​ ​
In the Crosshairs: When Public Safety and Patient Care Intersect




Few words in the United States elicit as much emotion and strife. As I sit and contemplate the horrific scenes of the past few weeks, I am left saddened and enraged but not shocked.

My heart goes out to all the victims and their loved ones. The attacks in Orange County, Boulder and Atlanta are only some of the most recent occurrences of needless tragedy. Regrettably, this ongoing violence can happen anywhere.

Parkland, Orlando, Las Vegas, Pittsburgh, Springfield, Midland, Odessa, Dayton, Gilroy, Virginia Beach, Thousand Oaks, Annapolis, Santa Fe, Sutherland Springs, Fort Lauderdale, Dallas, San Bernardino, Charleston, Newton, Virginia Tech…all could be Anytown, USA.

I’m not here to argue against the Second Amendment. I respect the rights afforded to us as U.S. citizens. I am also not here to argue that we don’t need common sense gun control measures. I respect the right for every life to be safe from gun violence.

I am here to say that this public safety crisis is our business in healthcare.

As long as healthcare providers are left trying to breathe life back into the victims; as long as the violence continues to cross the hospital thresholds, putting patients and staff at risk; as long as our nurses, doctors, social workers, and clergy are left holding the hands and hearts of loved ones whose lives have been shattered—it is our business.

The issue enters our hospitals every time violence occurs in our emergency departments, every time a patient, visitor, or coworker threatens or harms someone within our walls, and every time our staff members try to process the needless loss of life to gun violence.

My sentiment isn’t new or unique. It’s been more than two years since the hashtag #ThisIsOurLane—underscoring how firearm injury affects clinicians—went viral.

The mass shootings I mentioned above are extremely traumatic, yet our individual chances of being caught in the crossfire of a mass shooting remain very rare. We are much likelier to be victims of gun violence on a much smaller scale. This is where healthcare providers might have the greatest opportunity to make an individual impact.

Where do we start? While additional research on the topic of gun violence is a must, healthcare providers do have access to some current best practices on the topic. For example, UpToDate, a commonly used resource for clinical decision support, provides helpful information for adolescents and young adults who are a high-risk demographic for gun violence.

How might we talk about gun violence with patients or families? You may not feel comfortable talking about violence prevention, but there was a time before it was normal to discuss bike helmets and seat belts. This can and should be normal discussion too.

Just like anything else, how you approach the topic might make all the difference.

If you start by asking someone if they have guns in their home, you are very likely to be shut out from any further conversation. Some gun owners believe that anytime someone asks them about their guns, it’s to take them away. This has been my own experience with people I know.

Put yourself in their shoes to understand where they’re coming from. Consider starting with a statement such as, “Many of the patients I see have guns in their homes. I’d like to provide some safety information that might help reduce the risk of your child (or someone else in your home) accidentally being injured.” This subtle shift lays a foundation for a mutually respectful conversation and may alleviate the fear of this information being collected for inappropriate purposes. It also opens the conversation to gun risks outside of the home. For instance, most adolescents who commit suicide accessed the gun in their own home or at the home of someone they know.

What to talk about? You may be completely unfamiliar with guns, and that’s OK. There are plenty of reliable tip sheets and resources you can use to speak with your patients. Websites such as Safe Kids have comprehensive gun safety tips available. And while these are geared toward households with children, they are relevant to all households with guns.

Some important gun safety tips include:

  • Keep guns locked and unloaded; biometric safes (such as fingerprint access) are widely available and alleviate the risk of someone finding the key to the safe.  
  • If you must take your gun out of locked storage, keep it on your person to ensure it isn’t accessible to children or other at-risk individuals.
  • Encourage adult gun owners to take a gun safety course and practice handling the gun regularly in a safe place, like a shooting range. In other words, if you are going to own it, make sure you know how to use it safely.
  • Teach kids to get an adult immediately if they see a gun and to NEVER touch it without adult supervision.
  • Be comfortable talking to other adults about the guns in their homes if your children spend time there.
  • Remember that education isn’t a substitute for locking your gun in a safe that isn’t accessible to children or other at-risk individuals.
  • Be willing to temporarily remove guns if someone in your home is suffering from depression, suicidal thoughts, or has other mental health issues—particularly when not well managed.  

Some important mental wellness tips include:

  • Recognizing and addressing bullying behavior—both the bully and the bullied are at risk to be victims and perpetrators. 
  •  Be a positive and inclusive influence in a child’s life. You may be a relative, a neighbor, a teacher, or coach—take advantage of the little moments to be an example of someone who respects all people. 
  •  Pay attention to changes in behavior of those around you and seek help when appropriate. Early research points to increased gun violence during the pandemic, so heightened awareness during socially distressing times may be prudent. Warning signs of violence can be static (historical and unchangeable, such as a history of abuse), some may develop or escalate over time (such as substance abuse or social withdrawal), and some may be new or sudden changes of behavior (such as increased risk-taking or declining school performance). The American Psychological Association provides a more comprehensive list of these behaviors.

Ensuring universal access to quality mental health services and cultivating a society where hatred of entire communities of people doesn’t exist are critical to making our world a safer place.

But in the meantime, we can all play a small part in the individual lives of those we care for and care about. It just may be a culmination of all these little moments that ends up making the greatest impact.

About this blog

Regina Hoffman serves as the  executive director of Pennsylvania’s Patient Safety Authority and editor-in-chief of Patient Safety, its award-winning journal.  Ms. Hoffman was recognized by Becker’s Hospital Review as one of the top 50 experts leading patient safety in both 2018 and 2020. This blog serves as a source for her to share her insights in patient safety and leadership with Pennsylvania’s healthcare leaders.

***​ The views and opinions expressed at or through this blog are the opinions of the author alone and may not reflect the opinions or positions of the Patient Safety Authority or the Commonwealth of Pennsylvania, nor do these views represent in any way medical or legal advice. ​ 

​  < ​​Clear as Mud: Improving Communication at the Bedside                     
                                  ​​​ ​