SAFE
"Clinicians and Firearms"
"Clinicians and Firearms"

9/25/2024: California passes a required secure firearm storage law

California’s SB 53 requires firearm possessors to securely store their firearms whenever the firearm is not in their immediate control. Congratulations to all the healthcare providers, especially Dr. Susie MacLean, a retired physician from California, who has been advocating for this in her role as a Board Member at SAFE and as a member of the Silicon Valley Alliance for Gun Safety.

Previously, California only had a Child-Access Prevention, or CAP law. 

Governor Gavin Newsom signed a host of other laws hoping to further reduce firearm harm summarized in this press release:
https://www.gov.ca.gov/2024/09/24/governor-newsom-signs-bipartisan-legislation-to-strengthen-californias-gun-laws/

Learn more about the firearm storage law SB 53: https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240SB53

Watch "Advocacy in Action" SAFE virtual event co-hosted with This Is Our Lane and Brady

Dr. Sandy McKay and Dr. Joe Sakran co-facilitate an event designed to educate healthcare providers on advocacy, using safe firearm storage as a key example. Attendees will gain insights into healthcare advocacy, understand the mechanisms and importance of safe firearm storage and Child Access Prevention (CAP) laws, and learn how to effectively engage and educate lawmakers using a public health approach.

To review resources to help you take action, click here: https://bradyunited.app.box.com/s/5civpxz2c0lsvpidesvacoy9wv9lv4wr

"Since I Last Saw You" - a moving tribute by a resident physician on gun violence

Since i last saw you your heart has beat 20 million times. Your lungs have taken 5 million breaths. Your eyes have been open for thousands of hours.

When we went into your room every morning on rounds nobody talked much. There wasn't much to say. Not much changed from day to day. Yyou weren't getting better but you weren't getting worse. We watched your heart beating on the monitor over your left shoulder. We listened to the ventilator humming in the background, watched your chest rise and fall rhythmically with it.

Your family asked about the plan every day as we left the pediatric ICU. Visitors weren't allowed in the unit. Your dad wanted to know specific lab values, how your sodium trended overnight, how high your lactate was, if you were still on pressers. Your mom just wanted to know if you'd opened your eyes yet. Your little sister asked if she'd ever be able to hug her older brother again.

A few days after your admission i saw your parents meeting with the organ donation team. They'd had the conversation we'd all been thinking about since you were first admitted to the hospital. It was the direction we knew things were going in but there was a certain finality seeing them sitting there after being stuck in limbo for so long. Your parents were the ones to request the meeting. The medical team hadn't brought it up yet. They asked about who is eligible to become a donor, they asked if the gunshot wound would prevent you from becoming a donor, they asked about what organs you'd be able to donate, and they asked if they would ever be able to meet the recipients.

The organ procurement happened a couple days later and was successful. your heart, both lungs, your corneas, as well as your liver, kidneys, and small intestines have new homes.

Since i last saw you your heart has beat 20 million times, your lungs have taken 5 million breaths, your eyes have been open for thousands of hours. But you will never feel your heart beat against your chest again. You will never catch your breath when you step outside and breathe in cold winter's air. You'll never see another sunset.

In medicine, we are far too familiar with stories that don't have happy endings - where the ends don't justify the means. We put everything we have on the table and still get beat. Sometimes we do everything right and we still lose. Other times there's nothing left to do because the game is already over. We expect stories that don't have happy endings as part of the game.

Since i last saw you, I've been thinking about the silver lining in your story. Even though it was the worst day of your parents lives, other families got the call that after months or years of waiting their kid was finally going to get a new heart, a new lung a new kidney. By choosing in that time of immeasurable grief and heartbreak to share your heart with strangers, they kept your story going. Your story did not end that day. Every one of those 20 million heartbeats is physical evidence of that. I can't tell you that your story had a happy ending. I can't tell you that since i last saw you we've put a stop to gun violence because since I last saw you almost 900 other children have been killed by guns in the US. I can't tell you that we've finally woken up to the fact that even living in a home with a gun triples one's risk of dying by one and that those who buy firearms for safety are often doing more harm than good. Because since I last saw you five million more homes have guns in them.

I can't tell you that your story had a happy ending but i can tell you that your story isn't over yet.

Clinicians and Firearms: Request a Course Distribution Packet

Please send an email to info@standsafe.org or to avolkman@standsafe.org to request a distribution packet.

