It is abundantly clear to Satya, and to me and many others in the medical profession, that gun violence is a medical issue: In 2021, approximately 49,000 Americans died from gun-related injuries.
Children are not spared from this horrifying statistic. In fact, firearm injuries have been the number one cause of death among children in the United States since 2020. The Surgeon General recently deemed gun violence a public health crisis, emphasizing the need to address it from a health perspective.
Traditionally, hospitals have been the place to treat gunshot wounds, but Satir, now a pediatric trauma surgeon and director of the Center for Gun Violence Prevention at Northwell Health in New York, is among clinicians rethinking the role of the health care system to recognize that health care providers are essential to preventing gun injuries in the first place.
One of Northwell’s innovations is to screen all patients who come to the emergency department for risk of firearm injury. Patients are asked two questions: first, whether they have any guns in their home and, if so, whether they are properly stored; and second, whether they are at high risk for firearm injury. This question takes into account factors such as peer influence and whether they live in an area with a high rate of gun violence.
It’s crucial that this screening is implemented across the board so that these questions become standardized and part of routine medical care. Satya explains, “We ask patients and families about substance use, behavioral health issues, exercise, smoking, and health conditions, so why wouldn’t we ask them about their risk of firearm injury?”
Another key part of Northwell’s approach is intervention: People who keep firearms at home receive on-site counseling on how to store them safely, and if they don’t already have their firearms safely stored, the hospital provides them with a lock during counseling.
If hospital staff determine someone is at risk for becoming involved with a gang, the patient is referred to a Community Violence Intervention program that helps break the cycle of violence. Northwell hires “trusted messengers,” such as people from the communities they serve and people who have been shot, to talk to patients at the hospital. As case managers, they connect patients to community resources and provide additional social supports, such as housing and employment opportunities.
Northwell clinicians conducted more than 40,000 tests across three hospitals over a two-and-a-half-year period, which is remarkable given that asking questions about gun violence is rarely part of doctors’ and nurses’ training.
Satya acknowledges that changing clinical practice hasn’t been easy. The biggest challenge, he told me, was simply a lack of comfort with bringing up the issue of firearms. “People think it’s a polarizing thing,” he said. “They think it’s going to be emotional and they’re not comfortable having the conversation.”
But what Northwell has seen is that when the discussion revolves around the issue of gun safety, it’s well-received. “This isn’t a political issue, this isn’t a Second Amendment issue, this isn’t about gun ownership,” he said. “Everybody wants to see fewer mass shootings, fewer gun violence, to keep their families safe.”
Satya and Northwell President Michael Dowling have been spearheading efforts to engage health care leaders across the country to share best practices on what clinicians can do to prevent gunshot injuries. One of their projects is a learning collaborative that now includes more than 600 clinicians from 38 states.
The other is a parent-to-parent campaign: When parents are deciding whether to leave their children at someone else’s house, they have a lot of questions, like are there safety gates around the pool? They should also ask whether there’s a chance that an unlocked gun could be brought in.
“I appreciate this parent-to-parent approach for the same reasons that I admire the clinician-patient dialogue at Northwell: because it breaks the taboo of talking about firearms and opens the door to nuanced, thoughtful dialogue. The goal is not to blame gun owners or to make a political statement, but rather to work together on a shared priority: reducing harm and child safety, a goal we can all agree on.”
