Standing AFFIRM: A public health lesson from a… : Emergency Medicine News


public health, firearm injury prevention, gun safety


It is good to pause from time to time to reflect on where we are as a profession, what we are doing and where we want to go. It may be time to try something new if we are not getting the desired results. Now is the time for those of us working to reduce firearm-related injuries and deaths.

In medicine, nursing and public health, we share the goal of developing health-based approaches to firearm injury prevention. Many consensus conferences have been devoted to it, from the National Academies of Sciences, Engineering and Medicine ( at Northwell Health ( at the American College of Surgeons (, to only cite a few.

Since firearm safety is not part of our medical training, our profession is developing training and guidance to discuss the safe storage of firearms and advice on lethal means in patients at risk of self injury. -inflicted and interpersonal. Many physicians own and use firearms, but most do not, and this training establishes a skill we all need when discussing firearms with our patients.

As health care providers, we understand all too well the consequences of the misuse of firearms. Few understand the trauma of penetrating gunshot wounds and their catastrophic ripple effects as we do. And we realize that firearm injuries and deaths are ultimately a human behavior issue influenced by determinants of mental, physical and social health that establish an individual’s capacity to cause harm.

Avoid traumatic consequences

Combining the ability to harm with the ability to use lethal means can lead to traumatic health outcomes that we all wish to avoid. We physicians seek to mitigate this risk in any way possible, which requires understanding and addressing the capacity and opportunity for firearm injury in those at risk for all forms of harm: violence between intimate partners, suicide, targeted violence and cognitive decline among them.

Because the public health approach requires involving the people who make up the public, I attended the National Shooting Sports Foundation (NSSF) SHOT Show 2022, the firearms industry’s largest trade show in the United States (47,000 participants; The firearms industry includes not only manufacturing, as many may assume, but also firearms training, retail, distribution, marketing, and media. Of course, the main focus of the event was trade, but another subject was at the center of everyone’s concerns: security.

Gun safety figured prominently in the media and organizational activities throughout the industry. The safe storage of firearms, especially around children, a priority among physicians, has been addressed extensively and repeatedly, including through the widely successful ChildSafe project by NSSF. (

Suicide prevention is another priority for the firearms community, which has mounted a broad and robust response to this epidemic through many effective, evidence-based, and trusted programs. Among the many examples are Hold My Guns (, a growing national network of gun shops and individual federal firearms license dealers that works with gun owners to provide safe offsite firearm storage during times of crisis, and the Overwatch Project, a peer-to-peer network dedicated to preventing veteran suicide through a model based on the “friends don’t let friends drive drunk.” (

Work together

But we must address all of the complex mental, physical and social health issues that influence behavior to reduce the risk of injury and prevent firearm injuries at all levels. Organizations like the US Concealed Carry Association ( and the National African American Gun Association (, among others, maintain a growing library on health topics ranging from prejudice and human trafficking to aging and cognitive decline.

It’s the “public” in the public health approach, and they practice injury prevention and harm reduction strategies with an intensity and impact that we as medical professionals struggle with. to reach. However, despite their effectiveness, vigor and established channels, these programs and this community have not been included in our medical consensus conferences or educational initiatives.

Why is our healthcare industry working separately from the firearms industry on the same basic topics? I’ll get to those reasons next month, but relations between the medical profession and the firearms industry have been strained at best and openly antagonistic at worst. This high-level discord between industries carries over to our individual relationships at the bedside. We have lost the trust of this community and must dedicate ourselves to the work of restoration.

No one wants to see firearms misused. Everyone agrees that there are too many preventable firearm injuries and deaths in this country. We all want to work to reverse this trend. We would do well to pause at this point, reflect on progress, and seek a space where we can build trust to collaboratively develop, improve, and deploy the public health approach to firearm injury prevention. that our society needs.

Dr. Barsottiis the director of the AFFIRM program at the Aspen Institute, a program dedicated to reducing firearm injuries in the United States through nonpartisan health-based approaches. He is also a community practice emergency physician at Berkshire Medical Center in Pittsfield, MA, and a certified 4-H Youth Rifle Safety Instructor. Read his past columns on, find more information about AFFIRM at, and follow the foundation on Twitter@ResearchAffirm.

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