Newsletters

POSTED: March 18th, 2024
POSTED IN: 2024 Quarter 1, EM Pulse - The Official Newsletter of MOCEP,

Written by:

1. Dr. Vee Smith, Division of Pediatric Emergency Medicine Washington University in St. Louis
2. Dr. Lashaunda Johnson, Department of Emergency Medicine, Washington University in St. Louis
3. Dr. Kristen Mueller, Department of Emergency Medicine, Washington University in St. Louis

Firearm injuries and death are an evolving public health crisis in the United States. For decades, firearm injuries were the second most common cause of death amongst children in the United States. In 2020, firearm injuries surpassed motor vehicle collisions as the leading cause of death in children¹. For example, St. Louis has consistently ranked among the highest in the nation for firearm injuries and firearm related mortality. Between 2010 and 2019, over 10,000 unique patients presented to one of four St. Louis trauma 1 centers for acute firearm injury care². Most of the children and adults who experience acute firearm injuries in St. Louis are Black (non-Hispanic), uninsured, underinsured and live in areas of high social vulnerability². The incidence of nonfatal firearm injuries and firearm deaths have increased over time, and notably among girls and women in the St. Louis region. Although firearm injury intent (cause) is not always known, some studies have shown that many firearm injuries and deaths in St. Louis City are intentional (assault/homicide) with unintentional (accidental) injuries being the second cause³. Regardless of intent, firearm injuries are influenced by multiple socioeconomic factors that may vary by communities and regions.

As emergency medicine physicians we are often faced with the harsh reality of the downstream effects of firearm violence and injury in our clinical practice, and as we help our patients navigate life after violent injury. Hospital based violence intervention programs (HVIPs) serve as a promising solution that can help mitigate this public health crisis. For example, Life Outside Violence (LOV), the St. Louis region wide HVIP, provides victims of violence with the resources to promote healing and reduce the incidence of violent injury through the collaborative efforts of healthcare professionals across disciplines and community organizations. Participants in the program are empowered to create their own goals, with most individuals creating goals centered around health and healthcare, specifically their mental health, and employment opportunities⁶. In the most recent program analysis 78% of participants completed at least one of their goals. Goal completion is an important part of patient oriented HVIP outcome evaluation. Involving key stakeholders in this process allows for individualized service provision to effectively meet the needs of program participants. Additionally, in a recent evaluation of the LOV program, we found that LOV participants had statistically significant 61% lower odds of violent reinjury compared to matched controls, and when LOV participants were reinjured, they were less likely to have their second injury be from a firearm than matched controls.

There is also potential to mitigate accidental injuries and suicide by firearms through the use of gun locks. Several gun lock distribution programs are emerging in hospital emergency departments, inpatient wards, and outpatient clinics. Gun locks are inexpensive and easy to use, and a majority of gun owners are in support of safe storage of firearms.

While the firearm injury epidemic has been pervasive, as noted above, several actionable public health interventions appropriate to the ED and related clinical spaces are available and ready for broad scaling. These interventions have real potential to keep our patient and families safe and healthy.

1. Bernardin ME, Spectorsky K, Gu H, Fairfax C, Cutler K. Child Firearm Injury Circumstances and Associations With Violence Intervention Program Enrollment. J Surg Res. 2023 May;285:67-75. doi: 10.1016/j.jss.2022.12.032. Epub 2023 Jan 16. PMID: 36652770.
2. Mueller KL, Cooper BP, Moran V, Lew D, Ancona R, Landman JM, Spruce M, Marotta P, Liss DB, Mancini MA, Schuerer D, Ranney ME, Foraker RE. Incidence of and Factors Associated With Recurrent Firearm Injury Among Patients Presenting to St. Louis Trauma Centers, 2010 to 2019 : A Cohort Study. Ann Intern Med. 2023 Sep;176(9):1163-1171. doi: 10.7326/M23-0069. Epub 2023 Aug 29. PMID: 37639717.
3. Bernardin ME, Clukies L, Gu H, Fairfax C, Keller MS. COVID-19 Pandemic Effects on the Epidemiology and Mortality of Pediatric Firearm Injuries; A Single Center Study. J Pediatr Surg. 2023 Aug;58(8):1500-1505. doi: 10.1016/j.jpedsurg.2022.10.007. Epub 2022 Oct 22. PMID: 36402591; PMCID: PMC9596183.
4. Doh KF, Sheline EK, Wetzel M, et al. Pediatric firearm and motor vehicle collision injuries in the United States: Diverging trends. Am J Emerg Med 2022;53:59-62. doi: 10.1016/j.ajem.2021.12.029
5. Bottiani JH, Camacho DA, Johnson SL, et al. Annual Research Review: Youth firearm violence disparities in the United States and implications for prevention. Journal of Child Psychology and Psychiatry 2021;62(5):563-79. doi: 10.1111/jcpp.13392
6. Miller ZM, Chapman-Kramer K, Cooper BP et al. Persoanl Goals of young survivors of violent injury: Implications for practice.