Conan Gasque (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm  Conan Gasque. Our topic today is gunshot injuries and firearm safety. We're joined by Dr. Jennifer McCain from the Emergency Department here at Children's of Alabama. Dr. McCain, thanks so much for your time.

Jennifer McCain, MD: Oh, thanks for having me.

Host: So, I want to talk first about your role here at Children's of Alabama, what you do, and how gunshot injuries are a part of that.

Jennifer McCain, MD: Sure, thanks. Uh, I work in the ER at Children's. Um, I'm a nocturnist, which means I work night shifts. Um, I, there I see patients who are sick and injured, um, kids who have anything from common cold, coughs, flu, asthma, seizures, um, but definitely lots of injuries. We see those. I see children in the trauma bay and get them admitted to ICUs, things like that.

Host: Are gunshot injuries a large part of what you do? Do you see them frequently, would you say?

Jennifer McCain, MD: They have become more and more frequent here recently. Um, when I first started here in training in the 2000s, we were seeing about, between 15 and 20, um, children a year, uh, with gunshot wounds. And this past year we've, we're seeing on, on target for up to over 100, 105.

Host: Wow. So it's something that you've really seen an exponential increase over the last few years or so.

Jennifer McCain, MD: And really the last 10 years. If you look back at 2013, there were 35 children who were seen in our ER for gunshot wounds. And so compare that with just this past year where we saw 73 for the last several years and then this past year now we're up to 95 currently, but on target for 105.

Host: What is that like for you as someone who treats these children to see the numbers go up so dramatically like that?

Jennifer McCain, MD: Yeah, it really just makes us all question how we can do anything to help. We want to make sure that fewer children are having this problem. Um, we're seeing kids, if you think about it, two a week, uh, who are being injured, uh, from gunshot wounds.

And that's on target with what you hear from the rest of the country. If you look at the statistics across the country, we're seeing that now motor vehicle accidents, which have been the number one cause of childhood death, uh, for years, um, in the last several years, now firearm injuries have supplanted that.

They're now the number one cause of death for kids.

Host: How challenging is it for you as an emergency department doctor to treat some of these gunshot wounds? I guess it, it varies from one case to the next, but in general, how challenging can they be?

Jennifer McCain, MD: They can be extremely challenging. These can be some of the most challenging patients that we take care of when kids have gunshot wounds to the head or chest. Those are some of the most severely injured children we'll see within the department for the year.

Host: And obviously, you know, sometimes you have situations where these are accidental, um, cases and, and they, they end up in the emergency room. Um, so I want to talk a little bit about safety and different advice, uh, related to that, specifically for other physicians. How can other physicians initiate conversations with parents and guardians about the safekeeping of firearms?

Jennifer McCain, MD: Yeah, I think that's actually one of the most important things that we can all be doing as, as physicians that take care of kids, um, you know, it's a, it's a discussion point that maybe, maybe we weren't trained to do when we were in residency. It's something that, you know, when, when the numbers were so much smaller back in the years when I was training, anyway. Um, it wasn't a hot topic of things that we talked about, um, but these days I think that's something we absolutely need to address. And so we need to think about it in the same way we think about other, um, injuries that children have.

We've applied a public health approach to taking care of those kids, uh, injured by motor vehicles, by drowning, um, from, say, for, uh, sleep conditions that put kids at risk. So we've, we've, we've asked about these things for, uh, lots and lots of other areas. We worked on those. I think that we need to do a very similar thing with firearms, so I think pediatricians, as we're out taking care of our patients and asking them about, are their children wearing bike helmets, or when they're riding their bikes, or if they're riding a scooter, are there, are they making sure that we're writing the safe, the most up to date evidence that we have for riding in booster seats or car seats. We also need to be asking families about how guns are secured in their home, and we also need to talk to families about, you know, maybe they don't have a gun at their home, but the kids are going to play with the neighbors, and we need to talk to the neighbors about how are they securing their guns as well.

Host: So is the thought process that a doctor should just kind of talk to a parent about that just as sort of a standard question, I guess?

Jennifer McCain, MD: Absolutely. I don't think that it needs to be targeted to one group or another . I think this is a universally, um, important problem for, for children across the gamut. Um, once they're able to crawl and start toddling around and getting into things, um, they're at risk and it, it doesn't matter, um, what home that they're in, uh, that, that we need to think about it when they're going from, from a home that doesn't have guns at all to, to a grandparent's home, aunt's home, our friends, and they, they, likely some, some of those groups of people are going to have a gun in their home.

Host: So for those people who do have guns and who use guns, how important is it for them to have the proper training about using them in the safest possible way?

Jennifer McCain, MD: Yeah, I think it's critical, um, in the same way that we need to be aware of how to drive a car safely, or how to ride our bike safely. Uh, we need to be careful and aware of the, the dangers of, of firearms. Um, you know, kids may be getting some new rifles for Christmas, for their hunting, um, I think that those kids, um, as well as kids who currently have guns should go through fire safety courses, um, so they're aware of how to store their guns safely, um, and securely, and how to, um, be aware of the dangers of the, of the gun as they're carrying it.

Host: And storage is another thing I was going to ask about that. How, how important is it to store it safely and how big a difference can that make?

Jennifer McCain, MD: It can make immense difference. An immense difference. Um, you know, there's lots of studies out there that, that point towards, uh, benefits of, uh, of secure storage. Um, but easily we can reduce the risk of death for kids by 20 to 30% um, if families can just begin to secure their, their, their firearms, not only in their home, but also in their vehicles.

Host: And that's just a matter of knowing what to do, knowing how to store it safely, and then implementing those strategies.

Jennifer McCain, MD: Absolutely. It's going to make sure that they're keeping it safe, keeping it secure, and protecting their family from the firearm, but also protecting the firearm from being stolen. That's another reason for families to think about keeping their firearm away from others. If it's put away, then it won't get into the hands of someone who could use it in a way that was not intended for.

Host: In addition to storage, are there any other strategies that parents can use to limit a child's access to guns?

Jennifer McCain, MD: Absolutely. I think that storage is important. You know, we want to make sure it's not only just stored, um, locked and put away. We have to make sure the ammunition is put away, um, and they're stored in separate conditions. Um, as far as protecting their kids from them, I think the most important thing is, is, is talking to their kids and pediatricians, talking to families, families talking to their children, um, and, and letting them be aware of the significant dangers that are out there with, with these guns. They're not for play. They're, they're not for something that, um,needs to be- It's not something that needs to be in their day to day world.

Host: So gunshot injuries and firearm safety, certainly two very big topics in the world of medicine these days. Dr. Jennifer McCain with the latest advice on that. Dr. McCain, thanks so much for your time.

Jennifer McCain, MD: Thank you.

Host: Thanks for listening to Inside Pediatrics. For more podcasts like this one, go to childrensal.org or wherever you find podcasts.