1
|
Knoepke CE, Barnard LM, Batta N, McCarthy M, Thies K, Olivencia C, Robinson C, Kettering S, Huss S, Betz ME. Petitions for Extreme Risk Protection Orders and Second Amendment Sanctuary Status in Colorado. JAMA Netw Open 2024; 7:e244381. [PMID: 38558140 PMCID: PMC10985551 DOI: 10.1001/jamanetworkopen.2024.4381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024] Open
Abstract
Importance Extreme risk protection orders (ERPOs) temporarily bar individuals adjudicated as being at risk of violence (including suicide) from buying or possessing firearms. In protest, many US jurisdictions have declared themselves "Second Amendment sanctuaries" (2A sanctuaries). Many 2A sanctuaries continue to use ERPOs in low numbers, suggesting a poorly defined risk threshold at which they are acceptable. Objective To characterize circumstances under which ERPOs are used in 2A sanctuaries, highlighting their most broadly acceptable applications. Design, Setting, and Participants This cross-sectional study of civil court documents analyzed petitions for ERPOs filed in Colorado from January 2020 to December 2022. All petitions during the study period were included following de-duplication. These include petitions filed by law enforcement and family members against adults allegedly at risk of firearm violence across the state. Data were analyzed on a rolling basis between January 2020 and June 2023. Exposure ERPO petition filed in Colorado. Main Outcomes and Measures Seventy-seven data elements defined a priori were abstracted from all petitions and case files, including respondent demographics, petitioner types (family or law enforcement), types of threats (self, other, mass violence, combination), violence risk factors, and case outcomes (granted, denied). Results Of a total 338 ERPOs filed in Colorado, 126 (37.3%) occurred in 2A sanctuaries. Sixty-one of these 2A petitions were granted emergency orders, and 40 were full 1-year ERPOs after a hearing. Forty ERPOs (31.7%) were petitioned for by law enforcement. Petitions in non-2A counties were more likely to have been filed by law enforcement (138 of 227 [64.9%] vs 40 of 126 [31.7%]; P < .001) and to have had an emergency order granted (177 of 227 [78.0%] vs 61 of 126 [48.4%]; P < .001) than in 2A sanctuaries. Qualitative analysis of cases in 2A sanctuaries revealed common aggravating risk characteristics, including respondents experiencing hallucinations, histories of police interaction, and substance misuse. ERPOs have been granted in 2A sanctuaries against individuals threatening all forms of violence we abstracted for (themselves, others, and mass violence). Conclusions and Relevance In this examination of ERPO petitions across Colorado, more than a third of filings occurred in 2A sanctuaries. Nonetheless, law enforcement represent proportionately fewer petitions in these areas, and petitions are less likely to be granted. Serious mental illness, substance misuse, and prior interactions with law enforcement featured prominently in 2A sanctuary petitions. These case circumstances highlight dangerous situations in which ERPOs are an acceptable risk-prevention tool, even in areas politically predisposed to opposing them.
Collapse
Affiliation(s)
- Christopher E. Knoepke
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora
- Division of Cardiology, University of Colorado School of Medicine, Aurora
- Adult and Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora
| | - Leslie M. Barnard
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora
- Department of Epidemiology, University of Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
| | - Nisha Batta
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora
- Department of Epidemiology, University of Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
| | - Kimberly Thies
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
| | - Christian Olivencia
- Adult and Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora
| | - Caitlin Robinson
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
| | | | - Sheila Huss
- School of Public Affairs, University of Colorado, Denver
| | - Marian E. Betz
- Firearm Injury Prevention Initiative, University of Colorado School of Medicine, Aurora
- Injury and Violence Prevention Center, University of Colorado School of Medicine and University of Colorado School of Public Health, Aurora
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| |
Collapse
|
2
|
Barnard LM, Knoepke CE, McCarthy M, Rowhani-Rahbar A, Siry-Bove BJ, Betz ME. Views of voluntary, temporary out-of-home firearm storage among individuals living in a firearm-owning home: results from a qualitative study in two states. Inj Prev 2023; 29:431-436. [PMID: 37451860 PMCID: PMC10529183 DOI: 10.1136/ip-2023-044868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Firearms account for the majority of suicide deaths in the USA. A recommended approach for suicide prevention is reducing access to firearms by temporarily removing them from the home. We sought to understand how firearm owners and those who reside with them view and might use voluntary, temporary out-of-home firearm storage. METHODS From July to November 2021, we interviewed English-speaking adults in Colorado and Washington who own firearms or reside with them, using semistructured interviews. We used a team-based mixed deductive and inductive approach to code transcripts and identify themes. RESULTS Half of the 38 interviewees were men (53%) aged 35-54 years (40%); 92% identified as white. The average age that participants reported first having a firearm was 20.4 years; 16% reported never owning a firearm themselves, only living in homes with firearms. Qualitative findings fell into broad themes: (1) storage with family members/friends, (2) concerns/challenges with storing a firearm with a business/organization, (3) importance of trust (4) outreach methods for out-of-home storage programmes. CONCLUSION Programmes for voluntary, temporary out-of-home firearm storage will not be impactful unless such storage is desired and used. Understanding views of potential storage users can help support development of acceptable and feasible programmes.
