Knowledge of Medical Specialties Harnessed to Address Firearms Injury Reduction

While many psychiatrists treat affected individuals during and after firearms-related trauma, our colleagues in emergency and trauma medicine strive to reduce the effect of wounds on the patient. We know that restricting firearms access is conducive to harm reduction; however, the politics of putting any limits on firearms ownership can be polarizing, even in medicine.

Concerned by the increasing number of firearms deaths and injuries, the American College of Surgeons (ACS) set out in 2018 to address the need for an interdisciplinary approach to reducing the harm caused by the use of firearms. The solution required surgeons to engage and collaborate with stakeholders across health care disciplines, and others, including, legislators, policymakers, legal experts, community leaders, and firearms owners.

In February 2019 the ACS Committee on Trauma (CoT) convened the inaugural Medical Summit on Firearm Injury Prevention. There were representatives from 43 health care organizations, including emergency medicine, trauma surgery, psychiatry, pediatrics, other primary care specialties, trauma nursing, and psychology. I represented APA.

Physicians described the myriad challenges faced by firearms injury patients in the hospital and after they leave. The group brainstormed on ways to provide health care and educate communities about firearms safety in urban and rural settings. Alternate methods for conflict resolution were mentioned. Educating youth and others about the physical, emotional, and legal sequelae of firearms injuries also was stressed since movies and the media oftentimes distort the reality about the resulting pain and disability.

As a psychiatrist, I thought it important to introduce concerns about educating families about the firearms living will that gives firearms owners a say in how their weapons should be disposed of if they become incapable of managing them responsibly. Also, I reminded the participants that most people who die from firearm injuries have died from suicide. One physician responded, “We don’t see those people in our practices.” A medical examiner retorted, “That’s because they come to see me.”

I eagerly contributed to the discussion from clinical and forensic psychiatric perspectives as well as from a policy perspective. Most physicians do not have forensic training, and those who treat patients with firearms injuries must often interface with law enforcement officers and others who work in the justice system. Health care professionals also encounter aggression from patients, their loved ones, and others, especially in hospital emergency and crisis settings and after bad news is presented.

Soon after the meeting, I was invited to join the CoT’s Improving Social Determinants to Attenuate Violence (ISAVE) group. The group is composed of leaders in medicine, law enforcement, community engagement, and other disciplines and endeavors to develop strategies to reduce firearms injuries and enhance health care outcomes by investing in at-risk communities to diminish health disparities and increase safety. Public and mental health are components of the project that will focus on the social determinants of health.

ISAVE is developing a program to introduce trauma-informed care in more trauma centers. The goal is to train the health care team to use interventions that can alleviate anxiety and foster patient autonomy. The first module, which is designed to train the trainers, is being field tested in 15 U.S. medical centers. Also, trauma-informed care is being introduced in the next edition of the Advanced Trauma Life Support Manual (ATLS).

In September, 47 leaders from medical societies and other health care organizations convened for the second Medical Summit on Firearms Injury Prevention. It was great to reconnect with people after two and one-half years to learn about what other organizations have been doing to reduce firearms injury. The federal firearms safety law signed in July 2022 includes $750 million for states to establish and operate crisis intervention programs.

Several speakers described how they have been using community engagement to reduce firearms violence. The Health Alliance for Violence Intervention (HAVI) conducts research, sets standards, and offers competitive grants to support violence prevention and reduction in at-risk communities. HAVI also offers technical assistance for developing hospital-based violence intervention programs that use trauma-informed care and community engagement to reduce violence, develop collaborative relationships, and promote health equity.

One delegate described a pilot program in Alabama that embeds court-involved youth in a hospital to introduce them to career options while educating them about life skills, the importance of education, and the impact of firearms injuries on one’s physical functioning.

I began to think about how the collaborative care model can be implemented in outpatient trauma care clinics to serve patients who may not otherwise receive psychiatric care.

By the end of the meeting, delegates were motivated to share what they learned with their respective organizations. There also are plans to pursue individual and collaborative projects to reduce firearms injuries and to provide compassionate care for patients with firearms injuries. I look forward to learning how the group has progressed in the 2024 summit and will report back to you. ■

Cheryl D. Wills, M.D., is a forensic psychiatrist and an associate professor of psychiatry at Case Western Reserve University and vice chair for equity, diversity, and inclusion and chief of child psychiatry at Case Western’s Metrohealth System. She is also APA’s Area 4 trustee and received APA’s Special Presidential Commendation for her work as chair of its Presidential Task Force on Structural Racism Throughout Psychiatry.