A Simulation-Based Curriculum on Best Practices for Firearms Safety

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A Simulation-Based Curriculum on Best Practices for Firearms Safety


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Category: |Journal: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health (full text)|Author: A Ketterer, E Ullman, J Lewis, N Dubosh, V Novack|Year: 2019

Background

Gun violence in the United States is a significant public health concern, and emergency departments (ED) have been found to be at risk for the entry of firearms. Emergency providers (EP) have been shown to have low levels of familiarity with firearms. Given the risks for encountering firearms while at work in the ED, EPs may benefit from dedicated training on safely handling firearms.Educational

 

Objectives

After participation in this curriculum learners will be able to 1) describe safety measures if a firearm is found on a patient in the ED; and 2) demonstrate the ability to safely remove a firearm from the clinical work space until it can be secured by security personnel.

 

Curricular Design

Participants included medical students rotating on their emergency medicine (EM) sub-internship and EM bootcamp elective. An eight-item competency checklist was created by a group of attending EPs and hospital security personnel in accordance with gun safety standards, using a modified Delphi approach. Each student was asked to evaluate a patient with dyspnea during a regular simulation session. A model handgun was placed in the patient’s belongings, and upon discovering it the students were asked by the nurse to remove the firearm. The students’ baseline performance was evaluated using the checklist. Students then participated in a small group, hands-on didactic on how to safely handle firearms found in patients’ belongings. Students completed surveys regarding their baseline knowledge of, exposure to, and comfort with handling firearms. Two weeks later, the students were again presented with a model firearm in a different high-fidelity simulation case and asked by the nurse to remove the firearm. Students were evaluated using the checklist, and directed individual feedback was given.

 

Impact/Effectiveness

Fourteen students completed the curriculum. The median number of correctly performed steps pre-intervention was 5 (interquartile range [IQR] 4-6), and post-intervention was 7 (IQR 7-8, p = 0.002). Learners showed statistically significant improvement in two steps: pointing the firearm in a safe direction at all times (3/14 to 14/14, p = 0.001); and holding the firearm by the grip only (6/14 to 14/14, p = 0.008). This innovation is the first to formally teach learners on the safe handling of firearms found in the ED. This low-cost pilot project is easily transferrable to other training centers for teaching principles of safe firearms handling.

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