232: Health Care Providers Tackle Gun Violence From Triage to Training

Gun violence takes a massive toll on the US healthcare system and medical professionals. To discuss how, hosts Kelly and JJ were joined by Dr. Christine Petrin and Dr. Babak Sarani, who shed light on this pressing issue. Together, we delve into the emotional and physical ramifications, illustrating the stark reality through a heartbreaking story of a patient who suffered gunshot wounds on multiple occasions. 

We also underline the cruciality of discussing safe gun storage and usage, proving that advocating for gun control isn't the only answer. Shifting the narrative, Dr. Petrin and Dr. Sarani open up about their journey to create a firearm curriculum for medical professionals, and how important it is for health care providers and patients to be able to speak about firearms and firearm safety.

Further reading:
Gun Violence Prevention strives to create a safer and healthier community by reducing the incidence of gun violence and its impact on individuals, families, and society as a whole. (Doctors for America)
Stop filling our Trauma Centers with your thoughts and prayers. (#ThisIsOurLane)
#ThisIsOurLane — Firearm Safety as Health Care’s Highway (the New England Journal of Medicine)
This Is Our Lane: Mobilizing the Medical Community (Brady)
Doctors and hospitals can help prevent gun deaths. (Association of American Medical Colleges)
How Doctors Suffer from America's Gun Violence Problem (Time)

Transcript

Speaker 1: 0:08

This is the legal disclaimer, where I tell you that the views, thoughts and opinions shared on this podcast belong solely to our guests and hosts, and not necessarily Brady or Brady's affiliates. Please note this podcast contains discussions of violence that some people may find disturbing. It's okay, we find it disturbing. Hey everybody, welcome back to another episode of Red, Blue and Brady. I'm one of your hosts, JJ, and I'm your other host, Kelly.

Speaker 1: 0:49

And today, kelly and I have the honor of sitting down with two doctors. You've got Dr Christine Petron and Dr Babak Sarani, both of whom are sitting down with us to talk about all the different ways that folks working in healthcare can be joining in for the fight against gun violence.

Speaker 2: 1:05

Yeah, and this is a great episode if you're a medical professional, it's also a great episode if you're not a medical professional, because hearing from doctors who are on the immediate response to someone who has suffered from a gunshot wound and also along the journey of healing, really shows us the toll of gun violence, not just in the immediate moments but in the years to come, both on the people who are shot and also on the medical professionals who care for them.

Speaker 3: 1:36

So I'm Christine Petron. I'm a third-year resident at Georgetown. I'm doing a combined residency in internal medicine and pediatrics, so I see both adults and kids and I got interested in gun violence prevention really by seeing the difference in how these two professions are handling it. On the pediatrics side, I feel like we do a pretty good job of screening other guns in the home. We put that in the bucket of all of our other safety questions Are you wearing your helmet? Are you wearing your sunscreen? It's a normal part of our interview process and on the internal medicine side it's really just not a part of the adult visit. At least as part of my training so far, and seeing that discrepancy and trying to grapple with the news I'm seeing when I come home at night and what can I do to help fix everything that's going on in the world and address gun violence in a clinical setting that's one reason I got more involved in this advocacy Phenomenal.

Speaker 2: 2:26

And Dr Therani. What about you?

Speaker 4: 2:28

So my name is Bob Ack Therani. I am the chief of trauma surgery at George Washington University Hospital. I'm a professor in the Department of Surgery and also in the Department of Emergency Medicine, and a couple other hats that I wear with pride is I'm the past chair of the Brady United Against Gun Violence Regional Leadership Council for Washington DC, which is wonderful, and I am the current chair of the American College of Surgeons Committee on Trauma for Washington DC. That's the committee that kind of oversees trauma care for the nation, and I represent Washington DC on the committee. So kind of honored to have those hats to wear. I've been doing trauma surgery since about 2005. And really throughout my career, even during my training, I've just seen tremendous number of gunshot wounds, and the irony is I feel substantially more comfortable taking care of a gunshot wound than, say, a hemorrhoid, because I just see more of them.

Speaker 1: 3:20

And we're going to have to unpack all of that. But we were so thankful that both of you were able to come on and speak with us today and that you're doing work in this area, particularly the advocacy focused work, because, as we're going to talk about, this is a huge burden that's being placed on the healthcare system and on our healthcare workers right Because of gun violence, and I wonder, can we unpack even that a little bit? Because certainly I would assume that a hernia might be a little bit less mentally or emotionally taxing, right when you go home at night, as opposed to say, you know a pediatric gunshot wound, or am I wrong? Are people haunted by the hernias of past, of yesteryear?

