Prevent gunshot wounds in your community
The ED is the first line of defense in preventing gunshot wounds, stresses Joseph Waeckerle, MD, FACEP, editor in chief of Annals of Emergency Medicine. "Nurses need to be proactive in identifying patients at high risk for hurting themselves or others, and intercede accordingly," he stresses. "Those of us practicing in emergency medicine have a duty and obligation to educate anyone who comes to our ED."
A recent CDC study revealed that fatal and non-fatal firearm-related injuries are declining in the United States, but the rates remain high, especially among males aged 15-24.1 "While the news is encouraging about the recent decline in firearm-related injuries and deaths, the numbers are still too high. They reveal that young males are at high risk for purchasing, using, and being injured or killed by firearms," says Nancy Auer, MD, FACEP, president of the American College of Emergency Physicians.
ED nurses can do a lot to prevent gun injuries from occurring, stresses Gail Dodge, RN, BSN, CEN, MICN, clinical educator for the ED at San Antonio Community Hospital in Upland, CA. "As nurses we are also 'safe' because we serve in nurturing and caregiving roles and are perceived as non-threatening. Our hope is that even though we may never know it, we will have prevented a tragic incident somewhere," she says.
Here are some ways to prevent firearms injuries in your community:
Enlist help of companies to donate gunlocks. "Many companies are getting involved in community causes, and may be willing to donate materials or resources," says Dodge. In 1996, Master Lock partnered with ENA to create the program "Gun Safety: It's No Accident." Community kits are sent to nurses who are interested in doing outreach.
Each year, Master Lock donates 6000 gunlocks to the ENA's San Bernadino Riverside County Chapter, notes Dodge. "Master Lock provides the gun trigger locks and the glossy brochures and the ED nurses provide the 'labor'-going out into the community to provide programs," she explains.
Do community outreach. ED nurses in Riverside County participated in 16 events last year, reports Dodge. "A big bowl of candy attracts children to our table, so we can talk to them about not touching guns," she says. "Often, guns have been part of their lives, so we listen to them talk about finding guns in trash cans, or storing guns in closets. We've learned that casual treatment of guns is rampant." Children are given coloring sheets with gun safety messages, while the nurses talk to their parents about gun safety.
The nurses formed a local partnership with California Crime Prevention Officers Association. "We've partnered at safety fairs, been invited to several of their events, and presented at their annual conference," says Dodge. "It's a Domino effect, because a lot of people have contacted us since then who didn't know our program existed."
Bring up the topic subtly. "We don't ask right away, 'Do you have a gun in your home?' because it puts people off," says Dodge. "If they ask for information about a trigger lock, we offer them one. They are amazed we'd give them a $15 item at no charge. When they realize that we give away our educational material and the gun locks at no cost, they appreciate that we have no hidden agenda other than injury prevention. We jokingly tell them that we're trying to put ourselves out of business as ED nurses." One trigger lock is offered per family.
At times, the conversation turns political, but the nurses focus on prevention. "We run into a lot of gun enthusiasts who believe in the right to bear arms, and we listen politely. We make it clear that we're not telling anyone not to have a gun. We are just trying to tell them if you have one, be smart about it," says Dodge. "We have been told over and over that they appreciate the fact that we are not preaching, we are teaching."
Educate patients at discharge. Nurses should educate parents and children on the dangers of firearms at discharge, suggests Connie Cunningham, RN, BSN, director of pediatric trauma services and SAFE KIDS at Loma Linda. "Make sure parents and children are aware of the risks posed by keeping a firearm in the home," she says.
Nurses should ask parents the following questions, she suggests:
· If they own a firearm, is it empty, locked, and the ammunition stored away from the firearm?
· Have they taught their child to tell an adult if they find a gun, or call 911 if no adult is present, and to never touch the gun under any circumstances?
· Does the parent discuss the dangers of firearms with their child?
· When children visit friends, do the parents know if a gun is in their home?
Be nonjudgmental. The nurses hand out trigger locks to people from all walks of life, including police officers and gang members. "When gang [members] talk about protecting their families and homes with guns, they may be taking those same guns to go out and shoot someone at night," Dodge explains. "We make it safe and neutral for them to talk. Young males in particular don't want to acknowledge that they are listening to what we say, but you may be planting a seed."
Stay objective. "Don't jump on the emotional bandwagon that surrounds the firearm controversy in this country," warns Armstrong. "We, as nurses, deal in scientific fact. If you need help coming up with educational information, contact the Emergency Nurses Association, American Trauma Society, and, yes, even the National Rifle Association. Remember to base your knowledge on scientific fact, not fantasy or emotion, and get both sides of the story."
Instead of emotionally charged lectures, deliver fact-based speeches. "Your lectures should be based in fact and the latest scientific information. The best comment I receive from my audience is they don't know what side of the firearms controversy I stand on but they do know about firearms safety and how to take care of gunshot wounds," says Armstrong.
Organize a speakers list. "Go out to schools and interested groups to talk about firearms safety and the cost of gunshot wounds in our society," recommends Armstrong. "Educate the public about violence and the tragedy of penetrating injury from your perspective. It does make a difference! This is a good chance to promote your ED, your profession, and yourself."
Instruct gunowners in the use of trigger locks. "Trigger locks are supposed to be placed on an unloaded gun," stresses Dodge. "We come across a number of people who assume they can put it on a loaded gun, but if you manipulate the trigger, you are firing it."
Identify patients at risk. "The suicide rate is astronomically high in young people, and many use weapons," notes Waeckerle. "We need to identify patients with telltale manifestations of suicidal intentions, then intervene as quickly as possible."
Voice support for an ED-based national surveillance system. "We are the first to encounter victims of firearms violence," notes Waeckerle. "An ED-based nationwide surveillance system is needed to identify potential trends. Until we define the problem, we cannot begin to identify the solutions."
Reference
1. D Cherry, JL Annest, JA Mercy, et al. Trends in nonfatal and fatal firearm-related injury rates in the United States, 1985-1995. Ann Emerg Med 1998;32:51.
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