients, more than 70% agreed or strongly agreed that they wanted training on procedures to follow when they identify that a patient is at high risk of firearm injury
Respondents reported a variety of current practices regarding screening, counseling, and resource use for patients at high risk of firearm injury; the highest awareness and self-reported screening and counseling on firearm safety was with patients with suicidal ideation
Summary
Firearm injury and death is increasingly prevalent in the United States. A secondary aim was assessment of perceived personal vulnerability to firearm injury while working in the emergency department (ED). Physicians effectively risk stratify and counsel patients regarding preventive health including tobacco and alcohol cessation, correct use of infant car seats, the importance of wearing seatbelts and helmets, drowning prevention, and vaccinations.[8,9,10] Evidence suggests that similar risk stratification and counseling discussions may be effective for preventing firearm injury and its consequences.[11] Physicians can identify at-risk patients, provide factual information about firearm injury risk and, if needed, refer patients to resources that may reduce risk.[12,13,14] Contrary to the myth that patients resent being counseled on firearm safety by their doctors, the literature shows that patients are receptive to discussing firearm injury prevention with physicians, as long as counseling is delivered in a respectful manner.[15,16] While physicians who own firearms may be more likely to discuss firearm injury prevention with patients than those that don’t,17 in general, few physicians raise the subject with patients. This is true despite physicians in general believing they have the right to discuss firearm safety, and medical leadership groups and patients concurring and encouraging such discussions.[18]
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