From left to right: Parthi Desai, Angelique Richard, Andra Medea, Elizabeth Sheesley Martin, and Jose Prince

Clinicians are on the front lines in caring for gunshot victims. The continuous flow of these victims to emergency departments has sparked the medical community to speak out on ways to reduce the violence. Dr. Jose Prince, vice president & system chief, pediatric surgical services, at Northwell Health, says he has cared for hundreds of children who have been shot, adding that discussions about safety and access to guns do not impinge on the rights of responsible gun owners.

“I see this as a public health issue that affects all of us in every community we’re in,” Prince said.

Prince’s comments came during a panel Wednesday during the MedCity News INVEST conference in Chicago. He was joined by Angelique Richard, chief nursing officer at Rush University Medical Center; Andra Medea, founder of C3 De-escalation; and Elizabeth Sheesley Martin, workplace violence prevention counselor at UC Davis Health. The panel was moderated by Parth Desai, principal, Flare Capital Partners.

As gun violence worsens, Rush has increased the number of drills it conducts to improve staff preparedness, Richard said. The medical center has completed an assessment of all of its campuses and engaged a security firm to help with solutions. Those solutions include weapons detection systems in high-risk areas, such as the emergency department.

Similar to Rush, New York City-based NorthWell has hardened so-called soft targets, Prince said. But he added that these measures can only go so far. For example, they would not stop a domestic violence situation that leads to a killing in a parking lot. Prince said that while gun violence must be addressed as a public health issue, there has not been much research about preventing firearm injury.

Some healthcare providers are taking the initiative to gather and disseminate information about firearm violence prevention. The BulletPoints Project in California provides resources that help clinicians learn how to discuss firearms with patients and how to communicate with patients who are at risk of gun violence. Funded by the state of California, BulletPoints developed from the violence prevention research of Amy Barnhorst, a psychiatrist at UC Davis Health. Martin, a workplace violence prevention counselor at the health system, said that this project provides training that helps clinicians understand what they can do to prevent gun violence.

Hospital administrators sometimes view hospital violence as a sudden event, but it does not always unfold that way, said Medea, whose C3 de-escalation techniques are used in mental health settings, law enforcement, crisis centers, courts, and schools. Medea gave an example of a hospital behavioral unit that frequently took in transports from the sheriff’s office in the early morning hours. These patients often spent hours in handcuffs without food, water, or access to a bathroom. The intake process was often disruptive, leading to calls to security.

Using Medea’s de-escalation approach, the hospital changed its intake process. When those sheriff’s transports came in, the first contact with the hospital was someone offering food to put them at ease. Paperwork came later. This procedural change decreased disruptions.

“They simply don’t get calls from that floor anymore,” Medea said.

Technology can play a role in helping to prevent disruptive situations. For example, the wait time for a hospital bed can range from hours to days. Software can inform patients, Medea said. Adults have a need to know what’s going to happen to them next, she explained. If they don’t know, they feel disrespected and become angry. A device that they can check periodically or a notification on their phones can provide them with enough information that has the effect of preventing them from violently seizing control, Medea said.

In some cases, the presence of uniformed people, such as security and police, has the effect of escalating a situation, Martin said. UC Davis Health has several different training programs that employ non-violent intervention techniques. Patient-facing staff members are trained to deal with verbal and physical confrontations. The training extends to those who answer the phones because they often receive threats. Prince said it’s also important to provide help to healthcare providers and hospital staff after an incident. That response can come from chaplains and others, he said.

Photo: MedCity News