Collapse
Affiliation(s)
- Leslie M Barnard
- Epidemiology, University of Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher E Knoepke
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Cardiology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Marian E Betz
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
3
|
Barnard LM, Wright-Kelly E, Brooks-Russell A, Betz ME. Characterization of Mass Shootings by State, 2014-2022. JAMA Netw Open 2023; 6:e2325868. [PMID: 37494046 PMCID: PMC10372703 DOI: 10.1001/jamanetworkopen.2023.25868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- Leslie M Barnard
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Erin Wright-Kelly
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Ashley Brooks-Russell
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| |
Collapse
|
4
|
Barnard LM, Spark TL, Leavitt C, Leary J, Lehmkuhl LJ, Johnston N, Wallace EA. Leveraging Community Context, Data, and Resources to Inform Suicide Prevention Strategies. J Law Med Ethics 2023; 51:83-92. [PMID: 37226747 DOI: 10.1017/jme.2023.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Colorado has consistently had one of the highest rates of suicide in the United States, and El Paso County has the highest number of suicide and firearm-related suicide deaths within the state. Community-based solutions like those of the Suicide Prevention Collaborative of El Paso County may be more effective in preventing suicide as they are specific to local issues, sensitive to local culture, and informed by local data, community members, and stakeholders.
Collapse
Affiliation(s)
| | | | | | | | - Lee J Lehmkuhl
- FIRST CONGREGATIONAL UNITED CHURCH OF CHRIST, COLORADO SPRINGS, CO, USA
| | - Nicole Johnston
- SUICIDE PREVENTION COLLABORATIVE OF EL PASO COUNTY, COLORADO SPRINGS, CO, USA
| | - Erik A Wallace
- UNIVERSITY OF COLORADO SCHOOL OF MEDICINE, AURORA, CO, USA
| |
Collapse
|
5
|
Thomas AC, Siry-Bove BJ, Barnard LM, Rooney L, McCarthy M, Mustafa A, Rowhani-Rahbar A, Rivara FP, Betz ME, Knoepke C. A Qualitative study on diverse perspectives and identities of firearm owners. Inj Prev 2022; 28:434-439. [PMID: 35470245 PMCID: PMC9492625 DOI: 10.1136/injuryprev-2022-044522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Research surrounding firearm ownership is often contextualised within the perspectives of older white men. We expand this description using the perceptions of a diverse group of firearm-owning stakeholders. METHODS We conducted semistructured interviews from October 2020 to May 2021 with Colorado/Washington State stakeholders representing (1) firearm ranges/retailers; (2) law enforcement agencies or (3) relevant state/national firearm organisations. Data were analysed using standard qualitative techniques and included 25 participants, representing varied sociocultural groups including racial and ethnic minorities, political minorities and sexual minorities. RESULTS Participants for this analysis were of different self-identified sociocultural groups including racial and ethnic minorities (African American, Hispanic and Asian), political minorities (liberal) and sexual minorities, defined as Lesbian, Gay, Bisexual, and Transgender (LGBT). Perspectives on firearm ownership included an idea of gun culture as a component of (1) personal identity, (2) an expression of full citizenship and (3) necessary for self-protection. A strong subtheme was the intersection of minority group and firearm owner identities, creating a need for divergent social communities because of ideas on traditional gun culture. These communities are a safe place for individuals belonging to minority groups to escape negative external and internal group associations with firearms. CONCLUSION Perspectives on firearms and firearm ownership in the secondary analysis were heterogeneous and related to personal experiences, external and internal group pressures that influence individual behaviour. Understanding the breadth of perspectives on firearm ownership is imperative to engaging individuals for risk reduction. This study adds to the literature by expanding an understanding of the motivation for firearm ownership among diverse communities.
