S. Gondi is a third-year medical student, Harvard Medical School, Boston, Massachusetts. A.G. Pomerantz is a third-year medical student, Harvard Medical School, Boston, Massachusetts. C.A. Sacks is physician, Division of General Internal Medicine, Massachusetts General Hospital, and instructor in medicine, Harvard Medical School, Boston, Massachusetts.
Acad Med. 2019 Nov;94(11):1649-1653. doi: 10.1097/ACM.0000000000002935.
States are increasingly enacting extreme risk protection order (ERPO) laws, also known as "red flag" or gun violence restraining order laws, as one part of a multidisciplinary approach to address the national gun violence epidemic. Passed into law in more than 10 states and under consideration by legislatures in approximately 30 others, ERPO laws create a legal process to temporarily remove firearms from people who may pose a risk to themselves or others. By enabling family or household members, law enforcement, and, in some cases, health care professionals to petition courts when they are concerned about a potential crisis, these laws can potentially prevent firearm-related violence and save lives. Most states with ERPO laws do not give health care professionals a direct role in filing petitions; still, physicians may serve as a resource for patients or their families by counseling on firearm safety and raising awareness of this legal pathway. In this way, the success of ERPO laws depends, in part, on the ability of physicians to accurately assess risk. However, physicians are often not proficient in making these types of risk assessments, largely because of insufficient training, particularly in the context of firearm-related violence. The authors review the literature on physician skill in violence-related risk assessment, medical education in gun violence prevention, and the capacity for training to improve such risk assessments. The authors then make recommendations for integrating focused gun violence prevention training into undergraduate, graduate, and continuing medical education, reviewing notable examples.
各州越来越多地颁布极端风险保护令(ERPO)法律,也称为“红旗”或枪支暴力限制令法律,作为解决全国枪支暴力泛滥的多学科方法的一部分。这些法律已在 10 多个州通过成为法律,并在大约 30 个其他州的立法机构中进行审议,这些法律规定了一个法律程序,可暂时将枪支从可能对自己或他人构成威胁的人手中夺走。通过使家庭成员、执法人员,在某些情况下还包括医疗保健专业人员,在担心潜在危机时能够向法院提出申请,这些法律可以潜在地预防与枪支有关的暴力事件并拯救生命。拥有 ERPO 法律的大多数州并未赋予医疗保健专业人员直接提出申请的权利;尽管如此,医生可以通过咨询枪支安全问题并提高对这条法律途径的认识,为患者或其家人提供帮助。这样,ERPO 法律的成功在一定程度上取决于医生准确评估风险的能力。但是,医生通常不擅长进行此类风险评估,这主要是因为培训不足,尤其是在与枪支有关的暴力方面。作者回顾了有关医生在与暴力有关的风险评估方面的技能、枪支暴力预防方面的医学教育以及进行此类风险评估培训的能力的文献。然后,作者提出了将重点突出的枪支暴力预防培训纳入本科、研究生和继续医学教育的建议,并回顾了一些显著的例子。