An ER Doctor Takes on Gun Violence

Karly Scholz 0:01

Welcome to solving gun violence, a weekly student led podcast from the University of Virginia's Gun Violence Solution Project that tackles one of America's most urgent issues preventing gun violence. Each episode will feature experts sharing actionable insights to improve community safety while upholding individual rights. My name is Karly Scholz. I'm a fourth year at the University of Virginia and student host of the solving gun violence podcast. This episode features a conversation with Dr Maya Haasz, a leading expert on firearm injury prevention and lethal means safety. Dr Hass is a pediatric emergency physician and Associate Professor of Pediatrics at the University of Colorado and shoots medical campus, affiliate faculty member at the firearm injury prevention initiative and the Injury and Violence Prevention Center, as well as an executive member of the American Academy of Pediatrics Council on injury, violence and poisoning prevention. Her research focuses on improving firearm storage and safety education, particularly in emergency department settings to prevent firearm injuries among children and adolescents. We discuss how hospitals and healthcare providers can play a greater role in gun violence prevention, the challenges of addressing firearm safety and high stress environments, and what lessons from other public health campaigns can be applied to reducing gun related harm. If you're interested in practical, evidence based solutions and the future of gun violence prevention, you're in the right place. Let's dive in.

Karly Scholz 1:40

Dr Haasz, thank you so much for joining us today.

Dr. Maya Haasz 1:45

Thank you so much for having me.

Karly Scholz 1:48

Gun violence is often framed as a criminal justice issue, but your work approaches it through a public health lens. What does it mean to treat gun violence as a public health problem, and how does that perspective change the kinds of solutions and approaches we prioritize?

Gun violence is often framed as a criminal justice issue, but your work approaches it through a public health lens. What does it mean to treat gun violence as a public health problem, and how does that perspective change the kinds of solutions and approaches we prioritize?

Dr. Maya Haasz 2:03

So a lot of what we do is looking at different policies that will impact gun violence, and there are many of those that are happening in government. I think the approach I'm taking is that we could treat gun violence, as you said, as a public health issue. So if you look at motor vehicle collision deaths, for example, motor vehicle collision deaths in kids decreased about 50% in the last 20 years because we took a public health approach to motor vehicle collisions. So I think we could use that as an example of how we could treat firearm injuries. So we didn't take cars off the road. We actually said you have to wear seat belts, and kids have to use booster seats or car seats, and we are not going to allow people to drink and drive, and that allowed motor vehicle deaths to decrease by 50% now, if we take the same approach to gun violence, I think we could have a really large impact, and it also allows all of us to have an impact, rather than just having the politicians have our impact so encouraging people through education to store their guns safely, so that kids can't access guns, so that six year olds aren't accessing loaded weapons at their parents home, I think is an effective thing that we could do, looking at different types of laws that we could impact on the state level, looking at talking to families as clinicians, about safe storage, talking about restricting access for people who are at risk for suicide or in their moments of crisis. These are all things that we could be doing without having to go through governments and policies.

Karly Scholz 3:35

That's really interesting. You mentioned the motor vehicle example as a public health approach that successfully shifted behaviors around things like seat belts and drunk driving over time. Are there any other lessons from those kinds of public health campaigns that can be applied to firearm injury prevention?

Dr. Maya Haasz 3:52

Well, this is a little sneak peek into a paper that I hope will be published soon. What we wanted to look at in this new paper is, are people asking about guns when their kids go to play at other people's houses. We don't want kids at the end of the day to get hurt because they accidentally access the loaded firearm. And what we found was 30% of people had asked other parents about firearms in the home before their kids went to play. But here was the interesting thing we said, if you asked, what information source did you look at first? Was it social media? Was it information from another caregiver? Was it information from your healthcare provider? And I love what we found, which is that no matter where you got your information, that increased your likelihood of asking about firearms, where your kids play, and not only that, but every additional place you got information increased it even more. And so here is the clincher, is that we just need to keep talking about this. We need a cultural shift the same way that Mothers Against Drunk Driving made it just not cool to drink and drive. Of it created a whole cultural shift where that is just not something acceptable. I think the more we're able to talk about guns, to talk about safe storage, it's going to make it unacceptable for you to have a gun that your child could access.