Speaker 4: 3:57

Yeah, I mean, look, what you're saying is exactly right. The hernias, even if they're emergency cases, will come to the hospital. By and large we can fix them. By and large they go home and thankfully all as well. The experience for the patient is relatively short-lived, maybe stressful, but they all get over it. And cost to care for them maybe a little bit high initially because you have to go to the operating room and stuff like that, but again it's a short-lived kind of thing.

Speaker 4: 4:20

On Saturday I think of this past week you're not going to phone call from the in-house trauma surgeon. We have a 20-some-odd-year-old gentleman gunshot wound to the abdomen. He has a spinal cord transaction. He'll be paralyzed for the rest of his life, and so the surgeon was you know, appropriately so, I think concerned the individual. The surgeon was taking multiple other traumas and now is handed this person who's in extremis. You know the person goes to the operating room but comes in unable to walk, will be unable to walk and the cost of that outside of his own mental well-being, which is a big, big, big, big big deal that nobody talks about for the rest of his life, just the physical cost alone of the wheelchair and then the source that he's apt to get on his bottom because he can no longer feel anything. You know, his life expectancy has been shortened by decades and it's that simple, you know, I kind of tell people when you look at Christopher Reeve, who was the actor who played Superman so he was a multi, multi, multi-millionaire.

Speaker 4: 5:19

He fell off a horse, broke his neck and was paralyzed. He ultimately died. Most people don't know what Superman died of. Superman died of a soreness, bottom and pneumonia. So if you're a multi-hundred-millionaire and you can't afford to have someone take that meticulous care of you, what do you expect people who are shot in the inner city of America to do? Right? And so this young gentleman, his destiny is sealed. There's nothing we can do for that. And so, whether you look at it in the short term, which is the on-call surgeon, taking all these incoming injured and having to sort through them all, and now you hand the individual, this particular very, very severely injured person, or you look at it in the long term, the primary care physician, who has to deal with all the ramifications for the rest of the patient's life, it's just, I don't know. I'll tell you, man, it's tragic, pathetic, sad.

Speaker 3: 6:09

I don't know what the adjunct is I think to, in addition to the, the mental health burden for the patient who's experience gun violence, the number of my patients who have a loved one who's been a victim of gun violence, and just the I mean the completely different trajectory their life takes after that moment. I've had patients in the I? C? U coming in in complete liver failure because they started drinking or using drugs in the setting of losing a child, both a young child or even a grown child, and their lives are never the same.

Speaker 2: 6:34

it this isn't just one person who gets shot, it's an entire community of people who are unable to recover after an event like that I think something that's coming out from both of you shared is so often we just look at death, but it's whether you survive and, as you said, this person is now going to be susceptible to Source that could kill him or family members. Gun violence has such a big toll and, dr serrani, last year you had a story game attention in washington post and it was about a patient of yours who have been shot For separate times and the last time resulted in him dying. I'm just wondering if you tell listeners a little bit about that story and do you often see sort of repeat patients who come in and they've been shot and then they're shot again?

Speaker 4: 7:20

Yeah, so he's, you know he's. He was in washington post, it was also in all the local news, so you have to search to hard to find him. He's a. He was, I think, a wonderful kid. He arrived to us the first time he was shot. I want to say was, roughly speaking, sixteen years old when he first was shot I may be off by here and his initial wounding he was shot in the chest and the bullet across his lung, his left lung, his heart, his diaphragm, his liver, his stomach and I think, is intestine. And on arrival he cardiac arrest three separate times, three separate times. His heart fully stop and we open his chest. We identified the hole in the heart. We were able to show that shot. We were giving him blood transfusion and because he's such a young kid, he was able to come back as I started beating again and then he was really unstable and so we're wondering like, why is he so unstable? So we open up the abdomen to find that was bleeding aggressively from his liver. So we started fixing the liver. Then we looked around. We saw there's a hole in the stomachs. We fixed the stomach and I think I'm pretty sure there was a hole in the intestine we fixed as well.