Collapse
Affiliation(s)
- Arielle C Thomas
- American College of Surgeons, Chicago, Wisconsin, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bonnie J Siry-Bove
- Emergency Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Leslie M Barnard
- Department of Epidemiology, University of Colorado Health, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Lauren Rooney
- Firearm Injury and Policy Research, University of Washington School of Medicine, Seattle, Washington, USA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
| | - Megan McCarthy
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Ayah Mustafa
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
- Firearm Injury and Policy Research, University of Washington Seattle Campus, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Frederick P Rivara
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, Seattle, Washington, USA
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Christopher Knoepke
- Department of Cardiology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
6
|
Betz ME, Rooney LA, Barnard LM, Siry‐Bove BJ, Brandspigel S, McCarthy M, Simeon K, Meador L, Rivara FP, Rowhani‐Rahbar A, Knoepke CE. Voluntary, temporary, out-of-home firearm storage: A qualitative study of stakeholder views. Suicide Life Threat Behav 2022; 52:655-667. [PMID: 35224749 PMCID: PMC9378345 DOI: 10.1111/sltb.12850] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/16/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reducing firearm access during times of risk is a key component of suicide prevention, including the person at risk voluntarily, temporarily storing firearms outside the home. However, this approach relies on the participation of storage providers (ranges/retailers and law enforcement agencies (LEAs)). Our objective was to describe stakeholders' views and experiences surrounding voluntary, temporary out-of-home firearm storage for suicide prevention. METHOD We conducted individual interviews with (1) firearm ranges/retailers; (2) LEAs (in Colorado or Washington State); and (3) state/national organizations involved in policy development or enactment; public health; or firearm rights. Transcripts were analyzed using a team-based mixed inductive-deductive approach. RESULTS Across 100 interviews (October-May 2021), potential storage providers were supportive of voluntary storage programs, often reporting a desire to help their customers and community. However, potential storage suppliers cited civil liability, regulatory, and legal concerns associated with storing and/or returning firearms (to people who had previously expressed suicide risk). Stakeholders offered suggested strategies meant to address liability and increase storage accessibility. CONCLUSIONS Understanding stakeholder views supports the development of acceptable, feasible programs for out-of-home firearm storage during times of suicide risk. Clarification of existing regulations or creation of new policies is necessary to address potential providers' concerns.
Collapse
Affiliation(s)
- Marian E. Betz
- Department of Emergency MedicineSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA,Injury and Violence Prevention CenterColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA,VA Eastern Colorado Geriatric Research Education and Clinical CenterDenverColoradoUSA
| | - Lauren A. Rooney
- Firearm Injury Policy and Research ProgramHarborview Injury Prevention and Research CenterUniversity of WashingtonSeattleWashingtonUSA
| | - Leslie M. Barnard
- Department of Emergency MedicineSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA,Department of EpidemiologyColorado School of Public HealthAuroraColoradoUSA
| | - Bonnie J. Siry‐Bove
- Department of Emergency MedicineSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Sara Brandspigel
- Injury and Violence Prevention CenterColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Megan McCarthy
- Department of Emergency MedicineSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Kate Simeon
- Denver Health Emergency Medicine ResidencyDenver Health and Hospital AuthorityDenverColoradoUSA
| | - Lauren Meador
- Department of Emergency MedicineSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Frederick P. Rivara
- Firearm Injury Policy and Research ProgramHarborview Injury Prevention and Research CenterUniversity of WashingtonSeattleWashingtonUSA
| | - Ali Rowhani‐Rahbar
- Firearm Injury Policy and Research ProgramHarborview Injury Prevention and Research CenterUniversity of WashingtonSeattleWashingtonUSA,Department of EpidemiologySchool of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Christopher E. Knoepke
- Division of CardiologySchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA,Adult & Child Consortium for Outcomes Research & Delivery ScienceSchool of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| |
Collapse
|
7
|