Karly Scholz 5:13

What do you think makes gun violence a uniquely difficult public health challenge compared to other safety interventions?

Dr. Maya Haasz 5:21

I think that one thing that makes it difficult, it's that it's been a historically very divisive issue in the political realm. People feel that if you want any form of safety, it's gun control, and you're trying to take away guns. People on the other side are equally at fault and feel that they need to take away guns, or that they they call it gun control, and I think that what we really need to do is work together. We need to center the conversation differently. It is not about the guns, it is about keeping kids safe. It is about keeping and I'm sorry, because I'm a pediatrician, so I will be talking more about children, but it is about keeping guns out of the hands of people who can use them to hurt themselves or others, and that is somewhere we could really agree. So if we start with somewhere where we're in agreement. No one wants a child to die from a firearm injury. No one wants their six year old to shoot their three year old by accident. I don't want to see that in the ER and I have and so when we center the conversation around that, around things we can agree on and start there, I think we'll go a lot further.

Karly Scholz 6:35

As you mentioned, guns are historically a divisive issue, and of course, attention and firearm injury prevention is balancing public health interventions with personal choice and rights. People have strong feelings about guns and are often wary of others encroaching on their ability to own them and their rights. When you take a public health approach to firearms with patients, do you encounter resistance? How do you address it?

Dr. Maya Haasz 6:59

It's interesting that you ask this, because I give a lecture to our pediatric trainees every single month, and this question always comes up because I tell them, you have to talk to your patients about how they store their guns and how they keep their kids from accessing their guns. And every single time, one of the residents will ask me, but what about the patient who's resistant? So you're not going to get around that for every single patient, right? There is a whole spectrum of people. But when you start a conversation with I just want to keep your child safe, and don't make it necessarily about the storage of the gun. But how do you store your gun so that your child can access it and use it by accident. And it's the same approach I think we need to take as a country to gut violence and really make it about the safety of our children. And it's the same approach I take with the parents. I am seeing kids in the ER who have attempted suicide or who are at elevated risk for suicide. When I talk to their parents, what I'm saying to them is I'm concerned that if your child finds a firearm in their moments of crisis, they will not have a second chance, because firearms will be lethal in 90% of suicide attempts. So I know we both have your child's safety at mind. How do we make sure? How are we making sure that your child can access a gun in that moment of crisis? And I think really centering it around child safety brings people to the same place, because we have that same shared interest of keeping their kids safe.

Karly Scholz 1:48

Gun violence is often framed as a criminal justice issue, but your work approaches it through a public health lens. What does it mean to treat gun violence as a public health problem, and how does that perspective change the kinds of solutions and approaches we prioritize?

Your research focuses on the emergency department as a key site for delivering firearm storage and lethal means safety education. Can you tell us a little bit more, especially about what lethal means, safety really means in this context?

Dr. Maya Haasz 8:47

We know that farms are the most lethal means of suicide, so nine out of 10 times if a child uses a farm in their suicide attempt, they will die in that suicide attempt. But we also know that those crises pass. So usually if a child has a suicide attempt, half the time it is within 10 minutes of making the decision to attempt, and 70% of the time it's within an hour. And so lethal means safety. Means that if we could put some time and distance between the decision to attempt and access to the most lethal means of suicide, which is firearm, we're going to decrease the risk of that child dying from their suicide attempt. They cannot die by a suicide attempt with a gun if they do not have access to a gun. So I will tell you, most of the kids I see in the emergency department, and this is probably on every shift, is someone who has had a suicide attempt. They've taken some pills, and 1015, 20 minutes later, they either tell their parents, or they might even post something on social media, or they might text goodbye to a. Friend, but some sort of cry out for help, so that we could find them and help them and give them a second chance. If they use a firearm in their attempt, they cannot have that second chance. And so by talking to their family about lethal mean safety, by talking to their family about limiting access to firearms in that moment of crisis, we give them a second chance.