Speaker 4: 8:19

By some miracle of god honesty, he survived. And he survived to become to be totally normal. No, like strokes, known brain injury, nothing, despite his heart stopping three times. And I remember I would speak to him. His father was always here. I would speak to him and his father and I said to him you know his name was quarry. I would say, look, quarry you. Whatever led to this event. You can't get shot again. And the reason is, you know, I've operated on your chest and I've operated on your belly and nobody can get into your body again as fast as I did not. I can't do it either, by the way, it's not that I'm magical, it's just that the scars you see on the outside, you know have scars on the inside and the surgeon won't be able to operate as quickly as I did. So you gotta be careful, man. You get shot again like that, you're gonna die.

Speaker 4: 9:02

And the conversations he and I had, both in the hospital as well as in my office, when you would come for his post operative visits, what cori would do is cry. I mean, he would cry a river. I'm talking tears coming out of these young kids eyes. I would hit the ground and is a picture of the two of us on the internet when he came to our trauma survivors day and I introduced him and I offered him to come up and say a few words and he was so distraught he actually could speak. He was. He was so distraught with crying, couldn't speak as I didn't know what to do and I didn't want to be embarrassed in front of everybody. So I just want to hug them. I mean I like what else you gonna do to sixteen year old kid who's completely lost control of his emotions? As a picture of us hugging and I kind of felt for the, for the poor guy did.

Speaker 4: 9:46

And you know, as time went by, I think I think you can talk about from the primary care physician's perspective. He and I caught a lost touch because I'm a surgeon and we were done. You know I was still in our system, still recovering and stuff. I wanna spoke to our injury prevention people. All the trauma centers in the country have a dedicated injury prevention program. You have to have one In order to be a trauma center. I and I'm with all do you know I'm a little biased, I get it, but I think ours is fantastic and so I want to them and I said to them you know, look, you guys, I, you guys do great work every day. I just appreciate everything you do so much. What can you do me a huge favor, please?

Speaker 4: 10:18

Cori is a sixteen year old who was severely injured and his family home situation is not ideal. I can tell you that he's at extreme risk for injury. Can we just bring him into the fold a little bit more than we do others and just put some special attention on this kid? And they did. They went. They went and spoke to my great lengths. They found out that he had some family in philadelphia. They found out that he was kind of hanging out with not not the right crowd, perhaps here in dc, and they tried to facilitate a move from dc to philly. But cori said no, and I can. I can see that from his perspective. I'm not blaming him. He's a teenager, he's in high school. And I telling him why don't you get up and leave and go to some other you know city with no?

Speaker 4: 11:00

After, after you've been shot and everything else to yeah so he said no, and I kinda, you know, fell apart. And so then last next I heard of him was in coven, and I remember this very well cuz he came to my office out of the blue I'm with both wearing masks and I can't see. You know what, what brings you here? And his hand was completely mangled and I was like what happened to you? And he goes. I got shot again and he had sutures in his hand that had been removed his bones and healed correctly. His fingers were crooked. I was a cori, what, what? What happened, man? So I called our hands surgeon here and I said, you know, his name is a doctor, sam, up to dairy. And I said, look, sam, I need you just to me a solid favor. You know, this kid doesn't have insurance, he doesn't have good follow up just to see him in your office and he just needs help. And sam was like, yeah, absolutely, I, no problem, and I know that sam's office try to get a hold of cori. But the phone would just ring and ring and nobody ever picked up. So he never followed up. And then I heard that that was the second or third time he been shot. And then I heard he got shot one more time and the fourth time I heard someone called me and said hey, he never came back to do again for shooting. See must gone either to hospital center or to howard I don't know where, what they call me and said hey, your patient from you know how many years ago cori was just killed and I just that just killed me because I was so predictable and it was so like you know, when you know something bad is going to happen, you think you have the opportunity to prevent that bad thing from happening, like you see it coming. But time and time again we tried and it just failed. Now that's the bad news. There's no superlative to describe what that is. That is insufficient. The good news, if there's anything to be had, is, strangely enough, in the District of Columbia we're a little bit of an outlier and the District we don't see recurrent gunshot wounds. Commonly, the vast majority of people that we see who were shot are shot de novo, and there's an article that actually we just finished writing as a consortium Us, the doctors at hospital center, doctors over at Children's National as well as Howard University Hospital, so all the trauma centers got together and we shared our data, which is not easy, by the way.

