Health Policy Journal Club, Health Policy, Pediatric EM, Social EM

Health Policy Journal Club: A Study of Firearms Safety Education in the Pediatric Emergency Department

Acceptability of Long vs Short Firearm Safety Education Videos in the Emergency Department: A Pilot Randomized Control Trial

Firearm injury is one of the leading causes of death among youth, and 70% of unintentional pediatric firearm injuries occur in the home of the child or the homes of their friends and family.1 Messaging and education in safe firearm storage can help decrease youth access to firearms and reduce firearm injuries. Health care workers caring for children have the opportunity to ensure that parents and other caregivers receive important information regarding firearm safety. However, providing this information without impacting the efficacy of care or clinician time can be challenging, especially in the emergency department setting.

This study compared two approaches to providing firearm safety education in the pediatric emergency department (PED). Participants were recruited in the PED and randomized to view either a 30-second video or 3-minute video on firearm safety, with the 3-minute video including testimonials from victims of firearm violence, firearm owners, and pediatricians. Participants completed surveys before and immediately after viewing the video as well as at a 3-month follow-up. Among those completing all the surveys, 77.4% of them agreed or strongly agreed that video-based firearm safety education was acceptable and feasible in the PED setting. Those in the longer video group were more likely to report the video was an appropriate length and gained knowledge. The longer video might also increase acceptability of discussing firearm safety in the PED. Both the long and short videos demonstrated comparable acceptability and feasibility.

Considering the increasing concerns surrounding firearm injury in the youth, decreasing their access to firearms is essential. The PED is a unique setting where educational interventions can reach a wide variety of people from diverse backgrounds. With an average PED stay of 163 minutes,2 firearm safety storage education that is 30 seconds or 3 minutes long is appropriate, feasible, and effective for increasing knowledge, especially when using the 3-minute video. Use of video education tools can mitigate the barrier of inadequate time to provide firearm safety education and can deliver a message that can be incorporated into the routine ED workflow.



  1. Preventable Tragedies Finding from the #NotAnAccident Index. Everytown. Date accessed: October 26, 2023. Available from
  2. Barata IA, Mace SE, Wu M, et al. (2013). A comparison of length of stay between admitted and discharged pediatric patients in the emergency department. Ann Emerg Med. 2013;62(4):S111.

Haasz M, Sigel E, Betz ME, Leonard J, Brooks-Russell A, Ambroggio L. Acceptability of long versus short firearm safety education videos in the emergency department: A pilot randomized controlled trial. Ann Emerg Med. 2023;82(4):482-493.

Study objective: Safe firearm storage is protective against pediatric firearm injuries. We sought to compare a 3-minute versus 30-second safe firearm storage video in terms of acceptability of video content and use in the pediatric emergency department (PED).

Methods: We conducted a randomized controlled trial in a large PED (from March to September 2021). Participants were English-speaking caregivers of noncritically ill patients. Participants were surveyed about child safety behaviors (including firearm storage), then shown 1 of 2 videos. Both videos described safe storage principles; the 3-minute video included temporary firearm removal and a survivor testimonial. The primary outcome was acceptability, measured by responses on a 5-point Likert scale (strongly disagree to strongly agree). A survey at 3 months evaluated information recall. Baseline characteristics and outcomes were compared between groups using Pearson chi-squared, Fisher exact, and Wilcoxon Mann Whitney tests as appropriate. Absolute risk difference for categoric variables and mean difference for continuous variables are reported with 95% confidence interval (CI).

Results: Research staff screened 728 caregivers; 705 were eligible and 254 consented to participate (36%); 4 withdrew. Of 250 participants, most indicated acceptability in terms of setting (77.4%) and content (86.6%), and doctors discussing firearm storage (78.6%), with no difference between groups. More caregivers viewing the longer video felt the length appropriate (99.2%) compared with the shorter video (81.1%, difference 18.1%, 95% CI 11.1 to 25.1).

Conclusions: We show that video-based firearm safety education is acceptable among study participants. This can provide consistent education to caregivers in PEDs and needs further study in other settings.

EMRA + PolicyRx Health Policy Journal Club: A collaboration between Policy Prescriptions and EMRA

As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care physicians, and the lack of mental health services - are universal problems. As EM residents and fellows,  we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula. This is the gap this initiative aims to fill.  Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.  

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