233: The Evolving Role of Healthcare in Combating Gun Violence

Gun violence has tragically become the leading cause of death amongst children in the United States. We explore this alarming reality with our esteemed guest, Dr. Chethan Sathya, Director of Northwell Health Center for Gun Violence Prevention. Together, we unravel the proactive steps the healthcare sector is taking to protect our most vulnerable, using tools such as judgement free screenings and surveys. Through learning how best to talk about a topic often deemed "taboo," healthcare workers are playing an active role in advocating for gun violence prevention and creating safer environments for patients.

Further reading:
Stop filling our Trauma Centers with your thoughts and prayers. (#ThisIsOurLane)
How Doctors Suffer from America's Gun Violence Problem (Time)
Gun Violence and Its Impact on Healthcare (Penn Medicine)
"I’m tired of telling parents their child died of a bullet wound. I’m tired of saying “we tried everything during surgery, but we couldn’t save your baby.'” (Dr. Chethan Sathya)
Doctors and hospitals can help prevent gun deaths. Here’s how. (AAMC)

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, and welcome back to another episode of Red Bloom, brady I'm one of your hosts, jj, and I'm flying solo today, minus, of course, my phenomenal guest, dr Chase and Satha of Northwell Health Systems. Dr Satha is being so kind to sit down with me to talk about not just how doctors and healthcare workers can be impacting patients' health outcomes by fighting for gun violence prevention, but also how healthcare systems themselves, through the use of things like screenings and surveys, can be providing better, safer services to their patients.

Speaker 2: 1:18

My name is Chase and Sathya. I'm a pediatric surgeon, I am the trauma director at our level one trauma children's hospital here in New York and I'm also the director for our Northwell Health Center for Gun Violence Prevention.

Speaker 1: 1:29

Just a few things you know yeah yeah, yeah, but I'm wondering if you can tell folk a little bit about how you came to study gun violence, you know, especially coming from like this pediatric trauma surgeon background.

Speaker 2: 1:40

Yeah, of course you know. I think, listen, it was never my plan to be involved in gun violence prevention. To, you know, be a researcher in the space, to be a public health advocate in the space. It really happened, unfortunately, very naturally, right? You know, I started training as a pediatric surgeon and trauma surgeon in Chicago.

Speaker 2: 2:01

Prior to that I had done most of my training in Canada. I had treated many, many patients with gunshot injuries. You know there are a lot of gun injuries that happened in Toronto as well, and so I was used to that. But when I got to Chicago it was the first time that I actually had to treat infants and kids with bullet wounds and that really, really stuck with me. You know that was not the last. I treated kids with bullet wounds on my first week as a fellow trainee in Chicago. That happened week after week. That continues to happen here in New York. So you know, I would say that when you experience something like that and you see the trauma that these parents are going through and what these kids have to go through from a largely preventable disease, how can you not make it one of your life's missions.

Speaker 1: 2:40

And then, how did the transition to you coming to Northwell Health happen? And for folks who are unfamiliar with what that is and are like, what is that you know?

Speaker 2: 2:47

Yeah, yeah. So Northwell is the largest health system in all of New York state. It's also the largest employer, with about 100,000 employees. We have around 18 hospitals, and I came here as my you know to really for my first job as a pediatric surgeon after I finished my training at Northwestern in Chicago, and you know it was a great job, great group. I came here for the clinical work. I did not imagine that when I would start, our CEO of the health system would take a big stance on gun violence and make gun violence an institutional priority for us at the same level as cancer prevention, heart disease prevention. I hadn't seen that before and so it was very much a you know, right place, right time. Our passions aligned. That's what led to the center being developed. I'm very thankful for the opportunity that he and others have given many folks on our team to kind of lead in this area, and that's really how it happened. So it was definitely not something I planned on.

Speaker 1: 3:38

It's so interesting to me because of this work I talked to so many people who have gotten pulled into doing gun violence prevention work, either through their own you know survivorship or through just kind of existing in the US right. They came in with a very clear cut they wanted to do research, they wanted to be a social worker, they wanted to be a surgeon, and then suddenly kind of gun violence came and announced itself to them as an area of interest.