Betz ME, Brandspigel S, Barnard LM, Johnson RL, Knoepke CE, Peterson RA, Rivara FP, Rowhani-Rahbar A. Voluntary, temporary out-of-home firearm storage: a survey of law enforcement agencies in two states. Inj Epidemiol 2022; 9:24. [PMID: 35864502 PMCID: PMC9302866 DOI: 10.1186/s40621-022-00389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Temporary, voluntary storage of firearms away from the home during times of risk is a recommended strategy for suicide prevention. Law enforcement agencies (LEAs) are often suggested as storage sites, and online maps in Colorado and Washington display LEAs willing to consider storage. Questions remain about the experiences and views of LEAs, including barriers to providing storage. Methods LEAs in Colorado and Washington were invited to complete a survey via mail or online from June to July 2021; invitations were sent by email and mail, with telephone calls to non-responders. Survey data were analyzed using descriptive statistics, with testing between states and other subgroups using Fisher’s exact tests. Results Overall, 168 LEAs in Colorado (n = 91) or Washington (n = 77) participated (40% participation rate). Of those, 53% provided temporary, voluntary storage upon request by community members at the time of the survey. More LEAs said they had ever provided storage when the requester was under a court order (74% overall). Over half (60%) of responding LEAs had received at least one storage request in the prior 12 months. Many (41%) said they had declined to return a firearm after temporary storage due to safety concerns. Most LEAs supported engagement in suicide prevention (89%) and provision of community services (77%), but they simultaneously preferred being a storage option of last resort (73%). Factors negatively influencing storage provision included liability and funding concerns. Conclusions In Colorado and Washington, half of LEAs currently offer temporary, voluntary firearm storage upon request. While LEAs support suicide prevention and community engagement, broader provision of storage and participation in online maps may be limited by logistic, liability, and financial concerns. Addressing these barriers may facilitate broader suicide prevention efforts. Supplementary Information The online version contains supplementary material available at 10.1186/s40621-022-00389-3.
Collapse
Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA.
| | - Sara Brandspigel
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Leslie M Barnard
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Rachel L Johnson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Christopher E Knoepke
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ryan A Peterson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Frederick P Rivara
- Firearm Injury Policy and Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
8
|
Barnard LM, McCarthy M, Knoepke CE, Kaplan S, Engeln J, Betz ME. Colorado's first year of extreme risk protection orders. Inj Epidemiol 2021; 8:59. [PMID: 34670617 PMCID: PMC8527814 DOI: 10.1186/s40621-021-00353-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Extreme Risk Protection Orders (ERPOs) are a relatively new type of law that are being considered or implemented in many states in the United States. Colorado’s law went into effect on January 1, 2020, after significant controversy and concern over potential misuse of the law to confiscate weapons; many (n = 37 of 64) counties declared themselves “2nd Amendment (2A) sanctuaries” and said they would not enforce the law. Here, reviewed the patterns of use of the law during its first year. Methods We obtained all court records for ERPO petitions filed between January 1 and December 31, 2020. Data elements were abstracted by trained staff using a standardized guide. We calculated the proportion of petitions that were approved or denied/dismissed, identified cases of obvious misuse, and examined patterns by 2A county status. Finding and results In 2020, 109 ERPO petitions were filed in Colorado; of these, 61 were granted for a temporary ERPO and 49 for a full (year-long) ERPO. Most petitions filed by law enforcement officers were granted (85%), compared to only 15% of petitions filed by family or household members. Of the 37 2A sanctuary counties, 24% had at least one petition filed, versus 48% of non-2A sanctuary counties. Across the 2A counties, there were 1.52 ERPOs filed per 100,000 population, compared to 2.05 ERPOs filed per 100,000 in non-2A counties. There were 4 cases of obvious law misuse; none of those petitions resulted in an ERPO or firearm confiscation. Conclusion State-level studies suggest ERPOs may prevent firearm injuries. Robust implementation, however, is critical for maximal effect. Understanding ERPO experiences and challenges can inform policy creation and enaction in other states, including identifying how best to address concerns and facilitate evaluation.
