Study Highlights EMS Role in Reducing Firearm-Related Harm

Firearm-related injuries remain a grim reality for U.S. EMTs and paramedics — but a new UC Davis study asks how they can help prevent them, not just respond to them. The study is entitled, “Experiences with and perspectives on firearm injury prevention among emergency medical services clinicians.”

In this interview with EMS World, study lead co-author Amanda Aubel provided insights into this study and its conclusions. She is a research data analyst with the UC Davis Centers for Violence Prevention. Aubel also supports The BulletPoints Project, a program funded by the State of California that teaches medical and mental health care practitioners strategies to reduce the risk of firearm-related injuries in their patients.

EMS World: Please tell us about your study. What was it about?

Aubel: This study is one of the few to ask EMS clinicians about their experiences and perspectives related to firearms, and the role they currently play or could play in preventing — not just responding to — firearm-related injuries. While there has been growing recognition of the role of physicians and other hospital-based clinicians in preventing firearm injuries, little attention has been given to prehospital clinicians. EMS professionals have unique access to patients in their homes and communities, which presents a significant yet underutilized opportunity to assess and reduce the risk of firearm injury. We hope our findings will help guide future training for EMS clinicians and expand the network of health care professionals equipped to prevent firearm injuries.

EMS World: Why did you do this study?

Aubel: Firearm-related injuries are a major public health problem in the United States. Each year, more than 45,000 people die and countless more are injured or impacted by the ripple effects of gun violence, suicide, and unintentional shootings. EMS clinicians are trained to treat gunshot wounds, but they may also encounter firearms while on a call, sometimes in unexpected situations that pose risks not only to patients but also to EMS personnel and others on scene. While these experiences are well known anecdotally, there has been little research documenting them. We wanted to better understand these realities and identify opportunities to support EMS clinicians in keeping themselves and their patients safe. 

EMS World: What was your methodology?

Aubel: We conducted a 22-item online survey that was distributed to EMS agencies, predominantly in California and Nevada. EMS clinicians who had worked or volunteered during five or more shifts in the previous three months were eligible to participate. Participants were asked about their: recent encounters with patients at risk for firearm-related injury and their screening and counseling practices; career exposure to firearm risk situations while on duty; lifetime experience with firearms; previous training related to firearms and firearm injury prevention; and interest in future training.

The surveys were anonymous. We collected information on participants’ age, gender, current state of residence, state in which they grew up, type of EMS agency for which they primarily work or volunteer, and highest level of medical certification. We calculated standard descriptive statistics (counts and percentages) for each survey item and identified key themes among participants’ write-in responses to open-ended questions. A total of 234 participants completed the survey.

EMS World: What were your findings? Did any of them surprise you?

Aubel: Our findings confirmed what many in the field already know, which is that EMS clinicians encounter a variety of situations in which firearms pose a risk to both their patients and themselves, and the vast majority would like more training on how to handle these situations safely. 75% of participants reported that at least some of their calls in the past three months involved someone at risk of causing or sustaining a firearm-related injury. Yet in most of these cases, they had not asked about firearm access or provided education or counseling on firearm injury prevention.

While some participants noted that law enforcement is responsible for securing the scene before EMS enter, roughly half or more participants reported being on duty without law enforcement when firearms were accessible to suicidal patients (70%), children (47%), altered or unresponsive patients (58%), or in domestic violence situations (49%). These findings underscore the importance of EMS training on how to manage firearms in the field, both when law enforcement is and is not present.

Another notable, and somewhat unexpected, finding was that EMS professionals appear to have more personal experience and familiarity with firearms than many other health care providers. Seventy percent current or past firearm ownership, 73% said they had taken a firearms safety course, and over 80% said they feel comfortable handling a firearm. Given this experience, EMS clinicians may be especially well-positioned to talk with firearm-owning patients about safety in a way that feels respectful, relatable, and grounded in shared life experience.

EMS World: Finally, based on your research, what role can EMS professionals play in reducing firearm injuries?

Aubel: This study highlights the opportunities for EMS professionals to go beyond responding to firearm-related injuries and actively help prevent them. By identifying patients at risk, asking about firearms, and providing recommendations or referrals, EMS clinicians can play a critical role in reducing firearm injuries and deaths.

While universal screening for firearms may be impractical or unnecessary, EMS professionals can use a risk-based approach — asking about firearm access only when a patient has risk factors for injury. Some may already be familiar with this approach for other safety issues, such as intimate partner violence, where they assess risk and provide education or referrals.

To embrace this role, EMS clinicians need expanded and tailored training on identifying patients at increased risk of firearm injury and strategies for reducing risk, including safe storage counseling and ways to safely and legally remove firearms from the home during a crisis. Above all, conversations about firearms should focus on the patient’s health and safety, not personal opinions or politics.