Skip to main content
Book cover

Pediatric Firearm Injuries and Fatalities pp 111–126Cite as

Emergency Department and Hospital-Based Interventions

  • 256 Accesses

Abstract

Medical centers, particularly emergency departments (EDs), are a frequent touchpoint for children and youth exposed to violence in their homes, schools, and communities. Many circumstances place children at risk for firearm injury, and these circumstances vary with age. Young children encountering a firearm in the home can lead to tragic consequences and severe injury or death, whereas older children and adolescents are more at risk for intentional use of a firearm to harm either themselves or others. There are antecedents of injury that can be identified during a medical encounter, such as the access to firearms, depression, and suicidality. In addition, there are potentially brewing issues of revenge and retaliation that may offer medical personnel a chance to intervene before severe injury or death. This chapter will describe ED and hospital-based assessment and interventions for youth at risk of firearm injury and will focus on limiting access to firearms, preventing suicide, and reducing the incidence and impact of assaults from peer violence.

Keywords

  • Youth violence
  • Suicide
  • Domestic violence
  • Violence prevention
  • Firearm safety
  • Hospital
  • Emergency department

Emergency room doctors speak out on South California gun violence

By Thomas Curwen

August 19, 2013. Los Angeles Times

This is a preview of subscription content, access via your institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-62245-9_8
  • Chapter length: 16 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   64.99
Price excludes VAT (USA)
  • ISBN: 978-3-030-62245-9
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   84.99
Price excludes VAT (USA)
Hardcover Book
USD   119.99
Price excludes VAT (USA)
Learn about institutional subscriptions
Fig. 8.1

Suggested Readings

  1. Adhia A, Kernic M, Hemenway D, Vavilala M, Rivara F. Intimate partner homicide of adolescents. JAMA Pediatr. 2019;173(6):571–7.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  2. Ahmedani B, Simon G, Stewart C, Beck A, Waitzfelder B, Rossom R, et al. Health care contacts in the year before suicide death. J Gen Intern Med. 2014;29(6):870–7.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  3. Barkin S, Finch S, Ip E, Scheindlin B, Craig J, Steffes J, et al. Is office-based counseling about media use, timeouts, and firearm storage effective? Results from a cluster-randomized, controlled trial. Pediatrics. 2008;122(1):e15–25.

    CrossRef  PubMed  Google Scholar 

  4. Becher EC, Christakis NA. Firearm injury prevention counseling: are we missing the mark? Pediatrics. 1999;104(3):530–5.

    CrossRef  CAS  PubMed  Google Scholar 

  5. Butts J, Gouvis Roman C, Bostwick L, Porter J. Cure violence: a public health model to reduce gun violence. Annu Rev Public Health. 2015;36:39–53.

    CrossRef  PubMed  Google Scholar 

  6. Carter PM, Walton MA, Roehler DR, Goldstick J, Zimmerman MA, Blow FC, et al. Firearm violence among high-risk emergency department youth after an assault injury. Pediatrics. 2015;135(5):805–15.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  7. Chong VE, Smith R, Garcia A, Lee WS, Ashley L, Marks A, et al. Hospital-centered violence intervention programs: a cost-effectiveness analysis. Am J Surg. 2015;209(4):597–603.

    CrossRef  PubMed  Google Scholar 

  8. Conway PM, Erlangsen A, Teasdale TW, Jakobsen IS, Larsen KJ. Predictive validity of the Columbia-suicide severity rating scale for short-term suicidal behavior: a Danish study of adolescents at a high risk of suicide. Arch Suicide Res. 2016;21(3):455–69.

    CrossRef  PubMed  Google Scholar 

  9. Cunningham R, Knox L, Fein J, Harrison S, Frisch K, Walton M, et al. Before and after the Trauma Bay: the prevention of violent injury among youth. Ann Emerg Med. 2008;53(4):490–500.

    CrossRef  Google Scholar 

  10. Cunningham RM, Walton MA, Goldstein A, Chermack ST, Shope JT, Raymond Bingham C, et al. Three-month follow-up of brief computerized and therapist interventions for alcohol and violence among teens. Acad Emerg Med. 2009;16(11):1193–207.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  11. Dahlberg LL, Toal SB, Swahn M, Behrens CB. Measuring violence-related attitudes, behaviors, and influences among youths: a compendium of assessment tools. 2nd ed. Atlanta: Centers for Disease Control and Prevention, National Center for injury Prev Control; 2005.

