Update Course Rewind: Pediatric Surgeon and Firearm Injury Prevention 2022

For the first time in recorded history, firearm injuries in children have exceeded motor vehicle crashes. The deaths from suicide and homicide are both on the rise, particularly in the very young. And today, Dr. Peter Masiakos is presenting what we can do as pediatric surgeons to prevent firearm injuries. The question that I have for the audience is, do you or your institution promote safe arm storage for families in anticipation of trying to impact it? Or do you or anyone on your team routinely ask families about access to lethal means, particularly guns in the home. I think our trauma nurse practitioners talk about safe gun storage and there's a program out in the community with the gun locks. I know we did that in Atlanta and I think we we do it in Akron as well. At Cincinnati, we are in the process as part of an institutional firearms task force about standardizing how we teach trainees and others to think about counseling for firearm storage and then making sure that we have resources. We do within the Injury Prevention Coalition have some resources for lock locks, but they're not widely available. So thinking about how we make sure that those resources are available enough that when we ask families if they want them, they actually can access them. The AAP has all these questions pediatricians have to ask patients and one of them is are there firearms in the house? And are they appropriately locked? My guess is the pediatricians all ask these questions and then when somebody says yes, they're not quite sure what to do. So a couple of things, you know, Ohio, there's the Ohio AAP actually has a statewide initiative around lock box availability and gunlocks. So we're using that tool. Our primary care pediatricians have been really engaged in this process. We are trying to standardize that more broadly so that we make the resources more available, but also we want to screen everybody, just like we screen for Bicamet, just like we talk to people about seat belts. Secondary prevention is great and HVIPs and all those things are important from our recidivism standpoint, but primary prevention matters most and if we can avoid stress and injury at the primary level, that'd be better. You heard that Dr. Mirakotagal mentioned HVIPs. If you're wondering what that is, HVIPs stands for Hospital-Based Violence Intervention Programs. And they are multidisciplinary programs that identify patients at risk of repeat violent injury and link them with hospital and community-based resources aimed at addressing underlying risk factors for violence. In a paper that one of my colleagues wrote at MGH, it brought to bear what happened in America in 19 days after the Uvalde shooting. And the reality of 2300 deaths, it is tantamount to a public health crisis that we typically would respond to emphatically. And taking that into context, most of the deaths are still assault homicide related, even the non-fatal injuries. But a large cadre of the injuries are due to self-harm or unintentional injuries that we see in kids. They started looking into databases of how many times the documentation of firearm access appeared in the medical records, whether it be in medicine, neurology, OBGYN, orthopedics, psychiatry, or surgery records. It was pretty abysmal where we ask about alcohol and tobacco, the ask and recording of firearm access woefully small. And this is 80,000 data chart reviews to find the words for gun access firearms and self-harm. First, they looked at what's actually happening in the emergency department in order to get the answers to teach the students what to ask. In kids who presented to our emergency department in 2018 who had suicidal or homicidal ideation, only 5% of the kids were asked about whether they were access to lethal means in the home. Then they instituted a curriculum where each incoming interns since 2019 is given a 30-minute didactic going over the details of gun violence within Massachusetts. And then they spend 30 minutes times two talking to a standardized patient in a curriculum that was developed by the residents in each program. And what we found is that people did it. There were no opt outs, there were no concerns about comfort. There were no issues about whether or not it was the right thing to do. It kept going and they had every resident doing it in every curriculum. In one year, they reevaluated the documentation and they realized it went from 5% to 32%. And although this is a great response in one year, we still feel that we had work to do. We actually communicated with a group at Cincinnati Children's Hospital to see if we can make a different approach to this, just like they've been doing with vaccines and looking at virtual reality, artificial intelligence generated platforms. And Joe Real and Matt Zakov at Cincinnati Children's Hospital have designed a library now of avatar-based curricula. And we're starting to animate and we're going to do a proof of principle with respect to whether or not this platform, which is easily expandable, easily transportable, can be used in the same way that curriculum has been used. The other approach that we've been taking is going to the community. If you present mortality by state, Massachusetts is the safest city in the safest state, Boston being 40 deaths per year. However, if you look at the shots fired, it's a different phenomenon. And if we start moving away from the idea of only counting deaths and looking at gunfire and gun related trauma, it's a different discussion. We find that from the Boston PD data, there are about 1,000 to 2,000 911 calls for shots fired and most of them happen between the hours of 8:00 and 11:00, which portends a bad sleeping habit for kids in these neighborhoods. So deaths, we have to reframe into injuries and shots fired and community fear. And the the community is being uplifted through the program to participate in the education of our residents in a trauma informed way by bringing the community into the classroom and understanding exactly what they do in so far as dodging bullets for a living or not sleeping through the night because they're woken because of a gunshot or a siren. About two years ago, and I walked to Emerson College, which is a film school down the street from MGH and we asked the film folks if they can help us identify a way that we can raise the voices of the community. We are embedded in the classroom and there are three classes per semester that are done at Emerson College, bringing what we call community educators who are paid to present their side of the story to the kids who are going to be writing the future narratives of gun violence. Please don't forget to check out the short video about this program linked below in the description. Thank you for watching this video. Don't forget to subscribe to our YouTube channel, follow us on social media and download the Stay current app for hundreds of pieces of content in pediatric surgery. Cincinnati Children's Hospital and Stay current are sharing knowledge to improve child health around the globe.