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Prevention of firearm-related injuries with restrictive licensing and concealed carry laws: an Eastern Association for the Surgery of Trauma systematic review

BACKGROUND In the past decade, more than 300,000 people in the United States have died from firearm injuries. Our goal was to assess the effectiveness of two particular prevention strategies, restrictive licensing of firearms and concealed carry laws, on firearm-related injuries in the US Restrictive Licensing was defined to include denials of ownership for various offenses, such as performing background checks for domestic violence and felony convictions. Concealed carry laws allow licensed individuals to carry concealed weapons. METHODS A comprehensive review of the literature was performed. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to assess the breadth and quality of the data specific to our Population, Intervention, Comparator, Outcomes (PICO) questions. RESULTS A total of 4673 studies were initially identified, then seven more added after two subsequent, additional literature reviews. Of these, 3,623 remained after removing duplicates; 225 case reports, case series, and reviews were excluded, and 3,379 studies were removed because they did not focus on prevention or did not address our comparators of interest. This left a total of 14 studies which merited inclusion for PICO 1 and 13 studies which merited inclusion for PICO 2. CONCLUSION PICO 1: We recommend the use of restrictive licensing to reduce firearm-related injuries. PICO 2: We recommend against the use of concealed carry laws to reduce firearm-related injuries. This committee found an association between more restrictive licensing and lower firearm injury rates. All 14 studies were population-based, longitudinal, used modeling to control for covariates, and 11 of the 14 were multi-state. Twelve of the studies reported reductions in firearm injuries, from 7% to 40%. We found no consistent effect of concealed carry laws. Of note, the varied quality of the available data demonstrates a significant information gap, and this committee recommends that we as a society foster a nurturing and encouraging environment that can strengthen future evidence based guidelines. LEVEL OF EVIDENCE Systematic review, level III.

Distracted driving behaviors of adults while children are in the car

BACKGROUND Cell phone use while driving is common and can result in driver distraction. However, data on the frequency of this behavior with other occupants in the vehicle are lacking. This study investigates whether adult drivers engage in cell phone use with passengers in the car and determines whether the frequency of these behaviors was modified if the passenger was a child. METHODS Subjects (N = 539) who have driven children during the previous 30 days were recruited to complete a survey regarding their cell phone usage while driving. The inclusion criteria of participants were as follows: 18 years or older with a valid driver’s license, owns/uses a cell phone, drives with children, and reads English. Results were reported on a 4-point Likert scale (always, often, rarely, and never). RESULTS Eighty percent of respondents reported cell phone use in some way while driving with children. As compared with similar behaviors when driving alone or with adult passengers, the odds of reporting “always” compared with “often, rarely, or never” of holding a cell phone in hand was 0.66 when driving with children. No significant differences were noted for the following variables: use of a blue tooth device or use of a cell phone to speak or text when parked. CONCLUSION Cell phone use while driving is common. Distracted driving behaviors, although less frequent, persist when children are passengers in the vehicle. Further research into the effect of cell phone–related distracted driving behaviors of adults with child passengers is needed to address this public health concern.

Prevention of fall-related injuries in the elderly: an eastern association for the surgery of trauma practice management guideline