    Google Scholar 

  12. David-Ferdon C, Haileyesus T, Liu Y, Simon T, Kresnow M. Nonfatal assaults among persons aged 10–24 years — United States, 2001–2015. Centers for Disease Control and Prevention MMWR. 2018;67(5):141–5. 

    Google Scholar 

  13. Daviss W, Mooney D, Racusin R, Ford J, Fleischer A, McHugo G. Predicting posttraumatic stress after hospitalization for pediatric injury. J Am Acad Child Adolesc Psychiatry. 2000;39(5):576–83.

    CrossRef  CAS  PubMed  Google Scholar 

  14. De Vries APJ, Kassam-Adams N, Cnaan A, Sherman-Slate E, Gallagher PR, Winston FK. Looking beyond the physical injury: posttraumatic stress disorder in children and parents after pediatric traffic injury. Pediatrics. 1999;104(6):1293–9.

    CrossRef  PubMed  Google Scholar 

  15. Dowd MD, Sege R. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416–e23.

    CrossRef  PubMed  Google Scholar 

  16. DuRant R, Barkin S, Craig J, Weiley V, Ip E, Wasserman R. Firearm ownership and storage patterns among families with children who receive well-child care in pediatric offices. Pediatrics. 2007;119(6):e1271–9.

    CrossRef  PubMed  Google Scholar 

  17. Fein JA, Kassam-Adams N, Gavin M, Huang R, Blanchard D, Datner EM. Persistence of posttraumatic stress in violently injured youth seen in the emergency department. Arch Pediatr Adolesc Med. 2002;156(8):836–40.

    CrossRef  PubMed  Google Scholar 

  18. Fein JA, Kassam-Adams N, Vu T, Datner EM. Emergency department evaluation of acute stress disorder symptoms in violently injured youths. Ann Emerg Med. 2001;38(4):391–6.

    CrossRef  CAS  PubMed  Google Scholar 

  19. Fein JA, Pailler M, Barg FK, Wintersteen M, Hayes K, Tien A, et al. Feasibility and effects of a web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department. Arch Pediatr Adolesc Med. 2010;164(12):1112–7.

    CrossRef  PubMed  Google Scholar 

  20. Fischer K, Bakes K, Corbin T, Fein J, Harris E, James T, et al. Trauma-informed care for violently injured patients in the emergency department. Ann Emerg Med. 2019;73(2):193–202.

    CrossRef  PubMed  Google Scholar 

  21. Fischer K, Schwimmer H, Purtle J, Roman D, Cosgrove S, Current J, et al. A content analysis of hospitals’ community health needs assessments in the most violent U.S. cities. J Community Health. 2018;43:259–62.

    CrossRef  PubMed  Google Scholar 

  22. Fowler K, Dahlberg L, Haileyesus T, Gutierrez C, Bacon S. Childhood firearm injuries in the United States. Pediatrics. 2017;140(1):1–11.

    CrossRef  Google Scholar 

  23. Gairin I, House A, Owens D. Attendance at the accident and emergency department in the year before suicide: retrospective study. Br J Psychiatry. 2003;183:28–33.

    CrossRef  PubMed  Google Scholar 

  24. Gipson P, Agarwala P, Opperman K, Horwitz A, King C. Columbia-suicide severity rating scale: predictive validity with adolescent psychiatric emergency patients. Pediatr Emerg Care. 2015;31(2):88–94.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  25. Goldberg AJ, Toto JM, Kulp HR, Lloyd ME, Gaughan JP, Seamon MJ, et al. An analysis of inner-city students’ attitudes towards violence before and after participation in the “Cradle to grave” programme. Injury. 2010;41(1):110–5.

    Google Scholar 

  26. Goldstick JE, Carter PM, Walton MA, et al. Development of the SaFETy score: a clinical screening tool for predicting future firearm violence risk. Ann Intern Med. 2017;166(10):707–14. 

    Google Scholar 

  27. Grossman DC, Mueller BA, Riedy C, et al. Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA. 2005;293(6):707–14.

    CrossRef  CAS  PubMed  Google Scholar 

  28. Hayes DN, Sege R. FiGHTS: a preliminary screening tool for adolescent firearms-carrying. Ann Emerg Med. 2003;42(6):798–807.