Speaker 4: 13:02

When you want to share data like that, the lawyers tend to get involved very quickly. They become very difficult and hospitals in general don't really like to share data right, everyone's always afraid of getting sued. But we somehow convinced the lawyers to let us share data, and by share data I mean like name and date of birth. So we were able to then track and I'll just use my own name. We were able to track, you know, bob Axarani, november 13, 1971, was injured and went to this hospital, and then we tracked by name and date of birth every other admission that Bob Axarani had over the next 10 years. And so if the Corey Riggins episode occurred, where he came to me first and then went to, let's say, medstar or Howard.

Speaker 4: 13:40

Second, we knew that we started off in Children's Hospital because a lot of kids get shot and we wanted to track them from when the kids are shot to and they transition from children to adults. So we knew that too, and we were expecting a very, very high recurrent injury rate. We were expecting a recurrent injury rate somewhere in the order of 20 to 40 percent. We actually found six, six percent.

Speaker 1: 14:01

Can I, can you offer a second? Why were you expecting the rate to be so high?

Speaker 4: 14:05

Because, historically, when you look at like Philadelphia and you look at Chicago, those are the numbers that they found that if you've been shot once, one in five of you will be shot again. That's about 20 percent. And so what led to this project in the first place is I got my first job in Philadelphia and so when I came to DC I would tell people, when you get a gunshot victim, make sure you ask them if they've been shot before. And the reason you have to ask them that is they may have bullets inside them. And when we get X-rays we need to know what bullets are old and what bullets are new. We don't know what to do, but over the course of the last 10 years that have been DC, I kind of kept saying have you been shot before? And they'd be like no, and I would get X-rays and there was no bullets and I was like this is really strange. This is so not like Philadelphia. And so we decided to study it and come to find out. Dc is different. Now, why it's different? I don't know. Some people would say maybe the injury prevention arm in DC is better funded, and it is. I'm not saying it's funded to the point where I would want it to be funded, but it's better funded than perhaps other centers. I think it's because DC is so small and it's just easier to do stuff when you're a small you know a little boat, than when you're an aircraft carrier like Philadelphia. I don't know why DC is different, but what I can tell you is the recurrent injury rate in DC is small.

Speaker 4: 15:15

Having said that, the number of gunshots is, as you know, increasing significantly, and so I think we've stumbled upon something. This is something we're kind of noodling on a little bit ourselves, like all my authors and I of. I think we've identified a way to identify the next people who are going to get shot before they're actually shot. I think I can't prove this. I think if you know someone who's been shot, odds are someone in their geospatial network, whether it's their friends or just their neighborhood or their colleagues in school. They're the vulnerable cohort, because what you find is the gunshots are occurring kind of in that same area, even if it's not Bob Ack getting shot again, it's Bob Ack's friend, bob Ack's classmates, bob Ack's family, whatever. So maybe what we should do is increase, widen the penumbra for injury prevention.

Speaker 4: 16:09

Right now, injury prevention is if I get shot, I get resources, but if I don't get shot, I don't get resources. And I wonder if we should say Bob Ack got shot, all of his people are going to get resources to try to prevent the next shooting. That's what I'm noodling on. But that's like I said, that's a theory I'm not interested in. You want to talk about it from a primary care, like when I'm done with a patient and then you get to see the person in your clinic for the rest of his or her life and your career. How do you guys deal with it?

Speaker 3: 16:36

It's very similar to what you were describing before A lot of sacral wounds, a lot of wound care and making sure that they're there. Luckily, at Georgetown we have access to that, but I'm sure there's plenty of places in the country that don't have wound care centers available. A lot of risk for infection. Like I said, I think the mental health, the mental health pieces is critical.

Speaker 3: 16:54

I think that one other thing that we don't talk a lot about is we're talking a lot about sort of when people think about shootings. I think about school shootings and gang violence and community violence, like you're talking about, but over half of gun violence is suicide. In 2020, I think it was something like 54% of firearm deaths were from suicide, and that number only climbed during the pandemic. A teen kills themselves in this country every seven hours, and I think this is something that we see across medical specialty right. So whether you're in clinic, you're in the emergency department, you're getting admitted to the hospital for suicidal ideation or attempts, even OBGYNs dealing with prepartum or postpartum depression everyone needs to make sure that when we're doing our depression screening and our counseling, that we're screening to see if the access of guns in the home, because those numbers are really just staggering.

