Incorporating gun safety into clinical practice

Incorporating gun safety into clinical practice – includes patient information sheet

Pamela A. Camosy

Many of the patients cared for by family physicians are at risk for firearm injury or death. Awareness of the risk factors enables physicians to incorporate firearm safety into clinical practice. In addition, physicians can speak out for firearm safety in the arenas of public education and legislative advocacy.

Most physicians have read newspaper reports of children accidentally killed with firearms that were not safely stored by their parents. Many physicians respond to such reports with frustration or anger, realizing that, unlike most conditions physicians treat, such deaths are totally preventable. Violence in general is increasing at a disturbing rate, and public leaders are debating the best path toward a safer America. Among those leaders are medical groups, which view violence from a public health perspective: violence as an epidemic that is causing increasing morbidity and mortality. Can the violence problem be defined in terms of risk factors for which appropriate primary and secondary prevention can be provided? Can an individual physician take steps to protect patients from firearm injury?

There is a clear need for physicians to incorporate firearm safety issues into clinical practice and become involved in the public health approach to decreasing morbidity and mortality caused by improper firearm use. While the debate over firearm control rages, one approach on which everyone can agree is keeping firearms out of the hands of children, adolescents and mentally unstable people. In the same way the medical community was instrumental in making automobile and bicycle travel safer through seat-belt, car-seat and helmet legislation, physicians can incorporate firearm safety into clinical practice and become involved in the effort to decrease firearm morbidity and mortality.

Magnitude of the Problem

The medical implications of firearm ownership include accidental injury and death, homicide and suicide. Firearm use/misuse is now the eighth most common cause of death in the United States, claiming almost 40,000 lives each year, second only to motor vehicle accidents as a cause of fatal injury.[1,2] Firearms now rank second as the cause of accidental death in children 10 to 14 years of age, accounting for 72 percent of homicides in this age range.[3] Most children who unintentionally kill themselves or others while playing with a gun find the weapon in their home.[4] With 40 percent of homes in the United States containing one or more firearms, family physicians care for many people at risk for firearm injury.[5]

Reasons most commonly cited for ownership of handguns include protection (66 percent), collecting (25 percent) and hunting (15 percent).[5] Between 10 and 20 percent of homes with handguns contain guns that are loaded or not locked away, or both.[5] Table 1 lists risk factors for loaded firearms in the home.[6] Since a contributing factor in many accidental firearm deaths is the belief that the gun was not loaded, when in fact it was, patient education aimed at safe firearm storage might save the lives of many of our patients.[7]

TABLE 1

Risk Factors for a Loaded Firearm

Being in the Home

Handgun (more so than rifle)

Firearm not locked up

Firearm owned for protection (more so than for

sport)

No children live in the home

Southern United States

Nonwhite (more so than white)

Data derived from reference 6.

COPYRIGHT 1996 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group