A Simulation-Based Prospective Cohort Study on Teaching Best Practices in Firearms Safety

Abstract

Background: Gun violence in the United States is a significant public health concern. The high rate of weapons carriage by Americans places medical providers at risk for exposure to firearms in the workplace and provides an opportunity for patient safety counseling. Few curricular interventions have been published on teaching firearms safety principles to medical providers. Given the risk of encountering firearms in the workplace and the opportunity to engage patients in firearms safety counseling, providers may benefit from dedicated training on safely handling firearms. Methods: This was a prospective cohort pilot study of a simulation-based educational intervention for third-and fourth-year medical students enrolled in an emergency medicine subinternship and emergency medicine bootcamp elective. Before undergoing the educational intervention, students completed a preintervention simulation case during which they discovered a model firearm in the patient's belongings and were asked to remove it. Students then received the intervention that included a discussion and demonstration on how to safely remove a firearm in the clinical setting. Two weeks later, the students were presented with a model firearm in a different simulation case, which they needed to remove. During the preintervention and postintervention simulations, students were evaluated on their performance of the critical actions in firearm removal using an 8-item checklist. Students' scores on this checklist were compared. Results: Fifty-three students participated in the study, 25 of whom completed the postintervention assessment. The median number of correctly performed critical actions preintervention was 5 (interquartile range = 4-6) and postintervention was 7 (interquartile range = 6-8, P < 0.001). Students showed particular improvement in 4 steps: holding the firearm by the grip only, pointing the firearm in a safe direction at all times, removing the firearm from the immediate patient care area and placing it in a safe area, and ensuring that the firearm is monitored and untouched until police or security personnel arrive to secure it. Conclusions: This educational intervention is the first to formally teach students about the safe handling of firearms found in the clinical care space. This low-cost pilot project is easily transferrable to other training centers for teaching principles of safe firearms handling.

An Ethical Framework for Conducting Active-Shooter Simulation in the Healthcare Environment

“…Dr Andrew Ketterer and Dr Andrea Austin are emergency medicine physicians with an educational focus on simulation. Dr Ketterer has conducted simulations on provider familiarity with firearms and has collaborated with local law enforcement in these simulations' development and implementation 18 . Dr Ketterer has an additional professional focus on medical ethics and has obtained a Master of Arts in Medical Humanities and Bioethics.…”

“…Dr Ketterer has conducted simulations on provider familiarity with firearms and has collaborated with local law enforcement in these simulations' development and implementation. 18 Dr Ketterer has an additional professional focus on medical ethics and has obtained a Master of Arts in Medical Humanities and Bioethics. Dr Austin is a US Navy veteran, and during her time in the military, she conducted active shooter simulation events that involved both healthcare and military/civilian police personnel, including hyperrealistic events with moulage and sounds of gunfire.…”

Economics and Public Health: Two Perspectives on Firearm Injury Prevention

“…Victims, perpetrators, and community members affected by firearm injury intersecting with the health sector and healthcare-led brief screenings and interventions have proven successful for other public health problems (Babor et al 2007). Multiple groups are developing and testing evidence-based interventions to improve healthcare providers’ comfort with identifying firearm injury risks and providing counseling (Emergency Nurses Association 2021; Hoops et al 2022; Ketterer et al 2021; The Bullet Points Project 2021).…”