Collapse
Affiliation(s)
- Leslie M Barnard
- Department of Epidemiology, Colorado School of Public Health, Leslie Barnard, 3438 N Gilpin Street, Denver, CO, 80205, USA. .,Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Megan McCarthy
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher E Knoepke
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sabrina Kaplan
- Denver Health Emergency Medicine Residency, Denver Health Medical Center, Denver, CO, USA
| | - James Engeln
- Denver Health Emergency Medicine Residency, Denver Health Medical Center, Denver, CO, USA
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
| |
Collapse
|
9
|
Brown A, Schwarcz L, Counts CR, Barnard LM, Yang BY, Emert JM, Latimer A, Drucker C, Lynch J, Kudenchuk PJ, Sayre MR, Rea T. Risk for Acquiring Coronavirus Disease Illness among Emergency Medical Service Personnel Exposed to Aerosol-Generating Procedures. Emerg Infect Dis 2021; 27:2340-2348. [PMID: 34197282 PMCID: PMC8386780 DOI: 10.3201/eid2709.210363] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We investigated the risk of coronavirus disease (COVID-19)- patients transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to emergency medical service (EMS) providers, stratified by aerosol-generating procedures (AGP), in King County, Washington, USA, during February 16-July 31, 2020. We conducted a retrospective cohort investigation using a statewide COVID-19 registry and identified 1,115 encounters, 182 with ≥1 AGP. Overall, COVID-19 incidence among EMS personnel was 0.57 infections/10,000 person-days. Incidence per 10,000 person-days did not differ whether or not infection was attributed to a COVID-19 patient encounter (0.28 vs. 0.59; p>0.05). The 1 case attributed to a COVID-19 patient encounter occurred within an at-risk period and involved an AGP. We observed a very low risk for COVID-19 infection attributable to patient encounters among EMS first responders, supporting clinical strategies that maintain established practices for treating patients in emergency conditions.
Collapse
|
10
|
Barnard LM, Guan S, Zarmer L, Mills B, Blackwood J, Bulger E, Yang BY, Johnston P, Vavilala MS, Sayre MR, Rea TD, Murphy DL. Prehospital tourniquet use: An evaluation of community application and outcome. J Trauma Acute Care Surg 2021; 90:1040-1047. [PMID: 34016927 DOI: 10.1097/ta.0000000000003145] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is substantial investment in layperson and first responder training involving tourniquet use for hemorrhage control. Little is known however about prehospital tourniquet application, field conversion, or outcomes in the civilian setting. We describe the experience of a metropolitan region with prehospital tourniquet application. METHODS We conducted a retrospective cohort study characterizing prehospital tourniquet use treated by emergency medical services (EMS) in King County, Washington, from January 2018 to June 2019. Emergency medical services and hospital records were abstracted for demographics, injury mechanism, tourniquet details, clinical care, and outcomes. We evaluated the incidence of tourniquet application, who applied the device (EMS, law enforcement, or layperson), and subsequent course. RESULTS A total of 168 patients received tourniquet application, an incidence of 5.1 per 100,000 person-years and 3.48 per 1,000 EMS responses for trauma. Tourniquets were applied for penetrating trauma (64%), blunt trauma (30%), and bleeding ateriovenous fistulas (7%). A subset was critically ill: 13% had systolic blood pressures of <90 mm Hg, 8% had Glasgow Coma Scale score of <13, and 3% had cardiac arrest. Among initial applications, 48% were placed by law enforcement, 33% by laypersons, and 18% by EMS. Among tourniquets applied by layperson or law enforcement (n = 137), EMS relied solely on the original tourniquet in 45% (n = 61), placed a second tourniquet in 20% (n = 28), and removed the tourniquet without replacement in 35% (n = 48). Overall, 24% required massive transfusion, 59% underwent urgent surgery, and 21% required vascular surgery. Mortality was 3% (n = 4). At hospital discharge, the tourniquet limb was fully functional in 81%, partially functional in 10%, and nonfunctional in 9%; decreased function was not attributed to tourniquet application. CONCLUSION The high rate of application, need for urgent hospital intervention in a subset, and low incidence of apparent complication suggest that efforts to increase access and early tourniquet use can provide public health benefit. LEVEL OF EVIDENCE Therapeutic, level IV.