Speaker 1: 17:40

When we're doing and we'll get into the nitty gritty of some of the screenings later on, which I think is really important. But for folks who maybe haven't been to the doctor, haven't been in a while, when we're doing those pre screenings, are there questions for other things that may cause harm to an individual that comes up? Is it you know? Would you like a quite kind of the firearm part of the screening, for the same as when they're asking you know if you do any substances, if you smoke, you know how much do you drink? That sort of thing.

Speaker 3: 18:06

Absolutely, and this is why it's so important to wrap it into this bucket of just your regular safety questions. These are just my non-judgmental, routine run of the mill questions about safety Are you wearing your helmet? Are you wearing your sunscreen? Do you have a smoke detector at home? For my older patients I ask about you know, are you having safe sex? Are you? I do my intimate partner violence screening for people as well. It's all just sort of routine questions and this needs to be something that we routinely ask our patients and kind of just put it into that bucket of things that we are ready to ask.

Speaker 2: 18:39

And it just to kind of make sure I understand you were saying that right now on the whole tends to be in the pediatric space the gun violence screeners are part of it but not in the adult space, and that's something that you're trying to to to advocate for in the adult space as well.

Speaker 3: 18:58

Yes, exactly, and I think, too I, as wonderful as it is, and on the pediatric side we ask the question I think there's still a lot of lack of training and knowledge and confidence and actually counseling on. You know, when a patient says, well, yes, we do have a gun at home, I know when I first started I would sort of say, okay, great, and you're everything safe there, right, great, and move on. I had no idea what language to use or how to ask them questions, how to make sure that, like, they were practicing safe storage, and so I think there's there's room for improvement on both ends. And you know the other piece that I think is really important when I started residency only three years ago, the lead and cause of death in children was car accidents, as we all know.

Speaker 3: 19:38

Now that's not the case. It's gun deaths. It's wild that I have come to residency to learn how to study and treat and improve the health of children and adults. Here I am. It's not the respiratory illnesses, it's not the pediatric cancers or any of the other things, that I'm sitting here spending four years in my life learning to treat it's bullets, and it's something that can't not be part of my practice anymore.

Speaker 2: 20:03

If I know. Some people listening to this might be thinking well, I don't want you all to have my guns, they're sacred to me, or maybe I shouldn't have one, but I have one anyway. I'm wondering if I'm a patient and I come in and you're asking me the screeners, and you say, do you have a gun at home? And I say yes, what does that conversation look like? And is it confidential? I assume it is, but just what actually would happen next?

Speaker 3: 20:32

I can try to answer this first, dr Sarani, and then pass it over to you, but we know that patients want to have these conversations. There's data on this. We know that the majority of patients, including those who own firearms, believe it's within the role of a physician to counsel on firearm safety. As long as it's done appropriately and you're right these conversations can go very well. They can go very badly. That's something that Dr Sarani and I have worked on to think about how we can teach trainees and other providers how to counsel in a way that's non-judgmental and non-stigmatizing. I've had patient interactions start to go poorly. I've had patients say why are you bringing up something political? I don't want to talk about this, but 100 percent of the time when I bring it back to the issue of safety, we get back on track. The patient engages in the conversation. I have never lost a patient from having this conversation. They always come back.

Speaker 4: 21:22

Yeah, I think it comes down to no one's saying get ready a gun, just for the record. You can have whatever gun type you like, whether it's a handgun, shotgun or I'll even dare say an assault weapon. You can buy that legally. And that it is what it is, my friend. The point is to store it safely, store it responsibly and make sure that those who should not have access to it don't have access to it. That's the message.

Speaker 4: 21:48

Once you say that, I've got a couple of friends who are very much so gun owners. We talk about guns and we have yet to get into a tussle Because I quickly tell them look you guys, I'm not talking about getting rid of guns. That's not going to happen. So let's just talk about safe gun storage and safe use of guns. I think most patients are going to be okay with that If they have a trusted relationship with a physician. I'm not sure I would necessarily open up on the first encounter with that, but once you establish a relationship then it's weird. In America we can talk about, to Christine's point, your sexual practice and your smoking and everything else, but somehow this is the topic that's going to be personally insulting. You're kind of as a physician, you kind of have to set it up and know how to approach that, like you would any other private topic.