    CrossRef  PubMed  Google Scholar 

  29. Health Research & Educational Trust. Hospital approaches to interrupt the cycle of violence. Chicago: Health Research & Educational Trust; 2015.

    Google Scholar 

  30. Hettema J, Steele J, Miller W. Motivational interviewing. Annu Rev Clin Psychol. 2005;1:91–111.

    CrossRef  PubMed  Google Scholar 

  31. Hildenbrand AK, Kassam-Adams N, Barakat LP, Kohser KL, Ciesla JA, Delahanty DL, Fein JA, Ragsdale LB, Marsac ML. Posttraumatic Stress in Children After Injury: The Role of Acute Pain and Opioid Medication Use. Pediatr Emerg Care. 2020;36(10):e549–e557. 

    Google Scholar 

  32. Juillard C, Smith R, Anaya N, Garcia A, Kahn JG, Dicker RA. Saving lives and saving money: hospital-based violence intervention is cost-effective. J Trauma Acute Care Surg. 2015;78(2):252–8.

    CrossRef  PubMed  Google Scholar 

  33. Karraker N, Cunningham RK, Becker MG, Fein JA, Knox LM, editors. Violence is preventable: a best practices guide for launching and sustaining a hospital-based program to break the cycle of violence. Office of Victims of Crime, Office of Justice Programs, U.S. Department of Justice; 2011.

    Google Scholar 

  34. King CA, Grupp-Phelan J, Brent D, Dean JM, Webb M, Bridge JA, Spirito A, Chernick LS, Mahabee-Gittens EM, Mistry RD, Rea M, Keller A, Rogers A, Shenoi R, Cwik M, Busby DR, Casper TC; Pediatric Emergency Care Applied Research Network. Predicting 3-month risk for adolescent suicide attempts among pediatric emergency department patients. J Child Psychol Psychiatry. 2019;60(10):1055–64. 

    Google Scholar 

  35. Ko SJ, Ford JD, Kassam-Adams N, Berkowitz SJ, Wilson C, Wong M, et al. Creating trauma-informed systems: child welfare, education, first responders, health care, juvenile justice. Prof Psychol Res Pract. 2008;39(4):396–404.

    CrossRef  Google Scholar 

  36. Kramer E, Dodington J, Hunt A, Henderson T, Nwabuo A, Dicker R, et al. Violent reinjury risk assessment instrument (VRRAI) for hospital-based violence intervention programs. J Surg Res. 2017;217:177-86.e2.

    CrossRef  Google Scholar 

  37. Lowe SR, Galea S, Uddin M, Koenen KC. Trajectories of posttraumatic stress among urban residents. Am J Community Psychol. 2014;53(1-2):159–72.

    Google Scholar 

  38. Manual for Compensation Assistance Pennsylvania Victims Compensation Assistance Program [Internet]. In: Pennsylvania Commission on Crime and Delinquency. 2018. Available from: https://www.pccd.pa.gov/Victim-Services/Documents/2018%20VCAP%20Manual.pdf.

  39. Marsac ML, Kassam-Adams N, Hildenbrand AK, Nicholls E, Winston FK, Leff SS, et al. Implementing a trauma-informed approach in pediatric health care networks. JAMA Pediatr. 2016;170(1):70–7.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  40. National Academies of Sciences Engineering and Medicine. Health systems interventions to prevent firearm injuries and death: proceedings of a workshop. Washington, DC: The National Academies Press; 2019.

    Google Scholar 

  41. Nonfatal Injury Data [Internet]. National Center for Injury Prevention and Control, Department of Health and Human Services. 2017. Available from: https://www.cdc.gov/injury/wisqars/nonfatal.html.

  42. Pailler M, Fein JA. Computerized behavioral health screening in the emergency department. Pediatr Ann. 2009;38(3):156–60.

    PubMed  Google Scholar 

  43. Pallin R, Spitzer S, Ranney M, Betz M, Wintemute G. Preventing firearm-related death and injury. Ann Intern Med. 2019;170(11):ITC81-ITC96.

    Google Scholar 

  44. Petrosino A, Turpin-Petrosino C, Hollis-Peel ME, Lavenberg JG. ‘Scared Straight’ and other juvenile awareness programs for preventing juvenile delinquency. Cochrane Database Syst Rev. 2013;20(4):CD002796. 

    Google Scholar 

  45. Price J, Thompson A, Khubchandani J, Wiblishauser M, Dowling J, Teeple K. Perceived roles of emergency department physicians regarding anticipatory guidance on firearm safety. J Emerg Med. 2013;44(5):1007–16.