BACKGROUND Fall-related injuries among the elderly (age 65 and older) are the cause of nearly 750,000 hospitalizations and 25,000 deaths per year in the United States, yet prevention research is lagging. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, the Eastern Association for the Surgery of Trauma produced this practice management guideline to answer the following injury prevention–related population, intervention, comparator, outcomes (PICO) questions: PICO 1: Should bone mineral–enhancing agents be used to prevent fall-related injuries in the elderly? PICO 2: Should hip protectors be used to prevent fall-related injuries in the elderly? PICO 3: Should exercise programs be used to prevent fall-related injuries in the elderly? PICO 4: Should physical environment modifications be used to prevent fall-related injuries in the elderly? PICO 5: Should risk factor screening be used to prevent fall-related injuries in the elderly? PICO 6: Should multiple interventions tailored to the population or individual be used to prevent fall-related injuries in the elderly? METHODS A comprehensive search and review of all the available literature was performed. We used the GRADE methodology to assess the breadth and quality of the data specific to our PICO questions. RESULTS We reviewed 50 articles that met our inclusion and exclusion criteria as they applied to our PICO questions. CONCLUSION Given the data constraints, we offer the following suggestions and recommendations: PICO 1: We conditionally recommend vitamin D and calcium supplementation for frail elderly individuals. PICO 2: We conditionally recommend hip protectors for frail elderly individuals, in the appropriate environment. PICO 3: We conditionally recommend evidence-based exercise programs for frail elderly individuals. PICO 4: We conditionally recommend physical environment modification for frail elderly people. PICO 5: We conditionally recommend frailty screening for the elderly. PICO 6: We strongly recommend risk stratification with targeted comprehensive risk-reduction strategies tailored to particular high-risk groups. LEVEL OF EVIDENCE Systematic review, level III.

Gun buyback programs: a venue to eliminate unwanted guns in the community

BACKGROUND The United States has a high rate of death due to firearms, and gun buyback programs may mitigate these high death rates. Understanding the demographics, motivation, and geographic region of participants may improve program efficacy. METHODS Three Injury Free Coalition for Kids gun buyback programs, in collaboration with the local police, were studied: Phoenix, Arizona; Worcester, Massachusetts; and New Haven, Connecticut. Participants were defined as those who relinquished a firearm. A self-administered, anonymous, paper survey elicited information from participants regarding demographic data, formal training on the use of the firearm, how the firearm was acquired, potential child access, knowledge of others injured by a firearm, whether the firearm was stored unlocked, factors motivating the surrender of the firearm, and other factors. Survey results were entered into a composite database and analyzed for differences in location, race, sex, and other factors. RESULTS Participants (n = 301) were predominantly male (73.5%), white (80.9%), and older than 55 years (59.0%). They lived an average of 19.0 miles from the event by zip codes and had an average median household income of

Establishing an Injury Prevention Program to Address Pediatric Pedestrian Collisions

65,731. More than half (54.5%) did not purchase the firearm, acquiring it through inheritance, gift, or random find. Most (74.8%) had previous firearms training and were relinquishing for safety reasons (68.3%). Those relinquishing firearms for safety reasons were less likely to have purchased the firearm (odds ratio [OR], 2.46, p <0.05), less likely to have any formal training (OR, 5.92; p < 0.01), and less likely to keep the firearm locked (OR, 3.50; p < 0.01). Women were less likely to have purchased the firearm (OR, 0.50; p < 0.05). Fifty-three percent of those turning in firearms reported having at least one more firearm at home; designated themselves to be white, compared with all other groups combined (OR, 2.55; p < 0.05); more likely to report locking the firearm (OR, 0.11; p < 0.001); more interested in receiving a gun lock (OR, 0.15; p < 0.001); and more likely to know others who also own firearms (OR, 0.17; p < 0.001). In at least one of the cities participating in this study, as many as 30 percent of the weapons used in gun-wielding criminal acts were burglarized from the home of legal gun owners that had failed to secure them properly. CONCLUSION The gun buyback program is solely one prong of a multipronged approach in reducing firearm-based interpersonal violence. Additional research is necessary to determine effective methods to target individuals who would have the greatest impact on gun violence if they relinquished their weapons. Through the forging of relationships and enhancement of firearm knowledge among medical, law enforcement, judicial, and school communities, the prevention of intentional and unintentional firearm-related injuries will be able to be managed more effectively. LEVEL OF EVIDENCE Epidemiologic study, level II.

Motor Vehicle Collision-Related Injuries in the Elderly: An Eastern Association for the Surgery of Trauma Evidence-Based Review of Risk Factors and Prevention.

The implementation of a pedestrian safety education program in public schools can change the knowledge and beliefs about safe pedestrian behaviors among students and their parents or caregivers with the goal of reducing morbidity and mortality of children. WalkSafe is a well-established, multiphase pedestrian safety intervention program. This program has been shown to improve pedestrian safety knowledge of school-aged children in kindergarten through grade 5 after receiving a 3-day educational curriculum. A reduction in pediatric pedestrian struck injuries is anticipated following program implementation in an urban area with significantly increased incidence of such injuries.

