Patient Characteristics and Perspectives of Firearm Safety Discussions in the Emergency Department

• Type of Material: Article
• Authors: Lauren Hudak, Emory University; Henry Schwimmer, Alameda Health System; William Warnock, Emory University; Sarah Kilborn, Vanderbilt University; Tim Moran, Emory University; Jeremy Ackerman, Emory University; Jonathan Rupp, Emory University
• Language: English
• Date: 2021-05-01
• Publisher: WESTJEM
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Hudak et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.5811/westjem.2021.3.49333
• Title of Journal or Parent Work: WESTERN JOURNAL OF EMERGENCY MEDICINE
• Volume: 22
• Issue: 3
• Start Page: 478
• End Page: 487
• Grant/Funding Information: This study was funded by the Emory Medical Care Foundation 2018–2020 Grant Cycle #0004, $20,805 as Phase 1 of the Emory SAFE FIRST Pilot Study (Survey Assessment of Firearm Experiences, Firearm Injury Risk Screening and Treatment).; The authors have no other funding sources, financial or management relationships, or other competing interests relevant to the work presented here.
• Keywords: MEANS RESTRICTION; Science & Technology; Life Sciences & Biomedicine; Emergency Medicine
• Research Categories: Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Introduction: Firearm injury prevention discussions with emergency department (ED) patients provide a unique opportunity to prevent death and injury in high-risk patient groups. Building mutual understanding of safe firearm practices between patients and providers will aid the development of effective interventions. Examining ED patient baseline characteristics, perspectives on healthcare-based safety discussions, and experience with and access to firearms, will allow practitioners to craft more effective messaging and interventions. Methods: Using an institutional review board-approved cross-sectional survey modified from a validated national instrument, we recruited 625 patients from three large, urban, academically affiliated EDs in the South to assess patient baseline characteristics, perspectives regarding firearms and firearm safety discussions, and prior violence history, as well as firearm access and safety habits. We compared the degree to which patients were open to discussions regarding firearms across a variety of provider types and clinical scenarios between those with and without gun access. Results: Of the 625 patients consented and eligible for the study, 306 had access to firearms. The patients with firearm access were predominantly male, were more likely to have military experience, live in an urban or suburban region, and have experienced prior violence when compared to those without firearm access. Patients with and without gun access view firearm safety discussions with their healthcare provider as acceptable and analogous to other behavioral health interventions (i.e., helmet/seat belt use, alcohol/cigarette use). Patients were also accepting of these firearm safety discussions in many clinical contexts and led by multiple provider types. Of the patients with gun access, storage of each type of firearm was reviewed and the primary reason for ownership was for personal protection across all firearm types. Conclusion: Patients in the ED indicate openness to firearm safety discussions delivered by a variety of providers and in diverse clinical scenarios. Healthcare providers engaging firearm owners in appropriate risk-benefit discussions using a trauma-informed approach is a critical next step in research and intervention.