Health care professionals serve a vital role in preventative health. Discussing firearm safety habits with patients has been shown to improve patient safety by increasing the number of firearms that are kept locked and unloaded in homes. However, due to a lack of training, physicians often do not feel comfortable counseling patients and families regarding safe ownership of guns.

According to the CDC, gun violence remains a major cause of death and injury in the United States. Although physicians are frequently tasked with treating firearm injuries in acute care trauma settings and promoting injury prevention at primary care clinics, only a minority of medical education programs have dedicated curricula addressing firearm violence. It is well known that medical school curricula are overcrowded, limiting the ability for programs to introduce updated content. However, medical students recognize the importance of this focus in their training to become physicians; demand for firearm injury prevention education remains high. 

We created the “Clinicians and Firearms” curriculum to be readily adopted into pre-existing programming. It is newly re-designed around guidelines for technical standards outlined by M.D. and D.O. programs throughout the United States. Competencies defined by the AAMC’s Physician Competency Reference Set (PCRS) and individual programs were referenced during development. Although the course is intended to be completed in its entirety, individual components can be treated as stand-alone to best accommodate program scheduling and goals.

Our Distribution packet includes:

  • Course Overview

  • Course Marketing

  • CME

  • Instructions

  • Evaluation

  • Asset Library

  • Additional Resources

    Please send an email to info@standsafe.org or to avolkman@standsafe.org to request a distribution packet.

"Clinicians and Firearms"

Click “Start Course” and you will have a chance to read more about the course and who created it before clicking “Continue”.

Although the course is intended to be completed in its entirety (approximately 90 minutes), individual components can be treated as stand-alone to best accommodate program scheduling and goals.

SAFE created the Clinicians and Firearms curriculum to be readily adopted into pre-existing programming. It is newly re-designed around guidelines for technical standards outlined by M.D. and D.O. programs throughout the United States. Competencies defined by the AAMC’s Physician Competency Reference Set (PCRS) and individual programs were referenced during development.

Connecting your SAFE Chapter with the Local Community!

We are eager to introduce a new initiative aimed at enhancing our collective impact on community gun violence. This endeavor focuses on forging stronger connections between SAFE chapters based at medical schools in cities heavily affected by gun violence, particularly amongst black and brown communities, with local nonprofits dedicated to supporting the most vulnerable.

Our goal is to cultivate meaningful partnerships between our chapters and community-led organizations. Through this collaboration, we aspire to create opportunities that will enrich healthcare providers' understanding of how to engage with and support individuals from marginalized communities facing the brunt of gun violence.

We believe that by uniting our efforts with local nonprofits, we can drive profound and positive change. For more information or to explore how your chapter can participate in this initiative, please contact our intern, Hailey Ramzan (hramzan@stanford.edu), who is ready to provide support and guidance.

Together, let’s forge a path to healing, justice, and lasting impact. Your involvement can be the catalyst for a safer future for all.

White House Office of Gun Violence Prevention conversation rescheduled for May 3 @ 2 PM ET

This is a rescheduled event from April 3, and is one of SAFE’s two annual events that are open to all clinicians and trainees who are committed to learning more about SAFE’s work to embed gun violence prevention education into the curriculum of all healthcare institutions.

After getting a glimpse of SAFE's updated education modules and how you can help reach our goal of embedding gun violence prevention education into 100% of our country's medical schools, you will hear Dr. Dean Winslow, SAFE Co-Founder and Professor of Medicine at Stanford Medical School and Christopher Zaro, 3rd year medical student from UMass School of Medicine, speak with Greg Jackson, who serves as Special Assistant to the President and Deputy Director of the White House Office of Gun Violence Prevention and a survivor of gun violence.

All are welcome. Hosted by SAFE

Sponsored by The Center for Violence Prevention at the University of Texas Health in Houston.

Registration link: https://shorturl.at/ktvA3

SAFE partners with Be SMART

SAFE has forged a partnership with Be SMART, a program of Everytown for Gun Safety’s Support Fund. SAFE Chapters across the country have an opportunity to team with a local Be SMART chapter up to help educate your medical school community about the gun violence epidemic. You can receive support in planning an early Fall SAFE Chapter event at your medical school, focusing on the importance of secure storage education for all clinicians.

