If you could ASK one question to save your child’s life? Firearm Injury Prevention

Kiesha Fraser Doh, MD

Assistant Professor of Pediatric Emergency Medicine, Emory University

Two years ago one of my colleagues sent a reminder that June 21st is ASK day and that we clinicians should support this day as Pediatric Emergency Medicine Physicians.    ASK (Asking Saves Kids) is a day that the American Academy of Pediatrics and the Brady Center to Prevent Gun Violence have promoted to encourage parents to ask about the presence of unlocked guns in the homes where their children play.  ASK day is held annually on the first day of summer,  a season where children spend a lot of time in the homes of others. As a PEM Physician I am very cognizant of safety.  I ensure that my children are always buckled into car seats with whomever drives them, I ask about swimming pools and pets when they visit others homes and ensure that grandparents medicines are put up when we visit.  But I had never asked about the presence of unlocked guns in the homes my children visited. I embarked with trepidation and asked the parent of my son’s best friend. After I completed this uncomfortable conversation I began to reflect if this was a difficult conversation for me a pediatric emergency medicine physician who has seen multiple children harmed by firearms imagine the difficulty for other parents without a similar perspective.

Armed (pun intended) with this thought process five of my colleagues and I embarked on a research study and educational intervention in 2 pediatric emergency departments ( 1 urban and 1 suburban).  Our goal was to identify the percentage of parents who had asked this important question regarding the presence of unlocked firearms or guns in the homes that their children visited.  We further endeavored to educate parents who had not previously asked and to determine if an educational intervention could influence a change in storage practices and firearm safety. The 10-question survey was collected  by  pediatric emergency medicine physicians. The intervention component informed parents of the importance of asking about unlocked firearms in the home their children visited. In our study we determined that of the 138 participants in our convenience sample gun-owners were more likely to have previously asked about firearm presence in the homes their children visited. But in total only 30% of parents surveyed had ever asked.  After the educational intervention regarding the importance of asking, 79% of participants stated they would.  In our 4-week follow-up survey we learned that 90% were likely to initiate the conversation in the future and 58% actually had.(1)

Last summer we expanded our research to not just inquiring about unlocked guns but learning more about the presence of firearms in the homes of our patients and their access to firearms.  In this survey of >300 parent-child pairs with data obtained at 3 separate pediatric emergency departments (2 suburban and 1 urban) we determined that:

  • 30% of parents asked about presence of firearms
  • 47% of those with a firearm stored ammunition with gun
  • 45% of parents stored a gun in an insecure place
  • 50% of children had seen a gun in their home

Furthermore we asked parents if they felt their child could identify a real gun, then subsequently asked children the same question.  Children were then shown an image of two handguns one real the other a toy and asked to identify the weapon.

  • 77% of children believed they could identify a real gun
  • 65% of parents believed child could identify a real gun
  • In actuality only 45% of children could identify a gun

This is similar to previous research which was  done by Farrah and Simon et al in the 1990’s where 75% of parents believed their child could tell the difference between a real and fake gun and 23% thought they could be trusted with a loaded gun.(2)

With the evidence of these two studies we proceeded to our next firearm injury prevention initiative. We decided to distribute safe firearm storage devices. According to a study in JAMA 2005 storing household guns locked, unloaded and separate from ammunitions is associated with reduction in the risk of unintentional and self-inflicted firearm injuries and deaths.(3)  The U.S. General Accounting Office estimates that 31 percent of accidental deaths caused by firearms might be prevented with the addition of 2 devices: a childproof safety lock and a loading indicator.(4)

After obtaining  funding we chose a suburban county wide safety fair to distribute 250-gun safety boxes. In evaluations that were given to the participants 52% of participants acknowledged never asking about the presence of unlocked guns in the homes their children frequented. Contrary to previous studies that had stated some concern when firearm discussions were given by health care providers 92% of those surveyed felt comfortable discussing gun safety with a heath care provider and 80% planned to use the gun safety box in the next few weeks. The 3-month follow-up survey determined that 86% were using the device that was distributed at the safety fair. With the results of our first event we applied for more funding and have plans to do 4-gun safety box distribution events this year.

Prevention of unintentional firearm deaths is critical since approximately 1300 pediatric deaths occur from firearms each year. (5)   Firearm related deaths are the 2nd leading cause of injury related death and 3rd leading cause of death by US children overall.  91% of firearm deaths in high-income countries occur in the United States. (5)  Distribution of safe storage devices is a one method to prevent firearm injury as one in three children live in homes with firearms. (6)  This year twice as many kids have died from firearm related-injuries compared to those who have died from influenza through-out the influenza season.  Thus, Pediatric Emergency Medicine physicians need to be vigilant as advocates for firearm injury prevention and firearm injury research.  We should not be afraid to ASK, Asking Saves Kids.

 

References

  1. Fraser Doh, S. Chaudhary, et al Parental Acceptance of a Firearm Educational Intervention by Emergency Medicine Physicians, Poster presented at annual Pediatric Academic Society Meeting in San Francisco, May 2017
  2. Farrah MM, Simon HK, Kellerman AL Pediatrics 1999 Nov;104 (5 Pt1) 1059-63 Firearms in the home: parental perceptions
  3. Grossman, D. Mueller, B et al JAMA February 9, 2005
  4. CHOP Center for Injury Research and Prevention https://injury.research.chop.edu/violence-prevention-initiative/types-violence-involving-youth/gun-violence/gun-violence-facts-and#.WqCrl2bMzaa
  5. Fowler, K, Dahlbergh, L et al Childhood Firearm Injuries in the United States Pediatrics 2017:140
  6. Asking Saves Kids askingsaveskids.org

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