Speaker 1: 22:34

I wonder if you could share with some folks how you developed the resources that have been put together. So maybe help if there's physicians or other health care workers listening to this, because I know a lot of times maybe folks don't see that they're primary care physician, they're seeing a nurse practitioner or they're seeing somebody at maybe like a med clinic really quickly. So do you see a difference, one in that breakdown, because depending on who people are talking to and then what are some of the resources to maybe train folks on how to have these conversations.

Speaker 4: 23:05

So I'll start because I kind of began the process, but really Christine is the one who's taken it, so she gets 99% of the credit. But one of the things that I noticed was, to your point, there was no curriculum in any of the medical schools in DC. Dc has a lot of medical schools. Nobody was teaching how to even speak about guns like the verbiage, and that was my own shortcoming as well. Here I am Chief of Trauma, doing all this stuff for decade plus, and every time the topic of guns comes up, even I start kind of hemming and hawing and stuttering, and it was very awkward and so I thought, okay, well, if I'm not going to be able to do it, then surely others aren't either. Now I think to Christine's point, there's a yearning desire for this, and so what I simply did is called a bunch of my colleagues across the other trauma centers and the medical schools in the district and I was like look, we should probably put together some sort of a curriculum, and I bet you the surgeons will say, yes, that's kind of easy, because I'm a surgeon, I kind of know everybody face to face. But I bet you, like in my hospital, I know the internal medicine doctors, and I bet you the surgeons at Washington Hospital Center know their internal medicine doctors, and I bet you the surgeons at Children know their pediatricians. So I bet you we can kind of put together a critical mass of people who are interested. That's exactly what happened Just a couple of phone calls, literally, and the ball started rolling.

Speaker 4: 24:23

And then the question was all right, well, at least people interested. Now what do we do? And so for that I leaned on Brady United, because I was the chair of the leadership council, and so I turned to the Brady folks and I was like look, you guys know how to, how to message this, but what you don't know is how to message us to physicians. I know what, I know what I want to say, I just don't know how to say it. Can we all come together? And so we crafted a number of scenarios that we then videotaped. The budget for this, by the way, is zero. This is Bobak, one of his injury prevention coordinators His name is Alistair and Brady, with a video camera.

Speaker 1: 25:02

I will say Bobak Alistair Brady productions, though sounds very legit. It sounds like a very good studio, if I could make a million bucks and have an infinity pool.

Speaker 4: 25:10

guys, I'm in, I'm not holding my breath. And so we made these videos. But then we hit a little bit of a hurdle, and this is where Christine comes in. Is OK, we got all these videos and now we want to insert them into the medical curricula. But guess what? The medical curricula is really full of medicine. So what are you not going to teach in order to teach this? That was difficult, and that's kind of where we are. So, christine, you want to take it from there. Sure.

Speaker 3: 25:33

So we developed, with the videos, developed a full lecture, so there's about a 45-minute or so presentation that's supposed to be interactive and lead for discussion. We reflect on the videos together and there's even some role playing where you pretend to be a patient and a provider, kind of having this type of discussion. But you're right, and in fact the first time I tried to even work this into what we call a morning report or sort of like a very basic lecture for our internal medicine residents, I got a little pushback, it was a little hard to kind of get it in and then, once I did it, it was so well received that I've now been asked to give it as grand rounds for the entire internal medicine department at Georgetown as well as at Virginia Hospital Center, which I'm actually doing tomorrow. So very well received once it's actually done. But you're right, it's a little outside of the realm of maybe sort of your normal medical curriculum.

Speaker 3: 26:23

And the thing I start with when I introduce this lecture is that my goal is not to turn everyone into a gun safety expert, like. The laundry list of things that every physician needs to counsel on is just way too long. It grows longer by the day. I don't want to add to that or burden the clinicians inappropriately. So my goals really are let's introduce some quick tips, some quick tricks on how to have some helpful key phrases to bring up this issue with your patients, just to get the conversation going. Give you some basic language around safe storage, because, frankly, before I started doing this, I had no idea what the difference was between a trigger lock and a cable lock and I would never have been able to counsel patients on those.

Speaker 3: 27:02

So it's sort of let's just give you a couple of quick definitions and then, most importantly, let's point you to the experts. Let's show you who to go to, who are your trusted resources, who can you count on when you don't really know what you're supposed to say? But you've got a patient in front of you who you think could benefit from having this discussion, and the website that I typically point everyone to is nfamilyfireorg. Great list of brochures on there that we can print out and give our patients right there in the exam room, as well as some of the videos that Dr Serani had filmed, as well as others discussion guides on how to do this, state by state legislation, so that you feel unsure of what exactly the rules are in your state, you can go and check, and that's sort of the catch-all resource that I give to everyone of. Hey, listen, I don't need you to be an expert in this. This is who the expert is. If you have a question, go to them and they can help.

