Emergency Providers’ Familiarity with Firearms: A National Survey

Abstract

Background Emergency providers (EPs) are uniquely placed to advocate for firearm safety and have been shown to be at risk of exposure to firearms in the emergency department (ED). We sought to characterize EPs’ knowledge of firearms, frequency of encountering firearms in the ED and level of confidence with safely removing firearms from patient care settings. Methods This was a survey study of EPs representing medical centers in 22 states. A 15‐item questionnaire was e‐mailed to all EPs at all included institutions. Questions pertained to EPs’ knowledge of firearms, experience with handling firearms, and exposure to firearms while at work. We calculated response proportions with p‐values and conducted association analyses among survey items. Results Of 2,192 survey recipients, 1,074 (49.0%) completed the survey. A total of 635 (59.1%) reported encountering firearms in the ED or its immediate environment at least once per year, and 582 (54.2%) were not confident in their ability to safely handle a firearm found in a patient's possession. Frequency of handling firearms was significantly higher in states in the top quartile for firearm ownership, with 21.5% of respondents reporting handling firearms daily or weekly, compared to 10.9% in bottom‐quartile states. Level of firearms training also differed significantly: 42.1% of respondents in top‐quartile states reported formal training compared to 33.0% in bottom‐quartile states. Increased regional firearm ownership rates were associated with decreased rates of feeling unsafe at work. Conclusions The majority of surveyed EPs reported little experience with handling firearms. Firearm experience was associated with comfort with managing firearms found in patients’ possession. Regional differences were found regarding personal firearm experience and perceptions of workplace safety, both of which were associated with regional variations in firearm ownership. Despite this, no regional differences were found in encountering firearms in or around the ED. EPs may benefit from training on safely handling firearms.

Emergency Physician Survey on Firearm Injury Prevention: Where Can We Improve?

“…Despite respondents representing a convenience sample, the percent of respondents with a firearm in their home is similar to that reported in national surveys, and the geographic, gender, and racial/ethnic distribution of the respondents is similar to that in national data on emergeny medicine. 22 Among this diverse sample of EPs, despite half reporting no barriers to asking high-risk patients about firearm access, numerous training needs were identified. The most notable findings were the disparities between reported knowledge, attitudes, and normative beliefs about the values of screening vs actual reported counseling of high-risk patients.…”

“…26,27 According to this survey, the two primary barriers to EPs' effectively screening and counseling ED patients about firearm injury were not knowing how to respond to the information, and not thinking it will change management. Lack of resources, and skepticism about efficacy has been identified by others 22,[25][26][27][28] as common barriers to effective firearm injury prevention in the ED. Our findings, therefore, reinforce the importance of physician and patient self-training resources and handouts, In 2019, Pallin et al published a guide to when and how to intervene to reduce firearm injury.…”

“…These findings concord with our and others' work showing that firearm owners can help lead evidence-based interventions to reduce firearm injury risk. 22,28,[35][36][37] Future educational programs should make an effort to highlight the voices, expertise, and experience of firearm-owning EPs. 37,38 Nonetheless, deficits in knowledge were identified among this group, including lack of belief in the value of screening or counseling for patients who were at risk of non-suicide-related firearm injury.…”

“…Attending physicians, however, had more knowledge of hospital policy regarding handling and management of the firearm once it was discovered in a patient's possession, as compared to residents. [22][23][24][25][26][27][28] In another study Ketterer et al reports that "up to 25% of trauma patients brought to the emergency department (ED) have been found to carry weapons." 28 Overall, more research is needed to address safety in the ED and the handling of firearms when they are brought into the department; further collaborative work is needed.…”

“…21 A survey of EPs in 22 states reported that although two-thirds of respondents had encountered a firearm in the ED, fewer than half felt at all confident in their ability to safely handle the situation. 22 These missed opportunities may be related to the paucity of education on this topic in medical schools, or due to other unmeasured factors. 1,2 Prior work conducted by the American College of Surgeons described attitudes, beliefs, and practices of US surgeons regarding firearms and firearm injury prevention, and was used to develop consensus recommendations on surgeons' roles in firearm injury prevention.…”