With a surge in gun sales during the pandemic, exposure to firearms has increased for all. It’s imperative that clinicians give comprehensive firearm safety counseling to patients during these challenging times.
Lifelong Learning in Clinical Excellence | October 15, 2020 | 3 min read
By Katherine Hoops, MD, Johns Hopkins Medicine
We continue to mark grim milestones in the COVID-19 pandemic—7 million cases and 200,000 deaths. Our homes continue to be the site of virtual school, work, funerals, weddings, and holiday dinners. And the end feels nowhere in sight.
As a pediatric intensivist, I follow the data and literature on COVID-19 closely to prepare for an increase in cases this fall. As a parent, I try to help my kindergartener cope with limited socialization and online learning (made even more interesting by his beloved but noisy infant sister). As a concerned citizen, I follow the news and try to advocate for policies that will improve child health and well-being during this challenging time. And as a public health researcher and expert in pediatric injury prevention, I’m mindful of all the other dangers that continue to put children and adolescents at risk as our focus remains on COVID-19.
In 2018, nearly 40,000 people died from firearm injuries, over 8,000 of whom were under 24 years of age. The data are clear: increased exposure to firearms is associated with a higher risk of violence and death.
Children’s exposure to firearms may have significantly increased during the pandemic: one in three homes with children contains a gun, over half of those guns are not stored safely, and most families continue to spend most of their time at home to practice social distancing. Safe firearm storage reduces these risks.
Indeed, we know that gun purchases and gun violence have increased during the pandemic. Based on internet query data and government databases, interest in gun purchases and actual sales have reached all-time highs. As of the beginning of October, there have already been nearly 33,000 gun deaths, nearly 500 mass shootings, and 757 firearm deaths and injuries among children under 11 years of age (a number that exceeds the year-end total for the previous six years).
As we continue to counsel our patients to wear masks, wash hands, and practice physical distancing, we must also protect them from the dangers of unsafely stored firearms in their homes. Unfortunately, we know that clinicians rarely provide this life-saving counseling. Yet, it’s imperative that clinicians provide competent and comprehensive firearm safety counseling.
Here are a few tips for how to talk with patients about firearm safety:
1. Talk to patients about firearms.
You can use the “5A’s of Firearm Safety Counseling” methodology originally described in CLOSLER. Below is a brief summary:
- Ask about the presence of firearms in patients’ homes and encourage parents to ask about the presence of firearms in the homes their children visit.
- Advise patients on the risks of firearms in the home and the importance of safe firearm storage and safe handling. At a minimum, all firearms should be stored unloaded and separate from ammunition. Children and others who may be at-risk are increasingly protected by the application of an external locking device (like a cable lock) or by placing the unloaded gun into a drawer or wall safe.
- Assess interest in adopting safer practices. If they aren’t interested, try to understand why.
- Assist them in making behavior changes. For example, let them know that gun safes can be purchased relatively inexpensively through major online retailers or that cable locks are often under $10 or may be free from some local organizations.
- Arrange follow up. And don’t just check on their acquisition of a safe storage device and a face mask. Keep checking in to see how they’re coping with isolation, economic losses, and other hardships.
2. Attend a webinar or other educational session to learn more about firearm injury prevention.
Then advocate for the incorporation of rigorous education on firearm injury into the curricula at your institution and within your professional organizations.
3. Vote like lives depend on it. Because they do.
Strong child access prevention laws consistently result in reduced childhood and adolescent unintentional firearm injury and firearm suicide. We must hold elected officials to the same standard of excellence we demand of ourselves during these unprecedented times.