Speaker 2: 3:59

Yeah, yeah, I mean, it's not surprising, right, firearms being the leading cause of death among our children in this country. It's something that's the top of mind for many Americans. We've seen that this is an issue that can affect you in any community and we really all have to come together to transcend the polarization that we've seen happen right now. You know, most Americans want safer communities. They don't want mass shootings. They are for responsible gun ownership and safety, and I think we have to remember that in most of our conversations, because this has been become such a political, polarized issue and really it's just a public health issue.

Speaker 1: 4:33

And isn't it a shame that, like public health itself, has become a polarized health issue, especially over the last two, three years? However long this pandemic has been happening, who knows.

Speaker 2: 4:41

I know COVID-19 laid that bear for sure.

Speaker 1: 4:44

I think too, if we can, just to really drive home for our listening audience. One of the things you just mentioned there is that gun violence is the leading cause of death amongst children and I wonder, can you unpack that a little bit, because that's a newer transition. It used to be cancer, it used to be car accidents, now it's gun violence. Yeah.

Speaker 2: 5:01

Yeah, you know, I would say that for anyone that's been following public health trends and stats, it's not at all surprising. You know, we have had robust public health approaches to things like motor vehicle safety, tobacco cessation, drowning avoidance and, as a result, those have gone down for the most part, year after year, as causes of death for kids. We have not had a public health approach to something like gun violence and, as a result, not at all surprising that it has become the leading cause of death among kids. We saw that in 2019 and 2020, it became the leading cause of death. 2021, the data shows that it's even more of a leading cause of death among kids and it's only getting worse. So this is not just a nice little thing during the pandemic. This continues to happen, continues to get worse and it's something that we all kind of need to keep in our minds.

Speaker 1: 5:43

Well, and then, to that end, northwell Health, I think, is doing something really kind of revolutionary here on the aim of trying to prevent childhood and then I would say probably adult injury, before someone might, you know, have to come into your operating room, right, stopping it before it becomes an issue. And so I wonder if we can talk a little bit about this, this screening process that Northwell has been using. You know what is it? How did this happen? How did this develop?

Speaker 2: 6:06

Yes, definitely. So, you know, I think it's worth taking a step back for a second. And when we talk about the word gun violence, right, many of us are referring to firearm related injury and death across the country, and this could be firearm related suicide, unintentional injury or intentional injury, which includes homicides, violent assaults and mass shootings, which make up a sliver, of course, what we call gun violence in this country. I think it's important to really talk about the nuances in that term, because often what happens is we lump the term gun violence together and that naturally creates a polarization because, you know, you will have gun owners saying why am I responsible for inner city firearm violence, you know, and vice versa. So I think that nuanced discussion is really important and I bring that up because that's important even for the screening I'm going to talk about.

Speaker 2: 6:53

So traditionally in healthcare we've been very reactive to gunshots. You know, when someone comes in with a gunshot wound, I fix it up, I send them out. We then move to a state where you know, okay, we're not just going to send you out, let's give you some resources to help you maybe change behavior, whether it be safe storage or use violence intervention resources to be able to prevent an injury from happening again. Well, we're trying to do with our research here is to take that a step even beyond and prevent these injuries before it happens, as you mentioned. So we ask every single patient who comes into our hospital, in our emergency departments right now, questions around firearm injury risk. So we actually ask questions around firearm access with the purpose of offering safe storage counseling.

Speaker 2: 7:32

So if you screen positive for firearm access, we ensure that you safely saw your weapons and if not, that's okay. We provide education and if patients don't want to hear that, that's okay. It's traditionally been a very nice conversation actually. And we also screen for what we call firearm violence risk, which is a very different thing, and we offer violence intervention resources if you screen positive for that. So we're doing a trial around that. It's the first universal screening effort. The purpose there is to normalize how we talk about guns in the healthcare setting. We do think it's in our lane. We think that it's something we should be talking about, screening for no different than we screen for behavioral health issues or substance use. We need to start screening for gun injury risk and so far we've done 18,000 screens.

