1 00:00:00,000 --> 00:00:05,000 Global Cast MD, along with Cincinnati Children's Hospital, 2 00:00:05,000 --> 00:00:08,000 sharing knowledge to improve child health around the globe. 3 00:00:08,000 --> 00:00:15,000 Hello, Pediatric Surgery family. 4 00:00:15,000 --> 00:00:20,000 I'm Amgodi, a research fellow from Cincinnati Children's Hospital Medical Center. 5 00:00:20,000 --> 00:00:25,000 Our 11th annual update course in pediatric surgery was held past August. 6 00:00:25,000 --> 00:00:29,000 In this video series, we'll recap the sessions and share the main highlights with you. 7 00:00:29,000 --> 00:00:34,000 We are seeing a lot of penetrating trauma in the U.S. 8 00:00:34,000 --> 00:00:39,000 and there are more and more firearm injuries, even in younger kids. 9 00:00:39,000 --> 00:00:45,000 Sadly, firearms are now the leading cause of death in old children and adolescents in the U.S. 10 00:00:45,000 --> 00:00:49,000 overtaking motor vehicle crashes in 2019. 11 00:00:49,000 --> 00:00:54,000 And today, Doctors Mira Kodagal and Katie Russell will help us understand 12 00:00:54,000 --> 00:00:59,000 what to do for firearm screening and prevention of firearm injuries. 13 00:00:59,000 --> 00:01:03,000 Firearm injuries, the leading cause of death for kids, unfortunately, in the United States now, 14 00:01:03,000 --> 00:01:06,000 luckily not necessarily the same around the world. 15 00:01:06,000 --> 00:01:10,000 So this is an eight-year-old who's got a gunshot wound to the abdomen. 16 00:01:10,000 --> 00:01:14,000 He was playing with his four-year-old brother and he was unintentionally shot. 17 00:01:14,000 --> 00:01:16,000 What might you have done to prevent this? 18 00:01:16,000 --> 00:01:23,000 What are people doing in your hospital routinely in the room around firearm safety and education? 19 00:01:23,000 --> 00:01:28,000 What we as physicians and surgeons that take care of all these kids in partnership with our ED colleagues 20 00:01:28,000 --> 00:01:33,000 and pediatricians and others, is how do we improve safety and how do we reduce firearm injuries, 21 00:01:33,000 --> 00:01:38,000 some of which is about safety and some of which is about social determinants and community-level violence, 22 00:01:38,000 --> 00:01:41,000 both being really important. 23 00:01:41,000 --> 00:01:46,000 There are really great examples and toolkits out there of things you can use in your own hospital 24 00:01:46,000 --> 00:01:51,000 so you don't have to reinvent the wheel of understanding how to do firearm counseling. 25 00:01:51,000 --> 00:01:55,000 The Bullet Points Project is a great source of information in Ohio. 26 00:01:55,000 --> 00:01:59,000 The AAP chapter in Ohio has a program called Store It Safe, 27 00:01:59,000 --> 00:02:04,000 which can be used and there's material and you can literally just transfer them into your institution. 28 00:02:04,000 --> 00:02:11,000 Cincinnati Children's Hospital started a firearm-related injury task force to try to address this problem in community, 29 00:02:11,000 --> 00:02:16,000 recognizing that it includes both a focus on safety and education and suicide prevention, 30 00:02:16,000 --> 00:02:19,000 as well as community-level violence prevention. 31 00:02:19,000 --> 00:02:24,000 So we're doing stuff all across the board and this is actually going to become part of the Committee on Trauma, 32 00:02:24,000 --> 00:02:29,000 using this as a foundation to think about how we could share resources across the institutions 33 00:02:29,000 --> 00:02:33,000 and how hospitals and individual institutions might take a role. 34 00:02:33,000 --> 00:02:36,000 We know now that it's the leading cause of death in kids. 35 00:02:36,000 --> 00:02:42,000 Do we know where and how the majority of those are being shot? 36 00:02:42,000 --> 00:02:44,000 Is it in schools or is that a tiny percentage? 37 00:02:44,000 --> 00:02:49,000 So the American College of Surgeons did a non-fatal firearm study out of the Committee on Trauma 38 00:02:49,000 --> 00:02:54,000 and that data has just been finalized and collected and so the first pediatric paper will come out. 39 00:02:54,000 --> 00:02:56,000 The schools are a tiny part. 40 00:02:56,000 --> 00:03:01,000 When we look at percentages, it's something between 50 and 60 percent are assault-related. 41 00:03:01,000 --> 00:03:06,000 A lot of them are bystander injuries and then about 30 percent are unintentional. 42 00:03:06,000 --> 00:03:11,000 So kids who are playing with firearms are otherwise engaging with them at home 43 00:03:11,000 --> 00:03:15,000 because they're not safely stored and then the remaining are self-inflicted. 44 00:03:15,000 --> 00:03:21,000 Mike Nance has published a study in JAMA that the majority are self-inflicted coming out of rural communities. 45 00:03:21,000 --> 00:03:25,000 We continue to see that the rural-urban divide is very different. 