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A Randomized Controlled Trial on Teaching the Safe Handling of Firearms Using a Simulation-Based Assessment
Jake Hoyne1, Jennifer Yee, Charles Lei
1From the Department of Emergency Medicine (J.K., A.V.G., N.D.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; Department of Emergency Medicine (J.Y., S.L.-S.), The Ohio State University, Columbus, OH; Department of Emergency Medicine (C.L., M.P.), Vanderbilt University Medical Center, Nashville, TN; BerbeeWalsh Department of Emergency Medicine (W.B.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Medicine (N.O.), Section of Emergency Medicine, University of Chicago, Chicago, IL; and Department of Emergency Medicine (A.R.K.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Introduction:
Emergency providers risk encountering firearms in the emergency department, but a minority report familiarity with handling firearms. It may be unsafe if unfamiliar, untrained providers attempt to remove a firearm from the clinical care space. This study assessed the efficacy of an educational intervention training resident physicians in this task.
Methods:
Five emergency medicine residency programs conducted a prospective, single-blinded randomized controlled trial assessing performance of safely removing a firearm from the clinical care space during a simulated patient encounter. The primary outcome was completion of critical actions previously assessed in a pilot study. Residents viewed a 5-minute educational video developed for this study detailing the principles of safely removing a firearm from the clinical care space. The training video was emailed to prospective participants in the intervention group ahead of the simulation session. Afterward, a debriefing session was held with all participants to review the safe handling of firearms.
Results:
Sixty-six of 170 prospective participants (38.8%) consented to participate. There were no significant differences in gender, clinical training level, environment of upbringing, confidence in handling firearms, firearm usage frequency, or prior firearm training. Twenty-nine participants handled the firearm during simulation. The intervention group performed significantly better than the control group, completing a median of 7 critical actions (interquartile range, 7-8) versus 6 critical actions (interquartile range, 5-7), P = 0.035. This effect held among participants who handle firearms outside of work and/or have prior firearms training.
Conclusions:
This study demonstrates how a brief educational intervention was associated with improvement in participants' ability to safely remove a firearm from a simulated clinical care space. This approach can be integrated into existing curricula, and its success suggests broad applicability.
