Experiences with and perspectives on firearm injury prevention among emergency medical services clinicians

Abstract Background Firearm-related injury is a significant public health problem in the United States. Emergency medical services (EMS) personnel are uniquely positioned to recognize and counsel individuals at risk, but little is known about their firearm screening and counseling practices, experience with firearms, and training needs. To address these knowledge gaps and inform training efforts, this study examined the current and potential role of EMS clinicians in firearm injury prevention. Methods A 22-item survey was e-mailed to EMS agencies, predominantly in California and Nevada. EMS clinicians who had worked 5 + shifts in the previous three months were eligible to participate. Question topics included: participant characteristics, recent encounters with at-risk patients, career exposure to firearm risk situations, experience with firearms, and training on firearm injury prevention. Descriptive statistics were calculated, and write-in responses were analyzed thematically. Results Among 234 participants, 75% reported that at least some of their calls in the past three months involved someone at risk of firearm-related injury. Among those who responded to at-risk patients, 47% reported that they never asked these patients about firearm access and 88% said that they did not provide them with education/counseling on firearm injury prevention. 76% were at least somewhat worried about being injured by a firearm while on duty, and 19% reported having had a firearm drawn on or used against them during a call. Participants reported being on duty without law enforcement when firearms were accessible to suicidal patients (70%), to children (47%), and in domestic violence situations (49%). Approximately 70% reported current or previous firearm ownership, and 82% felt comfortable handling firearms. More than one-third had not received medical education on firearm injury prevention, and 85% expressed interest in future training. Conclusions As the sole health care providers for many patients and given their unique prehospital perspective, with additional training, EMS clinicians can expand their role in firearm injury prevention. Training should: respect the right to own firearms; prioritize a risk-based approach to firearms screening; highlight interventions for reducing firearm injury risk; address the increased risk of firearm injury among EMS clinicians; and align with local policies, including those involving law enforcement. Clinical trial number Not applicable

Two pulmonary emboli in a psych pod

Abstract Background A female patient known to have schizoaffective disorder self‐presented to an emergency department in a state of acute agitation and paranoia shortly after a 35‐day inpatient stay at a psychiatric facility. Case report The patient exhibited no signs or complaints of dyspnea or hypoxia, but later collapsed and became hypoxic after sleeping comfortably with sedation for 12 h in the psychiatric unit. She was intubated and a computed tomography angiogram revealed bilateral lobar pulmonary emboli and right heart strain. Conclusion Psychiatric hospitalizations, medications, diagnoses and relevant sequelae increase venous thromboembolism risk more than many realize