The national debate over gun violence, firearms legislation, or gun control, (take your pick) is as fraught as the debate over what to call it in t he public square.
While headline–grabbing mass shootings provide recurring triggers for public conversation, there's much less talk about handguns, pistols, shotguns, and rifles in the emergency department, where the devastating effect of guns on human flesh and bone is front and center.
Even the simple question, "Do you have access to firearms?" is one that few nurses and physicians routinely ask suicidal patients. You've got to wonder why not since six in 10 firearm injury deaths in 2009 were suicides, according to the Centers for Disease Control. What's more, 40% of suicide victims "visited an emergency department at least once and often many times" in the year before they died University of Colorado research shows.
Here's what we do know: Researchers from the University of Colorado School of Medicine surveyed 631 emergency department doctors and nurses in eight American hospitals as part of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) trial. They found that the circumstances under which a nurse or doctor would 'almost always' ask suicidal patients about their access to firearms varies widely.
For example, 64% said they would almost always ask if the patient had an actual plan to commit suicide with a gun. But only
- 9% would ask if the patient had overdosed but was no longer suicidal
- 22% would ask if the patient was suicidal but had no suicide plan
- 21% would ask if the patient was suicidal with a non-firearm plan
- 16% would ask if the patient had been suicidal in past month but was not today
The study also showed that 72% of nurses and 49% of doctors said they 'hardly ever' personally counsel patients or families to remove or lock up guns at home.
Asking, "Do you have access to firearms?" seems like a simple question. Yet at the same time, it can be a dangerous, personal, and politically charged query.
In the weeks following the shooting at Sandy Hook Elementary School in Newtown, CT, I spoke with ANA president Karen Daley, who told me that the issue of gun control isn't necessarily a political one, but it is one which nurses have a responsibility to take the lead in addressing.
"This is a public health issue," she said. "This is a safety issue for families."
She told me that nurses regularly counsel patients about everything from the importance of wearing seatbelts and sunscreen to quitting smoking. Moreover, nursing groups often weigh in on issues that affect the health of our society.
"Gun violence cannot fall outside that," she says.
Marian Betz, MD, MPH, an assistant professor of emergency medicine at the CU School of Medicine and lead author of the new study echoed those sentiments in a statement about the new study.
"This is an opportunity for intervention, but very often providers don't know how to react or they think someone else should ask about firearms," said Betz. "And then some have an aversion to getting into an area so fraught with politics. This is not an issue of gun control; it's a safety issue for patients in crisis."
The Surgeon General's 2012 National Strategy for Suicide Prevention, encourages healthcare providers "who interact with individuals at risk for suicide to routinely assess for access to lethal means."
Although nurses and other healthcare providers might be intimidated or unsure about asking about firearms access, doing so—and incorporating those skills into medical education—could potentially change the course of a suicidal person's life, researchers say.
"However, brief risk assessment of access to lethal means and possibly brief interventions are reasonable skills for emergency department providers to master," Betz said. "Whenever we have the opportunity to save a life, we ought to be taking it."
Alexandra Wilson Pecci is an editor for HealthLeaders.
