Study: Firearms injuries present large opportunity for violence interventions

Victims of firearm injuries offer emergency departments an opportunity to provide interventions that could prevent similar incidents in the future.

So far, few do.

In a research letter published in JAMA Surgery, emergency medicine experts said they see a huge untapped opportunity for violence interventions in emergency departments since only 1 in 5 firearm injuries currently even presents to any trauma center at all. 

Only 1 in 10 trauma centers even has a hospital-based violence intervention program. And while those programs have met with limited success, the healthcare industry appears to have plenty of work in front of it to identify, replicate and scale evidence-based practices to suit those who avoid the trauma department altogether.

Edouard Coupet, M.D., M.S.
Yale University

The study identifies three target groups ripe for intervention. Patients admitted to trauma wards with firearms-related injuries have drawn the most attention among existing programs, but those programs have only scratched the surface of what’s possible, according to lead author and emergency department physician Edouard Coupet, M.D., M.S., of Yale University.

“One, there’s an enormous underpenetration of these programs across the country," he said. "And two: how can we fine-tune these programs, optimize them and do our best to engage this population by developing the best evidence-based practices to prevent reinjury? A lot of that is a consequence of firearm injuries as a whole being underfunded,” he says.

The study also uncovered a third set of patients who typically presented to and were discharged from nontrauma center emergency departments with unintentional firearm injuries. That population presents a different type of opportunity, with potential interventions likely more focused on counseling and education around the effective storage of firearms.

Those interventions would have to come from brand-new pilot programs, however, and Coupet sees a more immediate hurdle confronting physicians when it comes to starting these conversations.

“I think a lot of healthcare providers haven’t been taught how to broach the topic of firearm safe storage and usage,” Coupet points out.

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The medical profession’s recent history with the firearms lobby suggests the political heat around this issue could also contribute to the difficulty in getting these conversations going. Despite that resistance, Coupet believes there’s common ground out there.

“I think both sides just want fewer unintentional deaths from firearms, and I think several providers have mentioned nationally that we’re not anti-firearms—we’re anti bullet holes. I think opening up that discussion is step one, really.”

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To the extent more and more emergency departments see work such as violence intervention as a key part of the industry’s public health issue, funding and attention will follow. Coupet compares the idea of reducing firearm injury to other key risk factors for further harm to patients, such as opioid use or domestic violence.

“We need to learn to engage these patients like any other issue, it just needs to be reflexive,” Coupet says. “And that means engagement of all hospital staff in addition to physicians. That includes patient technicians, nursing, hospital administration—everybody needs to be on board to engage this population and screen for patients that are more high risk.”