Collapse
Affiliation(s)
- Leslie M Barnard
- From the Division of Emergency Medical Services Pubic Health Seattle & King County (L.M.B., S.G., J.B., T.D.R.), Seattle, Washington; Department of Neurobiology (L.Z.), University of California Los Angeles, Los Angeles, California; Harborview Injury Prevention and Research Center (B.M., M.S.V.), University of Washington, Seattle, Washington; Department of Epidemiology (B.M.), University of Washington, Seattle, Washington; Department of Surgery (E.B., P.J.), University of Washington, Seattle, Washington; Department of Emergency Medicine (B.Y.Y., M.R.S., D.L.M.), University of Washington, Seattle, Washington; Department of Anesthesiology and Pain Medicine (M.S.V.), University of Washington, Seattle, Washington; Seattle Fire Department (M.R.S.); and Department of Medicine (T.D.R.), University of Washington, Seattle, Washington
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Murphy DL, Barnard LM, Drucker CJ, Yang BY, Emert JM, Schwarcz L, Counts CR, Jacinto TY, McCoy AM, Morgan TA, Whitney JE, Bodenman JV, Duchin JS, Sayre MR, Rea TD. Occupational exposures and programmatic response to COVID-19 pandemic: an emergency medical services experience. Emerg Med J 2020; 37:707-713. [PMID: 32958477 PMCID: PMC7507417 DOI: 10.1136/emermed-2020-210095] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/10/2020] [Accepted: 08/05/2020] [Indexed: 01/10/2023]
Abstract
Rigorous assessment of occupational COVID-19 risk and personal protective equipment (PPE) use is not well-described. We evaluated 9-1-1 emergency medical services (EMS) encounters for patients with COVID-19 to assess occupational exposure, programmatic strategies to reduce exposure and PPE use. We conducted a retrospective cohort investigation of laboratory-confirmed patients with COVID-19 in King County, Washington, USA, who received 9-1-1 EMS responses from 14 February 2020 to 26 March 2020. We reviewed dispatch, EMS and public health surveillance records to evaluate the temporal relationship between exposure and programmatic changes to EMS operations designed to identify high-risk patients, protect the workforce and conserve PPE. There were 274 EMS encounters for 220 unique COVID-19 patients involving 700 unique EMS providers with 988 EMS person-encounters. Use of 'full' PPE including mask (surgical or N95), eye protection, gown and gloves (MEGG) was 67%. There were 151 person-exposures among 129 individuals, who required 981 quarantine days. Of the 700 EMS providers, 3 (0.4%) tested positive within 14 days of encounter, though these positive tests were not attributed to occupational exposure from inadequate PPE. Programmatic changes were associated with a temporal reduction in exposures. When stratified at the study encounters midpoint, 94% (142/151) of exposures occurred during the first 137 EMS encounters compared with 6% (9/151) during the second 137 EMS encounters (p<0.01). By the investigation's final week, EMS deployed MEGG PPE in 34% (3579/10 468) of all EMS person-encounters. Less than 0.5% of EMS providers experienced COVID-19 illness within 14 days of occupational encounter. Programmatic strategies were associated with a reduction in exposures, while achieving a measured use of PPE.
