Children should not be shot: Child access prevention laws are just as important as child restraint laws!

By Kiesha Fraser Doh

In 2019, there were 563 emergency department visits for unintentional shootings involving children and teens in Georgia. Early 2020 estimates show that a total of 22 children gained access to a gun and unintentionally shot themselves or someone else. The youngest child was two years old when he shot his father in the back and killed him

In 2020, there was an increase in firearm injuries and deaths of children nationwide. During the first six months, there was a 1.9 times increased risk of firearm injury in children under 12 and an 1.4 times increased risk of children under 12 shooting someone else with a gun compared to pre-COVID period.

There are numerous ways to secure firearms safely by utilizing cable locks, trigger locks, lockboxes, and gun safes. Public policy that encourages gun owners to secure their weapons could potentially reduce the impact of this injury, similar to the impact that child passenger restraint laws have had on our society.  In 1975, many kids died in motor vehicle collisions (MVCs) due to inadequate and less sophisticated car design and lack of child and passenger restraints. Since 1975, the rate of pediatric passenger motor vehicle deaths has decreased by 56%.  

In the early 1980s, only 14% of American adults used seat belts, and only 7% of American children were restrained in seat belts or car seats. Starting in the ’70s and ‘80s, numerous public safety campaigns promoted car restraints, and the National Highway Transportation Association pushed for improved car design. Since the first child restraint law was enacted in our neighboring state of Tennessee in 1985, child restraint laws have been enacted in all 50 states and DC; these laws have encouraged parents to restrain 90% of children nationwide. In fact, since the passage of Georgia’s seat belt restraint law, 97% of Georgians now wear a seat belt

Since 1963 the child and teen firearm fatality rate has increased by 72%. From March-December 2020, there was a 30% increase in unintended shooting deaths by kids. One-third of children in the US live in homes with guns, and 85% of fatal pediatric firearm deaths in children 12 and under occur in their own homes. In addition, a recent survey in Georgia found that 53% of parents report storing their firearms insecurely: unlocked, loaded, or not separate from ammunition. 

Fifteen states plus the District of Columbia have laws that make it illegal to store your firearm negligently (Child Access Prevention-CAP laws).  Just 4 of those states require some or all guns to be locked up, and only one state, Massachusetts, requires all firearms to be locked up. CAP laws that require gun owners to store their firearms safely have been shown to reduce suicide and unintentional death and injury by up to 54%. In addition, the CAP law in Massachusetts has potentially impacted the number of children killed by guns; for example: in 2019, 163 children and teens died from firearm injuries in Georgia, while Massachusetts had 18 deaths. Georgia’s CAP law is considered a negligence law as it states that it’s illegal to knowingly give a gun to a minor for an unlawful purpose but Ga has no law that makes it illegal for gun owners to store their firearms insecurely. 

Motor vehicle collisions used to be the number one cause of death in children and teens, but now firearms injury has surpassed MVCs as the leading cause of death. By utilizing similar injury prevention approaches to those that enabled us to reduce the frequency of MVCs as a preventable cause of death in children and teens, we can reduce the rate of firearm injury. Medical organizations, public health agencies, gun owners’ associations, and public safety personnel all support safe firearm storage practices in homes with children and youth

“What can healthcare workers and Georgians do?” 

   We can lead by example: securely storing firearms unloaded, locked up, and separate from ammunition.

   We can talk to children and teens in our lives about the dangers of unsecured firearms and what steps to take if they find an unsecured firearm: “STOP! Don’t touch. Leave the area. Tell an Adult.”  

   We can ask if any firearms in the home are stored, unloaded, and locked before sending our child to someone else’s home. 

   We can have respectful, informed conversations with patients, parents, and caregivers about the risk of unsecured firearms and how to reduce that risk.

   We can work collaboratively with lawmakers and stakeholders to craft thoughtful, evidenced-based CAP laws.

   We can partner with community partners, families, and gun owners to advocate for safe gun storage in our communities.

Georgia Stay SAFE! Georgia Stay SAFE is a coalition of healthcare workers involved in injury prevention who came together to form a partnership based on our shared interest in promoting the prevention of firearm injuries in children.Georgia Stay SAFE Coalition is excited to announce the launch of Georgia Stays SAFE campaign this current week from June 20th-June 25th.

Georgia Stays SAFE stands for:

1.     Secure Firearm Storage

2.     Ask Before Play

3.     Focus on Safety

4.     End Firearm Injury

Skin and Soft Tissue Guideline

By Preeti Jaggi

Most antibiotics are prescribed in the outpatient setting and there are many opportunities for optimizing antimicrobial prescribing in this setting. Skin and soft tissue infections (SSTIs) are common presenting complaints in emergency department.  Infectious Disease Society of America guidelines recommend 5 days of initial treatment for non-purulent SSTI. In addition, randomized controlled trials have shown that cephalexin vs. both trimethoprim/sulfamethoxazole and cephalexin (to treat for presumed methicillin resistant Staphylococcus aureus as well as Group A streptococcus) are equally effective for non-purulent SSTI. This implies that cephalexin alone can be used for patients without abscesses. For patients presenting with purulent SSTIs, recent studies have shown comparable cure rates when trimethoprim/sulfamethoxazole or clindamycin are used for 7 instead of 10 days following I&D. 

In our system, we have found a wide range of variation in the outpatient management of SSTIs for both antibiotic choice and duration of treatment. For both purulent and non-purulent SSTIs, clindamycin or trimethoprim/sulfamethoxazole were generally being prescribed for 10 days, a longer duration than recommended. In a recent quality improvement project, we were able to improve antibiotic prescribing for both purulent and non-purulent SSTIs. Exclusion criteria were patients with impetigo, paronychia, preseptal and orbital cellulitis, cephalosporin allergy, and inpatient admission. 

Submersion Injury Guidelines

By Sarah Lazarus

Every summer, there are many articles and news reports of drownings. Some of these reports use terms that are outdated, such as delayed drowning, “dry” drowning, and near-drowning. The World Health Organization (WHO) defines drowning as the process of experiencing respiratory impairment from submersion/immersion in liquid.

  Any submersion or immersion incident without evidence of respiratory impairment should be considered a water rescue and not a drowning. Drowning remains a large cause of morbidity and mortality in children. Drowning is the leading cause in ages 1-4.  At least 10 people die from drowning daily.