Firearm injuries are the leading cause of death in children and adolescents in the United States, with about 5,000 injured or killed by firearms each year. As leaders at Cincinnati Children’s saw that trend reflected in their own community, they knew they needed to ramp up the hospital’s efforts to reduce firearm injuries.
On top of refining their ongoing initiatives, the hospital assembled a multidisciplinary task force to identify new, evidence-based interventions. The task force — which included hospital leaders, medical providers, behavioral health practitioners, and in-house experts on gun violence, trauma-informed care, government relations, child abuse, and health equity — developed a framework to guide their public health approach. Their efforts centered on three areas: firearm safety and education, suicide prevention, and violence prevention.
Firearm safety and education
The task force determined robust internal and external education initiatives could move the needle in preventing gun-related injuries. Those efforts include:
- Screening and counseling. Using virtual reality, the hospital trains team members how to effectively talk with patients and families about firearms. “We teach people how to practice all sorts of things in medical school, but we have not historically taught physicians or nurses how to have conversations about firearms. It can be a difficult topic,” said Meera Kotagal, MD, MPH, director of trauma services at Cincinnati Children’s. They also developed a uniform institutional process for distributing gun locks and lock boxes to families based on screening.
- Employee and community education. The hospital provides classes on responding to active assailants and how to stop or slow bleeding in an emergency. Both will become mandatory annual training for employees. The hospital also provides trauma-informed care training for local caregivers, such as staff members working with children in community recreation centers.
- Advocacy and partnerships. The task force has worked with government officials at the local and state levels to address gun violence. They’ve also cultivated relationships with like-minded professional organizations to find opportunities for collaboration.
Violence prevention
Collaborating with University of Cincinnati Health and the city, Cincinnati Children’s is developing a violence intervention program to help break the cycle of violence. It will connect violence-prevention experts with gun violence victims and provide ongoing support in areas such as mental health, education, extracurricular activities, employment, and legal advocacy.
They’re also working with the city to address the root causes of gun violence and devise early-intervention efforts to reduce children’s access to firearms, improve youth support, and cultivate thriving neighborhoods.
Suicide prevention
Cincinnati Children’s participates in the Preventing Youth Suicide Collaborative, a program to improve the identification and care of children at risk for suicide. The hospital has also implemented the Zero Suicide program, a quality improvement model to guide systemwide suicide prevention efforts.
The journey begins with the first step
Though the task force initiatives are in early stages, Cincinnati Children’s is already seeing the fruits of its educational efforts. More than 1,200 employees have received Stop the Bleed training while nearly 2,000 have completed the active assailant module. These numbers will continue to grow as the hospital rolls these programs out to its 19,000 staff members.
Kotagal acknowledges the scale of these multidisciplinary firearm injury efforts requires a substantial institutional commitment and may seem daunting for organizations beginning at square one. Her advice: just begin the work.
“It may not look perfect, and you may be building the plane while you're flying it. But by engaging and starting to think about what the critical issues are, you can make a difference,” Kotagal said. “Ultimately, it’s the only way to begin truly turning the tide on gun violence as a cause of death for kids.”
Total Injury Prevention
Firearm safety is just one facet of Cincinnati Children’s efforts to reduce pediatric injuries. Through its Comprehensive Children's Injury Center (CCIC), the hospital enhances community injury prevention programs and provides resources for families. Among their safety education programs:
- Home. Qualifying families receive a home evaluation and, as needed, safety equipment installed free of charge. Participating families experience 59% fewer ER visits as a result.
- Bikes and helmets. CCIC partners with community agencies to provide educational sessions for safer bicycle, scooter, and skateboard use.
- Pedestrian. “Walk this Way” events teach kids how to safely cross streets and remain vigilant around vehicles.
- Playground. CCIC works with local schools and recreation centers to identify and improve deficiencies in playground equipment and surfacing.
- Car seats. CCIC provides free assistance in installing and checking proper fit of infant/child car seats.