Speaker 1: 8:11

As a result, and so was this kind of an internal desire, though, as members of the healthcare system, you were like we need this. Or is this something where even patients were saying, you know, I wish someone had talked to me about this ahead of time. How did this initially even develop?

Speaker 2: 8:23

Yeah, you know it's really come through leadership in the system. But the development here is that one of my close collaborators runs our substance use program and the way that healthcare helped to de-stigmatize and depolarize a topic like substance use is they universally screened everybody. Rather than targeted screening of people who you think might be at risk and might introduce all kinds of bias, you screen everyone and that has really created an institutional support and normalization of talking about substance use across healthcare. Nationally we are taking the same approach with guns. That's where the inspiration for it came. My co-investigator on the study is the addiction services head for our system and that's what we're hoping to do.

Speaker 1: 9:01

There's so many things I feel like when I go into a doctor's office that I have like those automatic questions for everything from you know, do I feel safe in my interpersonal relationships to like smoking questions? And I've never felt very targeted because I know that that's kind of the boiler boiler plate right, that they ask everybody.

Speaker 2: 9:17

Exactly, exactly. We have signage everywhere saying we ask everyone Firearm safety is a healthcare issue, you know. So patients now at our system do expect it. It has gotten to the point that it is kind of part of our identity and the patients sometimes ask why did I not get screened? You know if we happen to miss it. So it is cool. I think it's part of the paradigm shift that we're hoping can be made on this topic.

Speaker 1: 9:38

And so, as you've mentioned, obviously this is still very new, but you certainly, you all have certainly done a lot of surveys because, again, so many people pass through the healthcare system, right, like it is one of the things that it's very hard to kind of completely opt out of right. And so what are some of the responses these questions have resulted in? Like, maybe, if we could start with the negative, I know one of the things that I hear from a lot of folks is, or you know, play devil's advocate. I don't want to say anything about firearms, because they're just going to put me on a registry, they're just going to take my guns away, you know, on that negative end. So I wonder, like, what are some of the negative things you've heard and what are some of the positives from this initial survey option?

Speaker 2: 10:17

I'll talk about the positives, as you mentioned in a second, but overwhelmingly it's been positive, right? Please really care about the safety of their loved ones, and so they're generally very appreciative of the education that we offer the negative responses. So, as you mentioned, it's really important to note that, though we're in New York, we serve Long Island, the five boroughs and all of Westchester, and we have a high rate of gun ownership here, right, the rest of New York is not like Manhattan.

Speaker 1: 10:42

People don't think of New Yorkers as going like out to go hunting, but that actually is a thing that a lot of people do.

Speaker 2: 10:50

Huge thing here? Yes, absolutely. So we're definitely serving a very diverse population, particularly from the firearm safety angle as well. And then the violence intervention angle. Right, we do have significant socioeconomic disparities through the five boroughs, queens, which we largely serve. So we really see the whole gamut when it comes to screening of both firearm access and violence risk. Now, some of the negatives, I would say, on both sides.

Speaker 2: 11:16

So with respect to the firearm access piece, of course, yeah, you do have families that say why are you asking? This is not your lane, something you should be asking about. But for the most part, you know, remember, we really frame this under an education umbrella and a safety umbrella for kids, elderly people in the household, those who might be at risk of suicide. And when you frame it in that way, even if someone is resistant, it's kind of an opportunity for them to tell you about, let's say maybe, that the good firearm safety practices that they do do. So there's a way to turn that conversation around and to really put it under the guise of safety that traditionally we haven't really had. I can't think of hardly any situations where there's really been confrontation because these questions. And then on the violence piece, you know, families often are scared. They're worried about retaliation. They're very much looking for resources like violence interrupter organizations, so that's a generally very well received conversation there.

Speaker 1: 12:08

Yeah, to take a step back to kind of you know some of the vulnerable groups that you mentioned that might be kind of identified within a survey like that. I mean I think we've gotten better about messaging in the US to understand that folks in crisis who may be experiencing suicidality, what that could be like for them. But you specifically mentioned as well then children in the elderly and I wonder if you could highlight, like what kind of risks might be identified in that firearm questionnaire for those two groups you know, like the youngest and the oldest amongst us.

