To Sathya — as well as to me and many of our medical colleagues — it’s abundantly clear that gun violence is a health-care issue. In 2021, nearly 49,000 Americans died from gun-related injuries.
This terrible statistic does not spare kids. In fact, since 2020, firearm injury has become the leading cause of death among U.S. children. The surgeon general recently deemed firearm violence to be a public health crisis, underscoring the need to address it from a health lens.
Traditionally, hospitals have been the place to care for gunshot victims after they have suffered their wounds. Sathya, now a pediatric trauma surgeon and the director of the Center for Gun Violence Prevention at Northwell Health in New York, is among a growing number of clinicians reimagining the role of health-care systems so that providers see themselves as integral to preventing firearm injury in the first place.
One of Northwell’s innovative efforts is screening all patients who come to the emergency department for their risk of firearm injury. Patients are asked two sets of questions: First, do they have a firearm at home and, if so, it is properly secured? And second, are they at an elevated risk of gun injury? This considers factors such as peer influence and living in an area with a high rate of firearm violence.
It’s crucial that this screening is implemented across the board. Doing so normalizes these questions and makes them part of routine medical care. As Sathya explained, “If we’re asking patients and families about substance use, behavioral health issues, exercise, smoking and wellness, then why aren’t we asking about firearm injury risk?”
Another important part of Northwell’s approach is its intervention. Someone who keeps firearms at home will receive counseling on safe storage then and there. If they don’t already secure their weapons, the hospital will provide them with a gun lock at the time of counseling.
If hospital staff determines someone to be at risk of becoming involved in a gang, that patient will be referred to community violence intervention programs that help to break the cycle of violence. Northwell even hires “credible messengers” — people from the communities they serve, and those who have been shot themselves — to speak with patients while they are in the hospital. They act as case managers to link patients to community resources and offer additional social assistance, such as housing and employment opportunities.
In 2½ years, Northwell’s clinicians have performed more than 40,000 of these screenings across three hospitals. This is remarkable, considering that asking questions about gun violence is hardly something doctors and nurses learn in our training.
Sathya admits that it hasn’t been easy to change clinical practice. The biggest issue, he told me, was simply lack of comfort about raising the issue of firearms. “People think it’s polarizing,” he said. “They think it’s emotionally charged, and they’re nervous to have the conversation.”
What Northwell has seen, though, is that when the conversations are centered on the issue of firearm safety, they are well-received. “This is not political, not about the Second Amendment, not gun ownership,” he said. “Everybody wants no mass shootings and less violence so that their family can be safe.”
Sathya and Northwell’s president, Michael Dowling, have been spearheading efforts to engage health-care leaders across the country to share best practices around what clinicians can do to prevent firearm injuries. One of their projects is a learning collaborative that now involves more than 600 clinicians from 38 states.
Another is a parent-to-parent campaign. When parents decide whether to send their kids to someone else’s house, many ask questions such as whether there is a safety gate around the pool. They should ask also whether there could be access to unlocked guns.
I appreciate this parent-to-parent approach for the same reason I applaud Northwell’s clinician-to-patient conversations: It breaks the taboo around talking about firearms and opens the door to a nuanced and thoughtful dialogue. The aim is not to vilify gun owners or to make a political statement. Rather, it’s about reducing harm and collaborating around the shared priority of child safety, which is a goal everyone should be able to agree to.
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