Karly Scholz 10:21

What makes the ER a particularly effective or challenging place for these conversations?

Dr. Maya Haasz 10:30

So I could start with what makes it a challenging place? What makes it a challenging place to have these conversations is that I don't have a long term relationship with patients. I have met them for the first time, and so I don't have that prolonged trusting relationship that pediatricians do, because they've seen these patients for so long. However, I am seeing kids who are at elevated suicide risk, and we screen all our kids for suicide risk at the door. We screen everyone who's 10 years and up for suicide. And so I think this is a real opportunity to talk to families and say, You know what, your kid has just told me, that they've had thoughts of hurting themselves or killing themselves in the last few weeks, and I'm worried about your kid, and what can we do about his safety? And we know that firearms will be lethal 90% of the times when they're used in a suicide attempt. So I just want to make sure that if he has a moment of crisis, he can't access a firearm, and then we go from there. So really again, centering it around the child safety and having patient centered care that understands their values and then tries to decrease access to the gun. I will say also that I'm not directive about how they have to store their gun, because I don't think that's helpful. If someone says that they need a gun to protect themselves because they have an unsafe situation or they feel unsafe, I think I have to respect that I don't know what their life situation is. I don't know what their home situation is, and I don't know what their neighborhood is like, so you have to respect people's lived experiences, and at the same time, try to keep the gun away from their kids. And if that's a temporary thing for a few weeks where the child is in crisis, well, let's at least have a plan in place for that.

Karly Scholz 12:17

You mentioned, which I think is really important, that a lot of your approach is focusing on what you both want, you and the parent both want to keep the child safe, and finding that kind of common ground is really effective with families. Are there any other strategies you've found work best when engaging families in these high stress situations?

Dr. Maya Haasz 12:36

Yeah, so I think, like I said, So really being patient centered and making sure that you understand their values, their needs for a gun. I also think you have to be non judgmental. People, as we talked about, have very strong feelings about firearms, one way or the other. And I think whatever those feelings are, you have to leave them at the door, because patients see that in your body language and in your spoken language, and if they don't feel that you're respecting them, or if they feel that you're judging them, or they're being criminalized, then they're not going to actually listen to what you're saying. So there's often a gap between what you're suggesting and what the parents are hearing and whether they take your message and actually act on it. And if you want them to actually act on it, there has to be patient centered care, which means listening to what they're saying, understanding their values and developing a plan based on a shared partnership that centers around the child's safety.

Karly Scholz 13:32

Organizations, like the American Academy of Pediatrics have been vocal advocates for firearm safety, yet discussing guns in a clinical setting remains controversial for many people. What role do you think pediatricians should play in preventing firearm injuries and what can be done to protect and expand their ability to have these conversations with families?

Dr. Maya Haasz 13:53

So pediatricians are in a really unique position, because they see parents, they see kids, and they see them from beginning of life and through their entire life. And so not only do they have the opportunity to counsel people, but they also have the opportunity to develop these trusting relationships. And I do think that they should leverage these relationships and take these opportunities to prevent firearm injuries. Now again, making the conversation about the child's and the child's safety, I have seen a six year old shoot his little sister, and we can't do anything for her. At that point. We can't do anything for a child that is shot if it's a fatal shooting, and so preventing these injuries in the first place is critical. Now I think that pediatricians counsel on car seats, they counsel on pools, they counsel on a whole bunch of other things that I don't remember, all to prevent injuries in kids, and if they put fire. Injury prevention into that context, I think it would be really useful. So as you're talking about pool safety and driving safety, this is just part of one of the normal things we talk about, to keep kids safe and to keep injuries from occurring. So right now, firearms are the number one cause of injury death in kids, they're responsible for more than a quarter of pediatric injury deaths, a quarter of injury deaths in kids. That's just way too much. And so if we are telling parents to put smoke alarms and carbon monoxide detectors in the home and use car seats and booster seats, why wouldn't we also be talking about how parents store their guns so that their children can't access them?