Speaker 2: 12:38

Yeah, I mean, I think that's where the firearm safety piece really comes in, say, storage.

Speaker 2: 12:43

You know that Brady does such a wonderful job with with respect to end family fire.

Speaker 2: 12:50

The key is that if you have a unlocked, loaded weapon in the household right, there's no question. The evidence shows that your risk of suicide homicide in the household goes up, whether that be an unintentional shooting, where a kid accidentally shoot somebody, whether that be a suicide among a family member right, this could be an elderly person who accidentally discharges that weapon or is having depression, right, and might have a behavioral event as a result of that. Or in many cases, even mass shootings. Right, there are circumstances where a number of mass shooters get their weapons from parents who have not locked up their weapons safely. So I think the risks have really been shown to be elevated, not to mention domestic violence or intimate partner violence. We know that this. You know firearms are a significant cause of homicide in this country, and so when you really frame it there, I think a lot of families are surprised by those stats. But they can be simply mitigated just by safely storing the weapon, you know, locked, unloaded and separate from ammunition.

Speaker 1: 13:50

So, as part of that screening, are resources for things on safe storage? Is that something that folks are then linked up with after, or is it more of a just kind of identified to them? Hey, you should try to figure some stuff out.

Speaker 2: 14:01

Oh, absolutely no. Resources are critical to the intervention. So if you screen positive for the firearm access piece, you get a gun lock, you get educational brochures, you get actual firearm safety counseling at the time of your visit in the hospital and then you get paired up with firearm safety courses and so on, if you want in the community. And then, on the violence intervention piece, same thing motivational interviewing.

Speaker 2: 14:23

We have credible messengers in the hospital that work as part of our violence intervention program that actually meet these patients, help de-escalate, help interview and help case manage and partner with them in the community when they leave. So really there's a lot of interventions and resources that are actually given within the healthcare setting before that patient needs to hospital.

Speaker 1: 14:40

That's huge. That's so many. That's amazing. I wonder, can you break down some of those resources? So it's sort of so. Let's say that I test positive through a screen.

Speaker 3: 14:49

Yeah.

Speaker 1: 14:51

What comes next? What's kind of the watershed that follows?

Speaker 2: 14:55

Yeah. So let's say I'm seeing you in the hospital and you say, yes, you do have access to a firearm. People then go through the five L's of firearm safety, talking about things like cable locks, for example, and we'll actually hand you a cable lock, show you how to use it. If you're interested. We'll start, of course, by telling you about the risks of having the firearm loaded and unlocked in your household.

Speaker 2: 15:16

This is not about taking guns away, not about gun ownership. This is simply about safe storage. So we have that conversation and then we also provide local, community firearm safety courses if you're interested, because we can't forget that millions of Americans that bought guns, particularly during the COVID-19 pandemic, are not learned owners. They're not really very educated gun owners. So there's a lot of teaching that can be done there. And then let's say you screen positive for the violence intervention piece. That's where, right then and there you meet a credible messenger who could talk you through things you might be struggling with in the community and what resources in the violence intervention realm, through community-based organizations, can we offer you when you leave the hospital.

Speaker 1: 15:55

What sort of training do healthcare professionals get before they go in and start asking all these questions, because I'm presuming that not everyone who is giving a screening, or everyone who is. Every healthcare provider who's meeting with a patient is a gun owner or is comfortable saying that this is a trigger lock, and this is what I to discuss firearms openly. So what sort of training or resources are given on the healthcare end to prep folks for this?

Speaker 2: 16:20

Huge. I mean. This took 60 months of training and education and it's still an ongoing thing. We can't remember that most people in healthcare are not trained to have these conversations. We're not taught that gun violence is a healthcare issue. We don't know how to have the conversation. So the education is absolutely critical. And we also have to remember that healthcare workers, people in hospitals, are no different than the community, so the same biases and the same notions are gonna exist, and so through education is where you get buy-in and you get team effort and then championship, and so the education is absolutely critical. It's an ongoing effort and there's no way you can do it without a very robust educational curriculum Teaching healthcare workers how to do this.

