CHICAGO — Violence has become a major public health concern for many hospitals and health systems, and providers are in a unique position to do more in addressing the role guns play in the problem.
That was the focus of discussion Friday during an American Medical Association and American Bar Association co-sponsored meeting “Preventing Gun Violence: Moving From Crisis to Action.”
“There are few issues today that are more vexing, more heartbreaking than the scourge of gun violence in our communities, cities and across the country,” said AMA President Andrew Gurman, M.D., to open the discussion.
Matthew Miller, M.D., co-director of the Harvard Injury Control Research Center, outlined the issue from a public health perspective with a few startling figures from the National Violent Death Reporting System:
- 1 in 3 homes in the U.S. has a gun.
- More gun suicides occur than homicides.
- There are 36,000 firearm deaths in the U.S. each year.
Miller then pointed to the public health approach taken to reduce motor vehicle fatalities as a good example of how to produce significant results.
In about the 1950s, physicians started asking why patients died and what caused an injury in a car crash instead of who caused the crash, said Miller. Once that thinking changed, cars began being built with seat belts, collapsible steering columns and shatter-proof glass, and fatalities went down.
And highways no longer were lined with as many trees — something that made losing control of a car more dangerous than otherwise.
The recognition that it’s a lot easier to alter the environment than to change human behavior led to an 85 percent reduction in motor vehicle fatalities over time, Miller said.
Miller pointed to five key elements of a public health approach to addressing gun violence:
- It must be population-based.
- Prevention (upstream if possible).
- A systems approach: Create systems in which it’s difficult to make mistakes or behave inappropriately. When errors are made, they should be buffered from becoming a serious injury.
- Broad and Inclusive: Include as many groups, people and ideas as possible.
- Create shared responsibility and focus less on blame.
In a later discussion, Mariam Betz, M.D., associate professor of emergency medicine at the University of Colorado School of Medicine, and Megan Ranney, M.D., associate professor of emergency medicine at Brown University's Warren Alpert Medical School, said physicians also need to change their focus when it comes to gun violence.
Traditionally, the medical model has focused on resuscitation after a shooting. We often ignore the series of events that led to a shooting, but we know that with these injuries, as with most other health-related conditions, there have to be preceding events, Ranney said.
While it can be difficult to develop a full picture when it comes to determining the highest risk moments for gun violence, Ranney says, we know there are a minimum of three high-risk conditions when we “can and must” screen for access to a firearm. They are suicide, assault and domestic violence, she said.
“In those moments of acute risk, it’s about reducing access,” said Ranney. For a woman who says she was the victim of domestic violence and carries a gun in her purse for protection, it’s about counseling her that carrying that gun increases her risk of a gun-related incident.
And simple measures such as the 15-minute tablet computer-based violence intervention program used in a University of Michigan study have showed a decrease in fights and weapon-carrying.
While such efforts will not eliminate of all gun-related violence, they are a start.
“We are a piece of the solution. We are not the cure-all, and we can’t do this alone. ... [Physicians] can and need to play a more active role in how they talk with patients,” said Betz.
For more on how hospitals are working to both prevent and treat violence in their communities, be sure to check out the American Hospital Association’s resource page on the topic. Plus, watch for continuing coverage of the AHA’s Hospital’s Against Violence initiative in the print edition of Hospitals & Health Networks and at hhnmag.com.