Karly Scholz 15:47

Gun violence, as you've noted, takes form in a lot of ways. It includes gun safety. It includes suicides. It includes accidental use of guns by children, and a lot of lethal means. Safety discussion focuses on suicide prevention, which, of course, is crucial and is often the most deadly of gun violence incidents. But how do you ensure that your research, your messaging, that your advice to pediatricians or the doctors approach takes a comprehensive approach to gun violence and all the different forms that comes in?

Dr. Maya Haasz 16:20

So I think there is a certain amount we could do as pediatricians, and I think part of that is counseling people about lethal mean safety. I think part of that is counseling people about access and storing their firearms. We also can recognize kids who have been injured in more minor ways, because we know that the kid who comes in after a fight at school comes in a few weeks later after stabbing and may come in a few weeks later with a gunshot wound. So recognizing early on in this cycle of violence, and referring that child to a violence interruption program or to recognize that they need some more mentorship, is another space that pediatricians can have some effect. That being said, you're right, there are many different forms of gun violence, and just as there are many different forms of gun violence and many different reasons for gun violence, there have to be many different solutions for gun violence, pediatricians certainly play a role, and we are ready, and hopefully ready and willing to play our role in gun violence prevention, but the answers come from a much broader array of people. We need everyone to pitch in. We need everybody to mentor. We need everybody to recognize the youth that are hopeless and engaging in gun violence in order to solve this problem. One of my mentors explained it really well. I will give a shout out to Patrick Carter, who works at Michigan, and he described gun violence as he said, it's like a cancer, and you don't use one medicine for every type of cancer. You're not using one medicine to treat breast cancer and prostate cancer and liver cancer. There are many different medicines, and I think it's similar with gun violence. There are many different types of gun violence, as you mentioned. There are many different reasons for gun violence, and I think we have to find different solutions across the spectrum for all of it

Karly Scholz 18:20

So interesting. What has it been like to recruit other pediatricians and doctors in this fight? Have you found a lot of interest, a lot of excitement around it?

Dr. Maya Haasz 18:31

I will say, in Colorado, it's actually been quite easy to get people engaged. We sadly have had a number of mass shootings in Colorado, which, while mass shootings make up less than 1% of all firearm injuries and all firearm deaths, I think they have a huge impact on community and on the psyche of everybody, not just physicians. I think particularly impactful when these mass shootings happen at schools and when they're hurting little children and when they're hurting teenagers, I think that is also getting the attention of physicians and pediatricians in particular, because we have committed our lives to taking care of kids, and at least for me, every time there's A shooting at a high school or a kindergarten, I kind of feel like I'm falling down on the job. And so in that respect, it's been pretty easy to get people engaged, and more and more, we're also getting our hospitals engaged and saying, What can we be doing to help turn this trend around?

Karly Scholz 19:41

As the field of firearm injury prevention continues to grow, what gaps in research do you think need to be addressed most urgently?

Dr. Maya Haasz 19:49

You know, it's challenging, because I'm not sure if you guys have talked about this before, but there has been no federal funding for research for about 25 years, and so. So the federal funding for research just started again in 2020 so the gaps are everywhere. It's really hard to focus just on one point. What I would love to see at this point is some different approaches to taking care of gun violence. We've seen it a little bit. We're really starting to dig in on the medical side as well, on how we talk about safe storage, on how we message on lethal mean safety. There's a lot a lot going on, which is super exciting, but we also have a whole lot of time to catch up on. So I'd really like to see a lot of multi disciplinary work different fields, coming up with solutions of how we could solve the issue, the problem of gun violence without addressing only policies.