Approach to a Standardized Injury Prevention Coordinator Training Curriculum.

Advancements in car and road safety in the US have led to a drop in the number of overall fatalities per million miles traveled in recent decades. However, elderly individuals (aged 65 and older) remain more likely to die or be severely injured due to motor vehicle collisions (MVCs) than younger people. As the elderly population continues to grow, the number of elderly injured by MVCs is also expected to increase. In this article, the authors investigate MVC-related injury prevention strategies aimed at elderly drivers and pedestrians. An evidence-based review of risk factors and prevention is conducted. The authors determine that injury prevention research is lagging and they recommend further research to strengthen future evidence-based guidelines.

Elder abuse: Paucity of data hampers evidence-based injury prevention.

The effectiveness of trauma center-based injury prevention programs is constrained by a number of variables. These include the wide range of injury types, the variety of possible interventions, institutional support and funding, and the knowledge and experience of the persons responsible for these programs. As the field of injury prevention has increased in complexity, so must the role and professional development of these injury prevention professionals responsible for these programs. Trauma center-based injury prevention coordinators are a diverse group with variable education and professional background especially related to public health, advocacy, epidemiology, biostatistics, and research. Furthermore, inconsistencies exist with their job titles, responsibilities, accountability, and authority, as well as the associated professional resources available to them. The American Trauma Society, with facilitation by the member organizations of the Trauma Prevention Coalition, has addressed the need to standardize the educational foundation for injury prevention coordinators by providing the basis of core competencies that are necessary to successfully oversee an American College of Surgeons Committee on Trauma-verified trauma centers injury prevention program. This inaugural Injury Prevention Coordinators Course was launched in conjunction with the Society of Trauma Nurses 2015 annual conference in Jacksonville, FL, with 7 additional courses having been held through March 2016, comprising 150 participants. The goal of this 2-day, formal trauma center-based, course is to address and standardize key educational segments, including impact of trauma, program development, program evaluation, public health models, injury and data analysis, epidemiology, advocacy, building partnerships and coalitions, and the use of media promotion to ensure consistency throughout the industry.

Are "Goods for Guns" Good for the Community? An Update of a Community Gun Buyback Program

B y 2050, 25% of the US population will consist of individuals older than age 65 compared to the 12.5% makeup in 2000. Wolf reported that in 2000, 4% to 6% of older people had been abused. Only a decade later, the US National Elder Mistreatment Study found that 1 in 10 people aged older than 60 has experienced some kind of mistreatment. While it is unclear if this represents an increase in abuse or an increase in reporting, it is certain that elder abuse is common and serious. The Injury Control and Violence Prevention Section of the Eastern Association for the Surgery of Trauma (EAST), the Practice Management Guidelines Section of EAST, the Injury Prevention Committee of the AmericanAssociation for the Surgery of Trauma (AAST), and the Geriatric Trauma Committee of AAST agree that such maltreatment of our elders must stop. The focus of this paper is to educate the trauma community about current literature on elder abuse prevention, encourage prevention initiatives, and direct future research.

Evaluating distracted driving behaviors in parents of children in suburban and rural areas of Alabama

BACKGROUND Gun violence remains a leading cause of death in the United States. Community gun buyback programs provide an opportunity to dispose of extraneous firearms. The purpose of this study was to understand the demographics, motivation, child access to firearms, and household mental illness of buyback participants in hopes of improving the program’s effectiveness. METHODS A 2015 Injury Free Coalition for Kids gun buyback program which collaborated with local police departments was studied. We administered a 23-item questionnaire survey to gun buyback participants assessing demographic characteristics, motivation for relinquishing firearms, child firearm accessibility, and mental illness/domestic violence history. RESULTS A total of 186 individuals from Central/Western Massachusetts turned in 339 weapons. Participants received between US