    CrossRef  PubMed  Google Scholar 

  46. Purtle J, Cheney R, Wiebe DJ, Dicker R. Scared safe? Abandoning the use of fear in urban violence prevention programmes. Inj Prev. 2015;21(2):140–1.

    CrossRef  PubMed  Google Scholar 

  47. Purtle J, Rich LJ, Bloom SL, Rich JA, Corbin TJ. Cost-benefit analysis simulation of a hospital-based violence intervention program. Am J Prev Med. 2015;48(2):162–9.

    CrossRef  PubMed  Google Scholar 

  48. Rich J. Wrong place, wrong time: trauma and violence in the lives of young black men. Baltimore: Johns Hopkins University Press; 2009. p. 232.

    CrossRef  Google Scholar 

  49. Rowhani-Rahbar A, Simonetti J, Rivara F. Effectiveness of interventions to promote safe firearm storage. Epidemiol Rev. 2016;38:111–24.

    PubMed  Google Scholar 

  50. Schwebel D, Lewis T, Simon T, Elliott M, Toomey S, Tortolero S, et al. Prevalence and correlates of firearm ownership in the homes of fifth graders: Birmingham, AL, Houston, TX, and Los Angeles, CA. Health Educ Behav. 2014;41(3):299–306.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  51. Scott J, Azrael D, Miller M. Firearm Storage in Homes With Children With Self-Harm Risk Factors. Pediatrics. 2018;141(3):e20172600. 

    Google Scholar 

  52. Sigel E. Violence risk screening: predicting cyber violence perpetration and victimization. J Adolesc Health. 2013;52:S53.

    CrossRef  Google Scholar 

  53. Simonetti J, Rowhani-Rahbar A, King C, Bennett E, Rivara F. Evaluation of a community-based safe firearm and ammunition storage intervention. Inj Prev. 2018;34:218–23.

    CrossRef  Google Scholar 

  54. UC Davis Health. What you can do initiative [Internet]. Available from: https://health.ucdavis.edu/what-you-can-do/.

  55. Vasiliadis H, Ngamini-Ngui A, Lesage A. Factors associated with suicide in the month following contact with different types of health services in Quebec. Psychiatr Serv. 2015;66(2):121–6.

    CrossRef  PubMed  Google Scholar 

  56. Walton MA, Chermack ST, Shope JT, Bingham CR, Zimmerman MA, Blow FC, et al. Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized controlled trial. JAMA. 2010;304(5):527–35.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  57. Weiss D, Kassam-Adams N, Murray C, Kohser KL, Fein JA, Winston FK, et al. Application of a framework to implement trauma-informed care throughout a pediatric health care network. J Contin Educ Heal Prof. 2017;37(1):55–60.

    CrossRef  Google Scholar 

  58. Wiebe DJ, Blackstone MM, Mollen CJ, Culyba AJ, Fein JA. Self-reported violence-related outcomes for adolescents within eight weeks of emergency department treatment for assault injury. J Adolesc Health. 2011;49(4):440–2.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  59. Winston F, Kassam-Adams N. AfterTheInjury.org: Center for Injury and Prevention- Children’s Hospital of Philadelphia; 2014. Available from: https://www.aftertheinjury.org/.

  60. Wolk C, Van Pelt A, Jager-Hyman S, Ahmedani B, Zeber J, Fein J, et al. Stakeholder perspectives on implementing a firearm safety intervention in pediatric primary care as a universal suicide prevention strategy: a qualitative study. JAMA Network Open. 2018;1(7):e185309.

    CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital of Philadelphia at the University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Joel A. Fein

Authors
  1. Joel A. Fein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joel A. Fein .

Editor information

Editors and Affiliations

  1. Department of Pediatrics, Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Dr. Lois K. Lee

  2. Department of Pediatrics, Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Dr. Eric W. Fleegler

Rights and permissions

Reprints and Permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Fein, J.A. (2021). Emergency Department and Hospital-Based Interventions. In: Lee, L.K., Fleegler, E.W. (eds) Pediatric Firearm Injuries and Fatalities . Springer, Cham. https://doi.org/10.1007/978-3-030-62245-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-62245-9_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-62244-2

  • Online ISBN: 978-3-030-62245-9

  • eBook Packages: MedicineMedicine (R0)