Speaker 1: 17:01

Yeah, it seems like this is such a careful and dedicated rollout and I'm just I'm kind of I keep coming back to you. Know why do you feel that gun violence, then, is a healthcare issue, that this is something that should be being taken on by more medical systems or other providers, like outside of Northwell too?

Speaker 2: 17:22

Yes, I mean one of our biggest national pushes health system and one of our focuses, given that our CEO has been so outspoken on this issue and really he was one of the first large health system CEOs to be so outspoken and you'd be surprised, but there's really there was a reluctance among many healthcare leaders to not only speak out on this but to really prioritize it, and that can be anything from you know, we've heard a combination of things. Like you know, there are many competing priorities. Of course, hospitals and health systems have a lot of other things they need to worry about, but then you also have a subset of hospitals that are concerned about what their board is gonna say, what is their you know patient population gonna say, and they're concerned it's not a topic that they wanna touch. So our big effort of the last three years has really been bringing health systems together. You know we've launched a public awareness campaign on the idea of parent-to-parent asking about safe storage. That's been uptaken by a thousand different hospitals across the country.

Speaker 2: 18:15

We have a new CEO council, healthcare CEO council on gun violence prevention and 55 of the largest health system CEOs have signed on and they're ideating right now on making one of the most substantial commitments to GVP from the healthcare industry in history. So I think you know there's a lot that's changed over the last two, three years very exciting, but also very needed, and healthcare has to come together on this. You know, we can't not make this a healthcare issue, because it really is, and that's the way that we're gonna transcend the politics of this and figure out solutions, just like we did for other issues like car safety and substances.

Speaker 1: 18:51

I think it's so interesting because while we've been talking, I think twice now you've kind of mentioned that like this is our lane, kind of tying it. I think back to that campaign that was started by doctors saying that, like, no gun violence is our lane. Gun violence is something that we need to be engaged with, because we're seeing the patients after they get shot, but we're also like dealing with their family members after as well, like we're dealing with a community that's dealing with all the secondary health issues and mental health issues that follow. So I think it's really phenomenal that Northwell has taken the lead on this, but I would love to see this become like the norm we're gonna figure this out.

Speaker 1: 19:24

It's just default. No one knows where it started, because everyone does it.

Speaker 2: 19:27

Oh, absolutely, absolutely. And there's so many hospitals that have done incredible work in this area. You know, I think it's about and they've been. You know, frankly, there's a number of hospitals that have been doing incredible work in this area for over a decade. It's about getting everyone the institutional support they need. You know, getting your C-suite at your hospitals to actually truly believe in this, versus just the surgeons or nurses or frontline workers that really care about this, which is where that this is our lane movement started right. So it's about getting everyone in the hospital involved, leadership included, and, yeah, it needs to be the norm. It definitely does.

Speaker 1: 20:03

So this is kind of a I mean, I know Northwell is really instrumental in this and it's kind of a mouthful but in the gun violence prevention learning, collaborative for health systems and hospitals, like so many things in gun violence prevention it's a long, long name. But I'm wondering if you could share kind of where you think this collaborative effort is going to go in the future. You know kind of what are some of your hopes for it.

Speaker 2: 20:26

Yeah, so the learning collaborative is our grassroots collaborative has 600 hospitals from 38 states.

Speaker 2: 20:32

That's a best practice implementation collaborative. I'll give you an example. You know, in our screening, or anyone's screening we've known that safe storage counseling from physicians to patients can change behavior and save lives. We know that balance intervention probably can save lives right, but when it comes to safety counseling and talking to our patients about gun injury risk, we haven't done it over the last 10 years. But that evidence has always kind of been there, nothing new. Only eight to 10% of any clinical team members across the country ever talked to their patients about gun injury risk. So we're really looking to change that, and I think you know the more we can think about shifting that view from an implementation lens, the better off we're gonna be. So that's really where the collaborative came from, because, though we have these strategies, there's all these barriers that we face as clinicians to getting programs off the ground in the hospital setting, whether it be balance intervention or firearm safety or whatever and so that's how the collaborative started.

