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Permanent AFFIRM: Emergency departments must connect patients with resources to… : Emergency Medicine News


gun safety, violence prevention, mental health


America’s health care safety net is growing even as it continues to fray. Emergency departments have become one-stop-shops for all health crises, but what defines an emergency is subjective, and what contributes to a patient’s presentation to emergency departments is even more varied.

The social determinants of health are also part of every presentation, and recognizing their effect on health is integral to understanding the root and proximal causes of a patient’s emergency medical condition. Social emergency medicine, defined by Harrison J. Alter, MD, of the Andrew Levitt Center for Social Emergency Medicine, as “the incorporation of social context into the structure and practice of emergency care”, grew out of our acceptance of this reality. (REM. 2022;44[4]:22;

EPs serve as a gateway to immediate patient care, which also means meeting the difficult socioeconomic and psychosocial needs of patients, as this column has previously noted. (REM. 2022;44[5]:1; The burden of care and the immense responsibility it creates can be overwhelming, especially considering the impact of COVID-19. Emergency departments serve as indicators of community needs, which ultimately vary based on location and access to community resources.

One of the building blocks of the social emergency medicine movement established by Dr. Alter, founding executive director of the Levitt Center, is a push toward outreach rather than outreach. In-reach is simply about understanding that having local resources within the ED is more effective than referring patients to external resources. This insight led us to ask how physicians can consider public health resources at the bedside and how social resources outside of the emergency department can help improve patient outcomes.

Answering these questions and easing this burden, even gradually, can give patients a better understanding of how their communities can meet their needs while creating better bedside conversations with their physicians. The idea of ​​a one-stop-shop applies to more than just EP services; we can extend this to also include community resources.

Address resource gaps

Every community has resources to meet most of its residents’ needs, but finding them is often the hardest part. Those who work in similar fields or on similar projects are often unaware that there is another in the community. It is not uncommon for multiple organizations to work to reduce suicide, but organization A may not realize that organization B is working on a complementary service or that both are missing the most at risk patients we see at the emergency.

It is virtually guaranteed that an individual will have difficulty accessing resources before a crisis if organizations in the same domain cannot even find each other. People have different needs at different times, and one resource may be enough to avoid a negative outcome.

Some simply need to store their firearms during difficult times in their lives, but do not seek mental health therapy. Others need intensified mental health treatment and do not possess firearms but have other lethal means available. What is needed is a convenient, relevant and uniform platform for accessing resources that is unbiased and freely available.

follow the map

A paradigm shift that improves community relationships with regional health systems is needed to change the public health landscape surrounding firearm injuries and suicide prevention. A sustainable model of care based on trust and mutual respect can be created around an easily accessible Community Assets page that functions as a one-stop shop for mapping all services related to firearm injury prevention, mental health to social determinants to safe storage.

Real-time, interactive mapping would not only provide support to EPs serving on the front lines, but also enable patients and their families to make informed decisions. Mapping shows what is present and what is missing, identifying resource gaps that warrant innovation and investment.

We all want the agency to address our issues, and we can have maximum impact by identifying and elevating the resources that already exist in our communities. The ER, as the hub of the U.S. health care safety net, has a broad responsibility, and EPs are largely accountable and fully invested in optimal patient outcomes. We can leverage this authority to develop referral systems and networks that enable our patients to succeed. We can make meaningful progress through simple steps such as mapping relevant community resources and connecting them through our EDs.

We must strengthen the voices and capacities of our communities, including healthcare workers, businesses, nonprofits, and firearms industry players, to bring about real and impactful change. We can certainly ease the burden of care for physicians while empowering citizens. Our call to action builds on community ties and networking opportunities across the country.

E-mail [email protected] if you want to learn more about how to map your firearm injury prevention resources, work with your community, and reduce firearm injuries and suicide.

Dr. Barsottiis the director of the AFFIRM program at the Aspen Institute, a program dedicated to reducing firearm injuries in the United States through nonpartisan health-based approaches. He is also a community practice emergency physician at Berkshire Medical Center in Pittsfield, MA, and a certified 4-H Youth Rifle Safety Instructor. Read his past columns on, and follow him on Twitter@ChrisBarsottiMD. Mr Maieris a Public Health Specialist for AFFIRM at the Aspen Institute and currently supports a grant-funded initiative in partnership with the Missouri Foundation for Health throughout Greene County, MO. Find more information about AFFIRM on https://affirmresearch.organd follow the foundation on Twitter@ResearchAFFIRM.