A gun safety effort that doesn’t stop at the front door

In Delaware County, a line wraps out the door for a free gun lock box event. Less than 18 minutes later, all the gun lockboxes are on their way to new homes.

In Lancaster County, community gun safety classes pop up in school auditoriums and sportsman’s clubs.

In Philadelphia, attentive hospital security teams put up posters with QR codes to offer visitors a chance to keep the community safer, beyond the hospital’s front door.

These scenes are part of a bigger picture.

The COVID-19 pandemic fueled a surge in gun sales nationwide, as an estimated 30 million people bought guns. Now, among many new gun owners, there is a desire to learn more about how to safely handle and store those firearms.

“There's nothing good about the amount of gun violence that we've seen in Philadelphia, particularly during the pandemic years,” said Elinore Kaufman, MD, MSHP, a trauma surgeon who treats many gunshot victims at Penn Presbyterian Medical Center, and the medical director of the Penn Trauma Violence Recovery Program. “However, there have been good things about the response.”

Across the region, Penn Medicine teams recognize that gun ownership is a reality in many communities, but injuries and deaths don’t have to be. Collectively, these teams are keeping patients, staff, and visitors safe by stopping weapons from entering health care facilities—and keeping the broader community safe by promoting safer gun storage everywhere else. And a research component of the work is showing how these efforts could serve as a model for other hospitals and health systems.

Penn Medicine began to install advanced weapons detection scanners from Evolv Technologies at the entrances of hospitals and clinics at the end of 2021 as part of a promise to protect workers and patients. But they soon became a conduit to deliver safety initiatives into the community, and even to learn about how to make that community safety effort most effective.

At Pennsylvania Hospital, the first to get the Evolv system, the security team noticed something as they stopped people from entering the hospital with weapons in their possession. Guns were carried in all sorts of ways—from holsters to pockets to purses to waistbands.

“So that kind of begs the questions, what are people doing in their homes when it comes to their firearms?” said Captain Terrence Betsill, the hospital’s security operations manager.

Kaufman and Kit Delgado, MD, MS, director of the Penn Medicine Nudge Unit, heard about how the Evolv system was successfully detecting firearms and recognized a chance for the health system to help. They partnered with security to hand out cable locks and safety brochures—and people happily accepted them. That initial success led to a more scalable strategy funded by a grant from Accelerate Health Equity. The team created a poster to display at security entrances that featured a QR code linking to a page where people could register for a free gun lock or safe after filling out a quick survey. Posters were put up first at Pennsylvania Hospital, and eventually HUP Cedar and a handful of clinics. It was a non-confrontational approach to connect with gun owners—no conversations needed.

“What do they say? You get more bees with honey, right?” Betsill said. “We know you have these guns. Let us offer you some information, some wisdom, and some gun locks.”

The survey component of the process wasn’t just curiosity. It was research, as the teams sought to understand the best ways to encourage people to safely store firearms. As described in NEJM Catalyst, the program’s initial phase proved that security teams and hospital operations could be part of a cohesive community safety program.

As the research progressed, an important question surfaced: Which locking mechanism led more people to actually safely store their weapons? Most community giveaway programs run by health systems, including Penn Medicine, give away cable locks, which are more affordable but take time to unlock. Security personnel reported conversations with people who expressed skepticism about the practicality of using cable locks in emergencies. Lock boxes offer gun owners faster access, but they are more expensive.

The program is now in its fourth year and has distributed more than 1,500 locking devices to Philadelphia community members. The research team was awarded a $3.8 million grant from the National Institutes of Health this spring for a five-year study that will survey more than 1,800 people to see if handing out locking devices more in line with the preference of firearm owners leads to higher rates of safe storage.

“There is good evidence out there that patients, community members, firearm owners are open to talking about these issues,” said Kaufman.

The strategy is to go direct. The classes are being held in places where people are more likely to interact with guns or feel the pain of gun violence: from sessions in school assemblies for educators to sportsman’s clubs with hunters.

Lancaster General Health is also looking inward, with trainings and resources for clinical teams to help facilitate conversations about firearm safety with patients.

“We appreciate the opportunity to be sources of safe and trustworthy conversations,” said Pringle.

A common theme running through these efforts is making safe choices easy to access through engagement with the community.

As Betsill, the security captain at Pennsylvania Hospital, noted, “even though we know this is gun violence is a problem, it's still a people problem. And you have to be able to connect with people.”

For the lock box program in Philadelphia, that can mean something of a road show, such as a recent handout event at the Delaware County Health Department office in Yeadon.

With a manner matching her name, Sunny Vespico, MSN, RN, TCRN, patiently helped people register for the free lock boxes, funded by a grant from the Pennsylvania Department of Health. The process required scanning a QR code and filling out a survey, just as visitors encountering the posters at the hospital entrances do. Once that was done, she showed people how the safes worked.

“You can practice it, just like you would practice something on the piano. You’re going to get better over time, and you can punch those numbers in really quick and open this thing in seconds,” she said.

Even with all of those steps, the lock boxes were all handed out in 18 minutes, with several people still in line. The people who couldn’t get a lock box then and there were shown how to order one online, also for free.

Vespico is the trauma injury prevention coordinator at Penn Presbyterian Medical Center. She was driven to this work by the realization that gun violence hits some communities disproportionately hard.

“My first two years in nursing, I was in central Pennsylvania at a level one trauma center, and I saw two firearm injuries. My first night working in Philly, there were 10,” she said. “That’s not fair.”

Then she lost her nephew to gun violence on Christmas Eve in 2019. She devoted herself to violence prevention, saying this project is a chance to use her privilege to make things better for the community. “I can’t fix it all, but, wherever I can, I want to make a difference.”

The people who showed up for the safe handout had reasons as diverse as their community. Frank Griffin’s wife was pregnant, and he said securing his firearm was “something I knew I had to do because having a child and a gun in the home, you have to be able to protect the child.”

Tiesha Gundy wanted to make sure her gun wouldn’t fall into the hands of a criminal if her house was ever broken into.

“I feel like I’m being proactive and just trying to do my due diligence to stop community violence,” she said.

Betsill says these gun safety efforts all boil down to one simple principle—caring.

“Our main goal is to keep people safe,” he said. “If we’re going to get the opportunity to keep people safe, inside the hospital and in our communities, then we’re doing pretty good.”