WORCESTER MEDICINE
Gun Violence Why is Worcester’s Gun Violence So Much Lower Than Other New England Cities? Continued into the forefront mindfulness that guns can present a danger in the household if unwanted or improperly stored. The ability to remove a gun from the household without questions asked is readily embraced by those wishing to rid their home of these lethal devices. Lastly, I would be remiss if I failed to give most honorable mention of the impeccable skills and abilities of the Worcester EMS system and emergency medicine trauma facilities. I have been a police officer for 38 years and over those years, I have sadly witnessed shooting victims in the field and have thought to myself that this poor victim isn’t going to make it. But time and time again, I have been pleasantly surprised to see the patient be wrenched from the jaws of death by the dedicated EMS squads to be followed upon by the incredible lifesaving interventions conducted at our local trauma facilities. While the violence has unfortunately occurred, its lethal effects are greatly mitigated, and the victim can live another day for us to pre-empt retaliatory violence. All this work is difficult and can be tremendously frustrating, but the young lives that are lost or diminished as a result of gun violence is a societal cost of such magnitude that there is little we do as police that is more important than intervening. Avoidance of gun violence in the first place is the gold standard, but we’ll take turning a kid around from gang warfare and gun involvement any day. + Edward J. McGinn, Jr. is Deputy Chief of Police for the City of Worcester.
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This Is Our Lane: Bringing Gun Violence Prevention to Medical Education and Clinical Care Peter T. Masiakos, MD, MS, FACS, FAAP
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hile many national health professional organizations have stated it is the responsibility of physicians to discuss firearm safety with their patients, few clinicians do – even among high-risk patients (for example, among those who have expressed suicidal or homicidal ideation). In June 2019, Massachusetts General Hospital launched the MGH Center for Gun Violence Prevention with a mission focused on clinical care and education, research, and community engagement with the goal of reducing morbidity and mortality from firearm-related violence. Our Center’s early quality improvement work determined that many of the reasons underlying this lack of directed counseling among clinicians were straightforward: few clinicians had received training in how to have these conversations or knew what to do next if a patient or family member did report having firearms at home.
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As health care clinicians and educators, we must stand front and center to address the gun violence epidemic. To begin to fill these knowledge and practice gaps, we developed an innovative training program to empower healthcare providers with tools to discuss this issue with patients in a culturally competent way. We assembled a team of resident and attending physicians— gun owners and non-gun owners--from across disciplines (including internal medicine, surgery, pediatrics, psychiatry, obstetrics/gynecology, and emergency medicine) to develop a didactic introduction and provide authentic and relevant clinical cases unique to each discipline. We then hired and trained a team of standardized patients. With buy-in from the residency program leadership in each department, every incoming intern in these departments at MGH in the summer of 2019-2021 went through a mandatory training. This didactic session teaches an evidence-based framework for incorporating violence prevention and firearm safety screening into clinical care, followed by a case-based simulation session to practice these skills. Since 2019, nearly 600 residents, medical students, and nurses have been trained in at least four other medical institutions: Harvard Medical School; Tufts School of Medicine; Dell Children’s Hospital’s emergency medicine residency program; Boston University’s Physician Assistant program; and Rutgers School of Nursing. In our analysis of the first year of this work, we determined that 70% of participants reported having had no prior training related to gun violence prevention and only 3% of participants reported knowledge of resources available at our institution and in Massachusetts to help facilitate conversations with patients. For example, prior to the training, 3% of participants were aware of Extreme Risk Protection Orders, a law passed in 19 states
Spring 2023