Speaker 1: 27:50

I wonder if we could talk about kind of where this work goes next. So you have the resources available, obviously, it seems like especially Dr Petrin is there going to be a Worldwide Speaking Tour on training folks how to do this? But where do you see this going? And then what sort of next steps? Too, would you like to see DC, but then also other cities across the US, roll out to maybe help, kind of as we've articulated deal with a problem that just seems to be increasing, unfortunately.

Speaker 3: 28:19

I'd actually say I would hope for the opposite of a speaking tour. I would hope that this curriculum can really just go to different residency programs, hospitals, clinics it doesn't necessarily need to be training programs and have them be able to give it themselves, like hopefully there is some advocate, some person who's also committed to this work, whether it's in South Dakota or in Maine or in New Mexico, and it's not just me trying to run around DC and give this lecture over and over again. I'm hoping that people kind of take it on and present it to their own institutions and then right now, as we've mentioned, really a primary care focus on it. So far, definitely a lot of engagement from internal medicine, from pediatrics, from surgery, but I would love to see this be used by psychiatry, by OBGYN, by emergency medicine. I feel like this should be a part of every clinician's curriculum, no matter where they're practicing or what setting they're practicing in, and that would be my hope.

Speaker 4: 29:16

Yeah, I really agree with that. We've made a key point that this is not proprietary. We're not going to put it behind some firewall. I know that the trauma group over at Harvard in Boston are also doing something extremely similar. They're a little bit ahead of us and so theirs is a bit more sophisticated, with simulated patient encounters and videotapes that they then play back and debrief dedicated time for the residents. So I think as our program grows, hopefully we can kind of do something along the same lines as what they're doing. But I think importantly, I'm really hoping that via Brady and as well as via the own academic medical school societies, that our curriculum will kind of just expand to other medical schools that haven't even started this.

Speaker 2: 30:01

And I just had a follow up from my own understanding, to be honest. So I heard you say right now, the way you've been rolling this out is in sort of the morning report or morning what was that yeah morning report grand rounds kind of these big academic terms for essentially a lecture.

Speaker 2: 30:17

Okay. So if you are like a nurse, practitioner or something in that setting in the future, when hopefully this is sort of rolled out to everyone, like how would that be disseminated to those other fields? Would it just be in like the classroom level, like in the academic part of their studies, or something else?

Speaker 3: 30:35

I think it would start similar to how this has started. Is that you find one advocate, one person either? In an NP program and a PA program, who it takes this on as something they're really passionate about and they introduce it into their curriculum and it hopefully just grows from there.

Speaker 1: 30:48

Because I'm picturing folks who are not. Maybe if you're in a rural area where you might be a doctor at a very small practice or a nurse at a very small practice, not connected maybe with a big hospital nearby, these things are still available to you online. So it's all there present, so you can start your own little wave of it going in your area and, I'm guessing, kind of tailor it as well to the folks that you're seeing and the gun, the firearms and the firearm injuries that you're seeing.

Speaker 4: 31:15

That's exactly right Because remember what Christine mentioned early on in the podcast, which is currently still the majority slight majority, but majority of gun related deaths are suicides and what you just said is the kind of the cohort that it's at risk for suicide.

Speaker 4: 31:30

It's the rural. The classics person at risk for suicide by gunshot is going to be rural America, typically older male, caucasian. That's kind of the basic demographic, not to say that they're the only people, but that's the majority of them. And so if someone is a rural practitioner then they really need to gear their conversation more toward safe gun storage, access, depression, things that lead to suicide by handgun, as opposed to urban, where the majority of the gun related deaths are homicide, and that's a whole different conversation to be had. So the idea is to create this various tools that the physicians can use and then adjust them to their own patient population. In DC last I checked with the medical examiner's office of all gunshot related deaths, about 93 to 95 percent are homicide, about five to seven percent are suicide, and that's because we are an urban center. That would not be true if I went to some very rural area, say in West Virginia or something like that.