Karly Scholz 20:49

Can you tell me a little bit more about that multi disciplinary approach? Are there any promising new approaches or technologies that you're particularly excited about when it comes to improving firearm safety or reducing injuries.

Dr. Maya Haasz 21:03

So I don't know a whole lot about what's out there. I actually was at a very interesting talk last week, and this just is an example of someone who talked about having merchant codes for firearm injury. There was a head of bank who came to talk to us, and I was really wondering, what could a bank do to prevent gun violence. And then she explained that by identifying gun purchases using merchant codes and identifying purchases of ammunition, they could actually see if there's suspicious activity and try to prevent the gun violence from happening. It's the same way we all get these notifications when our credit card is used in weird places. And so I thought that that was a really thoughtful approach to solving gun violence. Well, let's identify these pieces of suspicious activity before they happen. And so if we could do more of that, think of creative ways in different industries that could prevent gun violence from happening in the first place. I think that would be really exciting.

Karly Scholz 22:03

Can you tell them a moment in your story or in your journey to get to here and have this focus that deeply influenced your perspective on this issue?

Dr. Maya Haasz 22:13

I will my moment actually wasn't a moment in the hospital, and I'm I'm ashamed to say that when I would see these kids who came into the hospital who were, you know, I saw a four year old who was hit by a stray bullet and paralyzed for the waist down, and I took care of him that day, he just had a fever. This was a few months later, but it didn't actually change my trajectory. And I would keep seeing these kids, and I would treat their injuries or the consequences of their injuries, and it didn't change my trajectory. And so I was entirely clinical for the first seven years of my career as a pediatric emergency doctor. And then in 2018 after the shooting in Parkland Florida, I actually went to the march of our lives rally. And I really went because it was near my house. It was a beautiful day, and I was getting my kids out of the house, and that moment was really impactful for me. So hearing teenagers get up and tell me that they were afraid to go to school, or that they were afraid to go to the playground. And I remember 114 year old girl came up and talked about how her brother was shot while walking to school, and that really impacted me, because again, I felt I was falling down on the job I'd committed to taking care of kids, and I just wasn't doing it. And listen to how scared they were going to school. No child should be scared going to school. And if I had any doubt that I could be doing something more, these teenagers had organized rallies across the country that were attended by one and a half to 2 million people while they were still grieving and reeling from a shooting in their own school. And so that was really a turning point for me where I said I have to step up and be doing more, and my entire career changed. So if there's one call out, I could say it's to those teenagers and college students. If you wonder if you're making an impact, you are, at the very least, you've changed my mind and really impacted me. So I will send out a huge shout out to them for that.

Karly Scholz 24:22

Dr Haass, what does the solution to the gun violence epidemic in the United States look like to you?

Dr. Maya Haasz 24:27

That's a big question. I think what it looks like is recentering our conversation. I think we need to stop being so divisive and arguing about the little issues of gun laws, and each of us in our own way, in the broader scheme of things, trying to figure out how, through our fields, we can work together and address this from a public health approach, whether it be banking engineering, and I'm sure there is something in engineering that could make the. Sure that a six year old can't fire a gun, whether it be lawyers, I think we all can find a way to address this issue and then on a smaller scale, each of us stepping up and mentoring kids who need support. I think one of the most impactful things a survivor once told me, he said, violence is a product of hopelessness, and I truly think it is. I think violence, suicide, all of these forms of gun violence as they different as they are, they're all stemming from hopelessness and loneliness, and I think the role of caring adults can have huge impact on youth who are involved in gun violence just by being mentors and by giving them hope.

Karly Scholz 25:49

Dr Haass, thank you so much for joining us today. For similar information, you can find more on the gun violence solutions Project website, and we'll see you next week.

Transcribed by https://otter.ai