Speaker 2: 21:31

We finished the first 12 months, which were very focused on education. As a result of that, 40% of those hospitals started new programs actually according to the surveys that we did and the second phase is ongoing now where it's gonna be more about sharing those best practices. So let's say you're at hospital A in whatever state, and you wanna start a program. What are lessons learned from either a program you already started or what are lessons learned from other people that you can take to get that program off the ground? You know, how do you get institutional support? How do you deal with the barriers when it comes to workflow? We have a lot of other questions to ask and deal with their patients, and so it's that kind of discussion very much from a frontline, grass root kind of best practice implementation lens, and I do think it's very much kind of becoming the place where people are gonna go for that?

Speaker 1: 22:15

Why do you think that that is just gonna be kind of the default where people go into?

Speaker 2: 22:20

Well, I think right now, one of the reasons that we've started it and we're relatively new to this space is we needed to learn from other people. There are other hospitals, like I said, who have been doing this for years. So where do you go to really reach out and create that network so you can learn from other hospitals and say, okay, this is what I should be doing? That kind of forum didn't exist. That's why the collaborative started and that's where we're hoping to continue to see it go. It's really a collective network, more than anything, that showcases other programs across the country so that we can all learn. You know, like even for us in Northwell, we're starting to build out our violence intervention strategy. We're taking lessons learned from the collaborative and what others told us and them showing their programs to really build ours.

Speaker 1: 23:05

It's so great. So if folks are listening to this who are kind of like not working within the system or not working with a hospital, that's kind of aligned with this mission. Already you know what can they be doing to try to sign on, to try to get their workplace engaged. Or what can folks like me who have and for good reason no ties to medicine whatsoever? What can we be doing to help right the folks who struggled through Biochem and undergrad? What can we be doing to assist, despite being apart from this?

Speaker 2: 23:35

Yeah, you know, I think it really starts by helping to reframe the discussion. It's going to take a village. It takes all of us. Healthcare is a small piece of this, so even if you're not in healthcare, arguably your voice could be even more impactful than what I'm talking about. How do you reframe the conversation around the dinner table with their local lawmakers, with their community, your faith-based organizations, your schools? That's where it's critical, and if you can think of ways to do that and start doing that, and then think about local hospitals that you can bring into the mix, I mean, I think that's a win-win.

Speaker 2: 24:07

You know we'd love for anyone to reach out to us. I can provide my email contact find us If you're interested in learning more about the healthcare collaboration piece. I do think there's interesting collaborations, too, between organizations like Brady and the healthcare industry, where we have synergistic missions. You guys are viewing this as a public health issue. We do too. It's going to take everybody. So I think those conversations are important. I think the frontier for public health, too, that is fascinating, is we need more policy research.

Speaker 2: 24:36

You know, policy is not political. We need more policy research A lot of academics are shy about that, but we need that and we also need to start thinking about gun industry responsibility as part of the public health mitigation approach. I mean, industry responsibility is what changed motor vehicle safety and tobacco cessation, you know. So how do we get the same with respect to the gun industry? Because I do think it's a combination of accountability from people, but also the industry.

Speaker 1: 25:03

Well, and then do you want to plug? Where can folks find Northwell Health, specifically? Or where can they find your Twitter? Do you have a TikTok? Where can the folks listen and find you?

Speaker 2: 25:12

Yeah, of course I'm on Twitter at Dr Chatevon Sathya. If you Google Northwell Health Center for Gun Violence Prevention, you'll see our website for their contacts. Get more information there and we look forward to working with anyone who's interested.

Speaker 1: 25:25

Well, thanks so much, dr. I really appreciate it hey want to share with the podcast. Listeners can now get in touch with us here at RedBlue 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 3: 25:45

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 BradyBuzz. Be brave and remember. Take action, not size.