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Many Americans favor stronger gun control laws, including those who own guns. Two telephone surveys of 1,200 Americans each found that 88% favored childproofing guns and 70% to 80% favored safety devices that prevent the gun from being used by an unauthorized person or when the magazine or clip is removed. Seventy-three percent favored indicators showing that the gun was loaded. Most believed violent offenders should not be allowed to purchase a gun and 82% believed in mandatory gun registration. Even gun owners favored most of the safety measures.

Alcohol and drug abuse appear to play an important role in violent death among family members. Researchers interviewed the family members of 388 homicide victims and 438 people who committed suicide as well as an equal number of people who served as the control group. Alcohol and drug abuse increased the risk of homicide and suicide and the risk of violent death. Non-drinking family members of drinkers also had an increased homicide rate. Non-drug-using family members of drug users had 11 times the risk of homicide., Context. -- While acute alcohol and illicit drug use are common in homicide and suicide victims, the role of chronic substance use in violent death is unclear. Objective. -- To measure the magnitude of risk of violent death in the home associated with alcohol use or chronic abuse and use of illicit drugs. Data Sources. -- Data obtained from a case-control study of risk factors for homicide and suicide in 3 large metropolitan areas of the United States. Design. -- Matched case-control study including 388 homicide cases, 438 suicide cases, and equal numbers of controls matched for age, sex, race, neighborhood, and county. Data were analyzed by means of conditional logistic regressions in which other potential risk factors for violent death were also considered. Outcome and Exposure Measures. -- Homicide and suicide victims were identified from medical examiner reports in Shelby County, Tennessee; King County, Washington; and Cuyahoga County, Ohio. Structured interviews were conducted with proxy respondents close to the decedents to obtain information about alcohol or illicit drug use, and history of alcohol-related hospitalization or trouble at work because of drinking by the subject. Data about alcohol use by others living in the same house as the subject were also obtained. Results. -- The risks of homicide and suicide associated with alcohol or illicit drug use were elevated, as were the risks of violent death associated with several indicators of chronic alcohol abuse. In addition, nondrinkers living in a home with alcohol users were at increased risk of homicide (odds ratio, 1.7; 95% confidence interval, 0.98-3.0), and non-drug-using individuals residing in homes with illicit drug users were at greatly increased risk of homicide (odds ratio, 11.3; 95% confidence interval, 4.4-28.8). Conclusions. -- Alcohol and illicit drug use appear to be associated with an increased risk of violent death. The risk of homicide was increased for nonsubstance-abusing individuals living in households in which other members abused alcohol or drugs. The concept of the individual at risk of homicide should be broadened to include not only the abuser but also those who may be at risk because of their exposure to others.

Many people may have nonfinancial reasons for going to a hospital emergency department (ED) when they are sick. In a survey of 6,187 people visiting EDs in 56 hospitals nationwide, 49% had a nonurgent condition. Half said they had nonfinancial reasons for going to the ED. These included problems scheduling an appointment with their regular doctor because of work, lack of transportation and lack of a telephone. Those with insurance or a regular physician had similar reasons for using the ED as those who did not. Five percent were eventually admitted to the hospital., Objectives.--To characterize the reasons ambulatory patients use hospital emergency departments (EDs) for outpatient care and to determine the proportion of ED patients who initially are assessed as having nonurgent conditions, but subsequently are hospitalized. Design.--Cross-sectional survey during a single 24-hour period of time. Setting.--Fifty-six hospital EDs nationwide. Patients or Other Participants.--Consecutive ambulatory patients presenting for care. Patients who arrived by ambulance were excluded. Results.--Of 6441 ambulatory patients (79% of all ED visits) who were eligible for study, interviews were obtained from 6187 (96%). A total of 5323 patients (86%) had clinical reasons or preferences for seeking care at an ED, including 2799 (45%) who thought they had an emergency or an urgent condition or were too sick to go elsewhere. Nineteen percent (n=1199) reported that they were sent to the ED by a health care professional. Patients with a regular clinician or with insurance cited similar reasons for seeking care at an ED. A total of 3062 patients (50%) cited 1 or more nonfinancial barriers to care as an important reason for coming to the ED, and 949 (15%) cited financial considerations. A total of 3045 patients (49% of ambulatory patients and 37% of total ED visits) were assessed at triage as having a nonurgent condition; 166 of them (5.5%; 95% confidence interval, 4.7%-6.3%) were admitted to the hospital. Conclusions.--Most ambulatory patients seek care in an ED because of worrisome symptoms or nonfinancial barriers to care. Although many ambulatory patients appear to have nonurgent conditions based on triage classification, a small but disturbing percentage of nonurgent patients are hospitalized. JAMA. 1996;276:460-465