Take 30 seconds to share when you are free for a 15-20 minute call with a local Be SMART leader.

The 27th IVAT (Institute on Violence, Abuse and Trauma) Summit in San Diego

The 27th IVAT (Institute on Violence, Abuse and Trauma) Summit in San Diego this week addresses several topics related to the scourge of gun violence in our society.  On Sunday, August 28, SAFE participated in Taming an Escalating, Out-of-Control Epidemic:  Gun Violence Prevention as a Public Health Priority.  Topics covered ranged from the escalation in interpersonal violence and firearm purchases during the Covid pandemic and the alarming rise in mass shootings to advances in medical training and suicide prevention.  Progress on recent legislation dedicating much-needed resources to gun violence research was highlighted as well.

Pictured, left to right, Dr. Michael Levittan, moderator; Nicole Finney, UC Irvine School of Medicine, SAFE Chapter UCI and HEAL-IM Scholar; Arvis Jones, MT, MA, Grief and Loss Specialist, Linda Cavazos, Survivor Lead - Moms Demand Action Nevada and John McKenna, Executive Director SAFE.

John McKenna with Nicole Finney and Jessica Sea, SAFE medical students, UCI Chapter. 

Dr. Michael Levittan, IVAT Global Peace and Gun Violence Prevention Advisor with John McKenna

Letter to the Senate Judiciary Committee

Our letter in support of firearm safety and violence prevention for the Senate Judiciary Committee’s Hearing on “Constitutional and Common Sense Steps to Reduce Gun Violence” on March 23, 2021.

Following the hearing, President Biden proposed a historic $5 billion investment in targeted firearm violence prevention, including support for community-based violence intervention programs.

SAFE Support for Black Lives Matter

 Written by Deniz Cataltepe

Director of SAFE Medical School Chapters

SAFE: Scrubs Addressing the Firearm Epidemic was founded to rally the medical community to eliminate firearm violence with the same urgency and dedication that we have applied to exposing other health risks, such as cigarette smoking. Today, SAFE announces its support for the Black Lives Matter Movement and commits to addressing the serious public health effects of racism.

Firearm violence and systemic racism are intimately linked—Black communities are disproportionately affected by firearm homicide. In the U.S., Black people are 10 times more likely than white people to die from firearm homicide[1],[2]. Studies have shown that Black men have experienced a decrease in life expectancy of 4.14 years (compared to 2.23 years among whites) due to firearm mortality from 2000 to 2016[3]. Black women are two times as likely as white women to die from a firearm fatality due to intimate partner violence [4]. Since 2017, 82% of trans gun victims have been Black trans women [2].States with a higher calculated racism index have been found to have significantly higher Black-White discrepancies in rates of shootings of unarmed victims by the police [5].

As an organization that cares deeply about firearm violence prevention, SAFE is a staunch supporter of the Black Lives Matter movement. These disturbing, disproportionate rates of firearm homicide point to a significant racial health disparity that we cannot ignore. Systemic racism bleeds into every pocket of our communities, affecting the well-being of our Black patients through the insurmountable challenges they face in access to physical and mental health care, education, and employment. The neighborhood-level factors associated with firearm violence—lower home values, few retail and service businesses, lack of green space[6]—have been perpetuated in Black communities through decades of systemic racism in the form of redlining [7],[8].

The implicit biases we all carry have serious effects on the type of care we deliver to our Black patients,[9]with racial differences found in the use of invasive cardiac procedures [10], colorectal cancer treatments [11],and antiretroviral therapy prescription for HIV [12], to name a few [13]. Race can also be framed as an “environmental stressor,” with Black patients who report thinking about their own race at higher frequencies being found to have higher blood pressures [14]. As healthcare professionals who emphasize the value of preventive care, we must confront this epidemic at its root. It is not enough to treat our Black patients, and our patients who are victims of firearm violence, once they are rolled into our trauma bays. 

One of SAFE's core aims is to support evidence-based policy and research on the epidemiology and causes of the firearm epidemic in this country. In light of the devastating losses of Ahmaud Arbery, Rayshard Brooks, George Floyd, and Breonna Taylor, as well as the deaths of multiple Black children across the country this Fourth of July weekend, SAFE will continue this effort with an unwavering sense of invigoration. 