46 00:03:25,000 --> 00:03:31,000 In the rural population, we are much more likely to see self-inflicted injuries, both in adults and kids. 47 00:03:31,000 --> 00:03:35,000 In the urban population, assaults remain the predominant source 48 00:03:35,000 --> 00:03:39,000 and I think we have to recognize that one size doesn't fit all for all communities 49 00:03:39,000 --> 00:03:45,000 in terms of how we reduce injury, but recognizing that we have to both do the safety part. 50 00:03:45,000 --> 00:03:50,000 But if you live in a community where you don't feel safe, walking up to you and tell you 51 00:03:50,000 --> 00:03:54,000 it'll be really great if you could store your gun separately from the bullets, 52 00:03:54,000 --> 00:03:58,000 locked in a safe, is not going to be an effective strategy. 53 00:03:58,000 --> 00:04:04,000 You have to think about how we do community violence reduction by targeting drivers of community-level violence. 54 00:04:04,000 --> 00:04:07,000 The biggest of that is poverty and economic opportunity. 55 00:04:07,000 --> 00:04:12,000 This is work being done by some of our pediatric colleagues in Cincinnati, Matt Zalkoff and Joe Reel, 56 00:04:12,000 --> 00:04:18,000 and they're doing virtual reality counseling and screening and providing opportunities for folks to get training in that. 57 00:04:18,000 --> 00:04:22,000 VR counseling is something that's going to continue to develop and grow, 58 00:04:22,000 --> 00:04:29,000 but it's a strategy by which we can help people become comfortable with these conversations, but in a virtual reality way. 59 00:04:29,000 --> 00:04:33,000 Really cool work that's happening and I think will continue to grow and be widely available. 60 00:04:33,000 --> 00:04:39,000 The more we know where they're getting shot, we can actually do point of location measures. 61 00:04:39,000 --> 00:04:44,000 Are there innovations we could do in the schools? Are there innovations we could do if it's bystanders? 62 00:04:44,000 --> 00:04:50,000 Is there some way we can, for getting all the prevention stuff to stop people actually getting hit by bullets? 63 00:04:50,000 --> 00:04:58,000 In our lab we had talked about what kind of innovations can we do to just stop people getting shot even if you can't control the guns. 64 00:04:58,000 --> 00:05:06,000 The data that we have is poor and part of what you'll see in these papers that come out from the ACS firearm study is that we don't actually collect that data very well. 65 00:05:06,000 --> 00:05:13,000 So the amount of missingness in terms of the data is huge and that is a reflection of how we collect data when these kids come in. 66 00:05:13,000 --> 00:05:19,000 We don't actually know as much as we should because we're not really asking people, did it happen at the school? 67 00:05:19,000 --> 00:05:22,000 Were you close to home? What kind of weapon? Did you know the person? 68 00:05:22,000 --> 00:05:27,000 All of those things are pieces of information that we continue to need in order to make interventions. 69 00:05:27,000 --> 00:05:31,000 It's a topic that really can't be done on a national basis. 70 00:05:31,000 --> 00:05:36,000 It can to give us a big picture, but everybody's local environment for this is going to be so different. 71 00:05:36,000 --> 00:05:42,000 Like my environment, I can tell you 100% is suicide in rural environments, right? 72 00:05:42,000 --> 00:05:47,000 So what I have to work on is locking the guns and getting the ammunition separate. 73 00:05:47,000 --> 00:05:48,000 That's what I have to work on. 74 00:05:48,000 --> 00:05:49,000 Exactly. 75 00:05:49,000 --> 00:05:52,000 Now Mira's situation is probably very different than mine. 76 00:05:52,000 --> 00:05:57,000 In summary, firearm injuries are the leading cause of death for children in the U.S. 77 00:05:57,000 --> 00:06:02,000 Prevention measures, including firearm safety education in hospitals, are crucial. 78 00:06:02,000 --> 00:06:12,000 There are available toolkits for firearm counseling, such as the Bullet Points Project and the Stored Safe Program from Ohio's AAP chapter. 79 00:06:12,000 --> 00:06:21,000 While school shootings gain attention, the majority of incidents involve assaults, bystanders, unintentional injuries and self-inflicted wounds. 80 00:06:21,000 --> 00:06:26,000 Rural areas see more self-inflicted cases, while urban areas experience assaults. 81 00:06:26,000 --> 00:06:31,000 Virtual reality counseling is an emerging strategy to facilitate firearm safety conversations. 82 00:06:31,000 --> 00:06:38,000 Interventions require a thorough data, which is currently lacking, and regional differences should be considered. 83 00:06:38,000 --> 00:06:40,000 Thank you for watching this video. 84 00:06:40,000 --> 00:06:44,000 Don't forget to subscribe to the Stay Current MD YouTube channel. 85 00:06:44,000 --> 00:06:51,000 Follow our social media channels and download the Stay Current MD app for tons of content in pediatric surgery. 86 00:06:51,000 --> 00:07:14,000 Global Caste MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.