Speaker 1: 32:32

One of the things that I think is so interesting, just about kind of what we know about firearms in general, is that we are talking a lot about like death data, and but we also know that there's so much going into. You know we've many, many more people are shot in the US than are killed by firearm every year, and so we have that on top of it too, that like the, that injury data of how many people in the US are shot every day or who are living with long term gun injuries. Or I think, dr Petron, as you pointed out, are, you know, dealing with the ripple effects of long term gun injuries. Maybe they have a sibling who's been shot and who is now having to deal with a lifelong disability because of it.

Speaker 3: 33:07

So that's going to change the whole family dynamic and finances and whole domino starts and part of our part of our survey data on the curriculum we do. We do a pre survey and one of the questions we ask is have you ever treated a patient who's been a victim of gun violence and 100 percent of respondents say yes. I've never seen 100 percent of a room full of doctors say agree to anything other than this question. So it's. It's something that every single person, whether they're right at the beginning of their career or they are a seasoned, attending, and they've been doing this for decades. It comes across everyone's doorstep eventually.

Speaker 2: 33:39

And one of the things I would love if if you haven't already been able to address it you talked about. For one example, the majority of gun deaths are suicides. I'm wondering is there anything else that people tend to misunderstand about firearms or firearm injuries in the US that you've seen from your experience practicing?

Speaker 4: 33:59

Well, I mean, look, the, the, the headline you don't have to look too far to find is, you know, especially with mass shootings, the assailant is crazy and if we just kind of had some better mental health, clearly none of this would happen. That is 100 percent factually incorrect. The, the, the assailants, are not crazy in the sense of, you know, diagnosed psychiatric disorders. They do not have bipolar disease, they are not schizophrenic, they are not manic, any of the common diagnoses that one kind of thinks about when you talk about mental health. These people just don't have it, and that's one. Secondly, the people who do have, who do carry mental health diagnoses, are actually far, far more at risk of being victims of gun violence than perpetrators of gun violence. And these people, unfortunately, have been really mislabeled that it is almost their fault.

Speaker 4: 34:50

That is not true, that is just not true. And I can say this with such a such oomph because, guess what, many of the people who are the assailants are my patients, because in new turn they will be shot. And I can tell you they're not schizophrenic, they're not bipolar, they're not you know anything. I think this comes down to a variety of, depending on what instance we're talking about mass shootings, urban related attempted murder or rural suicide. There are different reasons why these things happen, but to put them under one umbrella of mental health is wrong. And it really gets to access. It really gets to knowing who might have had, might have been appropriate to have access, but now is no longer appropriate, and you know red flag laws or polos, things like that. That is a far, far more effective approach than just to say, well Jesus, if we just had more psychiatrists, clearly this wouldn't happen. That is not true.

Speaker 2: 35:46

Yeah, and that misperception that mental illness is related to something like dangerousness, when in reality it makes people more likely to be victims of gun violence, is something that we confront on this podcast all the time, and there's a lot of nuances to it and a lot to dig into, to tease out those relationships, and so if people want to learn more about that, where can they find you? So yeah.

Speaker 3: 36:11

So, like I said, med Peds at Georgetown and that's where a lot of this is being ruled out right now. I always point other providers to endfamilyfireorg for different resources. As far as our curriculum and our videos, we are working on getting those put up into a publicly accessible sort of repository with other resources so that people can download those and start using them.

Speaker 4: 36:32

Not quite ready just yet, so endfamilyfireorg is the main plug that I'm yeah, I think I would echo that until we get all of our videos up to some form of a public domain we're talking about what type of setup that will be. I was I'm leaning on Brady to kind of help me with something that is accessible to all nationwide and worldwide, but we're not quite there yet. But stay tuned. I would certainly hope that we'll be there in the next six months or so.

Speaker 1: 36:55

Well, we will definitely keep an eye out for that, because it looks like it's going to be amazing. So thank you all so much. Hey want to share with the podcast. Listeners can now get in touch with us here at Red, blue and Brady via phone or text message. Simply call or text us at 480-744-3452 with your thoughts. Questions concerns ideas, cat pictures, whatever.

Speaker 2: 37:19

Thanks for listening. As always, brady's lifesaving work in Congress, the courts and communities across the country is made possible thanks to you. For more information on Brady or how to get involved in the fight against gun violence, please like and subscribe to the podcast. Get in touch with us at BradyUnitedorg or on social at Brady Buzz. Be brave and remember. Take action, not size.