We will promote research that addresses and unpacks the systemic racial causes at the core of this issue so that our interventions can be better targeted to those in need. This includes support for violence intervention models including the Cure Violence model, in which  "violence interrupters," who have close ties with neighborhoods considered most at-risk, connect with individuals in those communities; the Gun Violence Intervention, with partnerships created among faith leaders, social service workers, researchers, and law enforcement to hold “call-ins” with the small segments of communities responsible for violence; and Hospital-Based Violence Interventions, in which hospitalized young adults affected by firearm violence are connected with case workers during their hospital stay [15].

We will integrate the topic of systemic racism and its consequences on firearm violence into discussions at our medical school chapters across the country, beginning with our Stand SAFE 2020 event scheduled for this fall. We will educate ourselves and members of our national organization on the barriers posed to our Black patients by systemic racism, as well as the toll that can be taken on them by our implicit biases, which are so often hidden from our own awareness. 

We will demand change from our representatives—like we have done successfully in the past with increased funding for firearm violence research—to confront police firearm violence and implement proven Violence Intervention strategies. We will work to end the loss of Black lives to senseless firearm violence. 

[1]Centers for Disease Control and Prevention, CDC WONDER, “About Underlying Cause of Death, 1999-2016,” last accessed July 6, 2020, https://wonder.cdc.gov/ucd-icd10.html. 

[2]Everytown, Everystat, last accessed July 6, 2020, https://everytownresearch.org/everystat. 

[3]Bindu Kalesan, et al., “Cross-Sectional Study of Loss of Life Expectancy at Different Ages Related to Firearm Deaths Among Black and White Americans,” BMJ Evidence-Based Medicine 24, no. 2 (2018). 

[4]Giffords Law Center, “Gun Violence Statistics,” last accessed July 6, 2020, https://lawcenter.giffords.org/facts/gun-violence-statistics/. 

[5]Aldina Mesic, et al., “The Relationship Between Structural Racism and Black-White Disparities in Fatal Police Shootings at the State Level,” Journal of the National Medical Association 110, no. 2 (2018): 106-116. 

[6]Michelle C. Kondo, et al., “The Association Between Urban Tree Cover and Gun Assault: A Case-Control and Case-Crossover Study,” American Journal of Epidemiology 186,no. 3. (2017): 289-296. 

[7]Yasemin Irvin-Erickson, et al., “A Neighborhood-Level Analysis of the Economic Impact of Gun Violence,” Urban Institute, June 2017, https://www.urban.org/sites/default/files/publication/90671/eigv_final_report_3.pdf. 

[8]Matthew Benns, et al., “The Impact of Historical Racism on Modern Gun Violence: Redlining in the City of Louisville, KY,” Injury(2020). 

[9]William J. Hall, et al., “Implicit Racial/Ethnic Bias Among Health Care Professionals and its Influence on Health Care Outcomes: A Systematic Review,” American Journal of Public Health105, no. 12 (2015): e60-76. 

[10]N.R. Kressin and L.A. Petersen, “Racial Differences in the Use of Invasive Cardiovascular Procedures: Review of the Literature and Prescription for Future Research,” Annals of Internal Medicine 135, no. 5 (2001): 352-366. 

[11]L.F. McMahon Jr., et al., “Racial and Gender Variation in Use of Diagnostic Colonic Procedures in the Michigan Medicare Population,” Medical Care37, no. 7 (1999): 712-717.  

[12]R.D. Moore, D. Stanton, R. Gopalan, and R.E Chaisson, “Racial Differences in the Use of Drug Therapy for HIV Disease in an Urban Community,” New England Journal of Medicine330 (1994): 763-768. 

[13]Aaron E. Carroll, “Doctors and Racial Bias: Still a Long Way to Go,” New York Times, February 25, 2019, https://www.nytimes.com/2019/02/25/upshot/doctors-and-racial-bias-still-a-long-way-to-go.html.

[14]LaPrincess C. Brewer, et al., “Association of Race Consciousness with the Patient-Physician Relationship, Medication Adherence, and Blood Pressure in Urban Primary Care Patients,” American Journal of Hypertension 26, no. 11 (2013): 1346-1352.

[15]Giffords Law Center, “Healing Communities in Crisis,” last accessed July 6, 2020, https://lawcenter.giffords.org/wp-content/uploads/2019/01/Healing-Communities-in-Crisis.pdf.