Many urban juvenile offenders appear to have easy access to guns. Researchers interviewed 42 men and 21 women between 13 and 18 years old who were incarcerated in detention centers in Atlanta. Sixty-six percent were African-American. Forty-one boys and 12 girls had owned at least one gun and 84% got the gun before the age of 15. Some were as young as 9 when they got their first gun. Forty-two percent did not actively seek the gun but were given a gun by a friend or relative. Many got the gun for protection since all knew someone who had been shot and almost three-fourths had been threatened with a gun. Forty percent said they felt safer when carrying a gun and an equivalent percentage said they felt powerful. However, one-third also felt anxious that they would be caught. Going to a club was the top reason to be armed, according to 35% of the offenders. Forty-one had pointed a gun at someone at some time. Most bought their guns on the street, often from drug dealers., Objective. - To learn how, when, where, and why juvenile offenders acquire guns. Design. - Following acquisition of informed consent, we conducted semistructured interviews between June and November 1995 with a convenience sample of 63 juvenile offenders aged 13 through 18 years, each of whom was incarcerated at a detention center in metropolitan Atlanta, Ga. Setting. - Five detention centers in metropolitan Atlanta. Main Outcome Measures. - Frequency of handgun acquisition and use, age at and method of first handgun acquisition, feelings experienced when carrying guns, development of gun-carrying behavior, drug use, and gang membership. Results. - The mean age of respondents was 15.7 years. Forty-one male and 12 female respondents had owned a gun. Eighty-four percent of gun carriers acquired their first gun before the age of 15 years; more than half received their first gun passively, without any specific plan to do so. Adolescents who purposefully obtained their first handgun were more likely to become frequent or constant carriers. Forty percent left safer and 40% said they left more energized, excited, or powerful while carrying a gun. However, 34% reported increased anxiety about getting caught: Almost all stated that guns are readily available from a wide range of sources. Conclusion. - Knowledge of the developmental patterns of gun carrying by delinquent adolescents could be useful in formulating effective strategies to reduce firearm violence. JAMA 1996;275:1754-1758)

The risk of homicide at the hands of a family member or close acquaintance is higher when fire arms are kept in the home. Additional high risk factors include the history of domestic violence and drug abuse. The myth that having a gun in the house provides security does not bear up under the evidence of this evidence. In contrast to the money expended on firearms and home security, little has been done to better society's ability to deal with the issue of domestic violence. At the very least, this observation should motivate physicians, social workers, law-enforcement officers and the courts to strive harder to identify and protect victims of battering and other types of family violence. Early identification and effective intervention could avert a subsequent homicide.

There is much that communities can do to prevent heat-related deaths. A study of the Chicago heat wave in July, 1995, found that elderly people with chronic diseases who lived alone and had no social contact had the highest risk of dying. The incidence of heat-related deaths in Memphis dropped significantly after the city instituted an aggressive campaign to prevent these deaths. Relatives, friends and neighbors can watch out for elderly residents and public buildings can provide air-conditioned shelter. Radio and television can be used to publicize information about measures for preventing heat stroke.

A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually. Seven years later the empirical data on the technology's impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion. In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT. We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data. Providers must do their part by reengineering care processes to take full advantage of efficiencies offered by health IT, in the context of redesigned payment models that favor value over volume. [ABSTRACT FROM AUTHOR]

Although a median-income US family of four with employer- based health insurance saw its gross annual income increase from $76,000 in 1999 to $99,000 in 2009 (in current dollars), this gain was largely offset by increased spending to pay for health care. Monthly spending increases occurred in the family's health insurance premiums (from $490 to $1,115), out-of-pocket health spending (from $135 to $235), and taxes devoted to health care (from $345 to $440). After accounting for price increases in other goods and services, the family had $95 more in monthly income to devote to nonhealth spending in 2009 than in 1999. By contrast, had the rate of health care cost growth not exceeded general inflation, the family would have had $545 more per month instead of $95-a difference of nearly $5,400 per year. Even the $95 gain was artificial, because tax collections in 2009 were insufficient to cover actual increases in federal health spending. As a result, we argue, the burdens imposed on all payers by steadily rising health care spending can no longer be ignored. [ABSTRACT FROM AUTHOR]

Evaluates the impact of adding first-responder defibrillation by firefighters to an existing advanced life-support emergency medical services system. Return of spontaneous circulation in the field; Survival to hospital admission; Survival to hospital discharge; Neurological status at discharge; Need for attention to links in the chain of survival.

Determines if failure to achieve return of spontaneous circulation following prehospital advanced cardiac life support (ACLS) warrants termination of efforts at the scene. Survival to hospital admission; Survival to hospital discharge; Neurological status at discharge; Survival on rapid transport of adults who fail to respond to an adequate trial of prehospital ACLS.

The article is a letter responding to an editorial by Sanders and Kerns published in a previous issue about terminating cardiopulmonary resuscitation for cases outside of the hospital.

Several letters to the editor is presented in response to articles in previous issues including "Emergency department patient dumping: an analysis of interhospital transfers to the Regional Medical Center of Memphis," by A. L. Kellerman and B. B. Hackman and "Patient dumping&#X2014no one wins and we all lose," by H. S. Berliner, both in the October 1988 issue. Responses by the authors are also presented.