Collapse
Affiliation(s)
- David L Murphy
- Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Leslie M Barnard
- Public Health Seattle and King County, Emergency Medical Services Division, Seattle, Washington, USA
| | - Christopher J Drucker
- Public Health Seattle and King County, Emergency Medical Services Division, Seattle, Washington, USA
| | - Betty Y Yang
- Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Jamie M Emert
- Public Health Seattle and King County, Emergency Medical Services Division, Seattle, Washington, USA
| | - Leilani Schwarcz
- Public Health Seattle and King County, Emergency Medical Services Division, Seattle, Washington, USA
| | | | - Tracie Y Jacinto
- Public Health Seattle and King County, Emergency Medical Services Division, Seattle, Washington, USA
| | - Andrew M McCoy
- Emergency Medicine, University of Washington, Seattle, Washington, USA
- American Medical Response Puget Sound, Seattle, Washington, USA
| | | | | | | | - Jeffrey S Duchin
- Public Health Seattle and King County, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael R Sayre
- Emergency Medicine, University of Washington, Seattle, Washington, USA
- Seattle Fire Department, Seattle, Washington, USA
| | - Thomas D Rea
- Public Health Seattle and King County, Emergency Medical Services Division, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
12
|
Yang BY, Barnard LM, Emert JM, Drucker C, Schwarcz L, Counts CR, Murphy DL, Guan S, Kume K, Rodriquez K, Jacinto T, May S, Sayre MR, Rea T. Clinical Characteristics of Patients With Coronavirus Disease 2019 (COVID-19) Receiving Emergency Medical Services in King County, Washington. JAMA Netw Open 2020; 3:e2014549. [PMID: 32639570 PMCID: PMC7344378 DOI: 10.1001/jamanetworkopen.2020.14549] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023] Open
Abstract
Importance The ability to identify patients with coronavirus disease 2019 (COVID-19) in the prehospital emergency setting could inform strategies for infection control and use of personal protective equipment. However, little is known about the presentation of patients with COVID-19 requiring emergency care, particularly those who used 911 emergency medical services (EMS). Objective To describe patient characteristics and prehospital presentation of patients with COVID-19 cared for by EMS. Design, Setting, and Participants This retrospective cohort study included 124 patients who required 911 EMS care for COVID-19 in King County, Washington, a large metropolitan region covering 2300 square miles with 2.2 million residents in urban, suburban, and rural areas, between February 1, 2020, and March 18, 2020. Exposures COVID-19 was diagnosed by reverse transcription-polymerase chain reaction detection of severe acute respiratory syndrome coronavirus 2 from nasopharyngeal swabs. Test results were available a median (interquartile range) of 5 (3-9) days after the EMS encounter. Main Outcomes and Measures Prevalence of clinical characteristics, symptoms, examination signs, and EMS impression and care. Results Of the 775 confirmed COVID-19 cases in King County, EMS responded to 124 (16.0%), with a total of 147 unique 911 encounters. The mean (SD) age was 75.7 (13.2) years, 66 patients (53.2%) were women, 47 patients (37.9%) had 3 or more chronic health conditions, and 57 patients (46.0%) resided in a long-term care facility. Based on EMS evaluation, 43 of 147 encounters (29.3%) had no symptoms of fever, cough, or shortness of breath. Based on individual examination findings, fever, tachypnea, or hypoxia were only present in a limited portion of cases, as follows: 43 of 84 encounters (51.2%), 42 of 131 (32.1%), and 60 of 112 (53.6%), respectively. Advanced care was typically not required, although in 24 encounters (16.3%), patients received care associated with aerosol-generating procedures. As of June 1, 2020, mortality among the study cohort was 52.4% (65 patients). Conclusions and Relevance The findings of this cohort study suggest that screening based on conventional COVID-19 symptoms or corresponding examination findings of febrile respiratory illness may not possess the necessary sensitivity for early diagnostic suspicion, at least in the prehospital emergency setting. The findings have potential implications for early identification of COVID-19 and effective strategies to mitigate infectious risk during emergency care.
Collapse
Affiliation(s)
- Betty Y. Yang
- Department of Emergency Medicine, University of Washington, Seattle
| | - Leslie M. Barnard
- Division of Emergency Medical Services Public Health–Seattle and King County, Seattle, Washington
| | - Jamie M. Emert
- Division of Emergency Medical Services Public Health–Seattle and King County, Seattle, Washington
| | - Christopher Drucker
- Division of Emergency Medical Services Public Health–Seattle and King County, Seattle, Washington
| | - Leilani Schwarcz
- Division of Emergency Medical Services Public Health–Seattle and King County, Seattle, Washington
| | | | - David L. Murphy
- Department of Emergency Medicine, University of Washington, Seattle
| | - Sally Guan
- Division of Emergency Medical Services Public Health–Seattle and King County, Seattle, Washington
| | - Kosuke Kume
- Division of Emergency Medical Services Public Health–Seattle and King County, Seattle, Washington
| | - Karen Rodriquez
- Division of Emergency Medical Services Public Health–Seattle and King County, Seattle, Washington
| | - Tracie Jacinto
- Division of Emergency Medical Services Public Health–Seattle and King County, Seattle, Washington
| | - Susanne May
- Department of Biostatistics, University of Washington, Seattle
| | - Michael R. Sayre
- Department of Emergency Medicine, University of Washington, Seattle
- Seattle Fire Department, Seattle, Washington
| | - Thomas Rea
- Department of Medicine, University of Washington, Seattle
| |
Collapse
|