Welcome to this webinar on promoting firearm injury prevention and safety among ED patients. The content presents a brief overview of evidence-based research and practice recommendations to improve triage, screening, identification, and harm reduction among ED patients who are at risk of firearm injury and death. For more in-depth coverage of these topics, please consider taking the full Learning Management course and listening to the accompanying podcast series from nursing leaders who share their expertise about caring for these patients. 136,000 Americans are shot every year, over 1 million in the past decade. In 2017, U.S. gun deaths reached their highest level in at least 40 years, with nearly 40,000 deaths that year alone. Non-fatal firearm injuries are also on the rise, with roughly 1 out of every 5 visits among youth aged 0 to 19 who are treated for gunshot wounds in the United States Emergency Departments each year. For every person who dies from gun violence, there are 129 other individuals who are treated in U.S. Emergency Departments each year, and 13 people who suffer trauma serious enough to be hospitalized. The mounting public health crisis results in significant personal, societal, and financial costs due to lifelong trauma, disability, and years of potential life loss to those who are impacted by firearm injuries. Having a gun in the home increases the risk of dying by suicide, homicide from intimate partner violence, and unintentional firing of a weapon by young children. Emergency nurses have an opportunity to discuss gun safety with at-risk individuals, parents, and families as part of overall injury prevention and health education. This figure illustrates that guns have a much higher lethality rate than other means of suicide. While firearms remain a consistent means of suicide for men over the lifespan, this is especially true for men aged 65 and older, with guns being used in over three-quarters of suicide deaths among males in that age group. The means used in suicide for women change over time. While younger women are most likely to die by suffocation, poisoning becomes a more common means of suicide as women age. However, use of firearms is growing, and in 2018, it was the most common means of suicide for women. Significant health disparities in firearm injury persist, with youth and minority populations disproportionately affected by all types of firearm violence. Emergency nurses have expressed concern that screening for risk of firearms injury may precipitate patient violence. With the rising occurrence of violent incidents and active shooters in the ED, the fear of violence from patients is valid, and may be a barrier unless addressed. Patient safety and nurse safety go hand in hand. When nurses feel safer in the work environment, they're more able to attend to their patients' needs and concerns. The nurse-patient conversation about firearm access can benefit from an approach that focuses on safety of patients, families, and communities, rather than restrictions about individual gun ownership. The ability of health care providers to assess the risk of firearm injury and death is important for patient safety and the continuum of care. Patient risk assessment can occur during clinical care in the ED and during recommended follow-up visits in pediatric clinics, primary care offices, urgent care facilities, and inpatient hospitals. Connecting patients back to community resources in their primary medical homes is a critical function of ED discharge planning. Despite widespread stress and trauma, Black people may be less likely to receive mental health diagnoses. Experts say the reasons for this are complex. Mental health conditions such as depression may present differently, which some providers may not be trained to recognize. When caring for this group of patients, it's important to recognize the disproportionate effects of socioeconomic factors and community and police violence that may increase the likelihood of exposure to trauma in Black communities. While the number of gun fatalities among young children is low, less than 200 a year, firearm-related injuries and trauma cause harm to children who are victims themselves or who are exposed to violence in their families and communities. One in three adolescents who die by suicide had a depressed mood at the time of their death. Twenty-six percent had a clinically diagnosed mental health problem, and about the same number disclosed their intent to die by suicide to someone before the incident. This emphasizes the importance of identifying risks and providing support services to these individuals when they are in crisis, which precipitates a visit to the emergency department. Although the frequency of suicide attempts is greater among adolescents and young adults, older men and women show the highest suicide rate worldwide. Suicide attempts in older adults are also more likely to be fatal. According to the Centers for Disease Control and Prevention, one in four women and one in seven men will experience physical violence by their intimate partner at some point during their lifetimes. Domestic violence assaults involving a gun are 12 times more likely to result in death than those involving other weapons or bodily force. IPV can vary in how often it happens and how severe it is. It can range from one episode of violence that could have lasting impact to chronic and severe episodes over multiple years. Despite a general emphasis on danger posed by strangers, intimate partners with guns post the greatest risk of fatal violence to victims. To encourage young people to seek treatment, it's important to normalize conversations about mental health during the ED visit. When treatment recommendations are summarized at the end of the patient visit, there's another opportunity to reinforce components of the firearm injury risk assessment. This can be a good time to discuss in-home access to firearms within the context of overall safety and injury prevention education. Suicides are often impulsive in children and adolescent age groups, with previous findings indicating that many who attempt suicide spend 10 minutes or less deliberating. Safe storage practices such as unloading and locking all firearms in a safe place and locking all firearms and ammunition can be potentially life-saving in these instances. The American Academy of Pediatrics recommends that all youth over age 12 be screened for risk of suicide and self-harm using standardized tools. During the ED patient visit and discharge process, emergency care providers can incorporate counseling with the family of at-risk youth, including a conversation about safe storage of firearms or removal of guns from the home, and other points of access, such as vehicles. ED providers can be the link between youth and their primary care provider or other school and community-based resources. For example, some emergency departments have participated in national programs to distribute gun safety locks or vaults to high-risk patients. Suicide prevention programs for older adults who are seen in the ED should include screening to identify risk factors related to both mental and physical health so that individuals can be treated for chronic illness and depressive disorders that contribute to suicidal thoughts and behaviors. Despite skepticism from ED providers, lethal means restriction is an effective method for preventing firearm-related injury. The evidence also suggests that state statutes that limit access to firearms among persons under a straining order for domestic violence are associated with a reduced risk for intimate partner homicide with or without a firearm. Remember, firearm injuries are preventable. Emergency nurses have an important role through patient screening and education. Screening and assessment are evidence-based practices that identify at-risk patients for appropriate follow-up during the patient visit and through follow-up recommendations. Safe storage and lethal means restrictions are injury prevention strategies that reduce risk of firearm injury and death. Thank you for taking the time to view this webinar. To learn more about this important topic, you can access the online course and podcast series that accompany this program.

firearm injury prevention

ED patients

gun deaths

emergency nurses

intimate partner violence