Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Objective: School-associated firearm violence among children and adolescents is a national public concern. The objective of this study was to determine the accessibility of firearms, methods of firearm access and firearm safety knowledge among middle and high school students in Orange County, California. Methods: After permission from school officials and parents was obtained, a 24-question survey was distributed to 176 students in grades 6 through 12 at four schools in Orange County. Data was collected over a 12-month period beginning in February 2003. Data analysis was presented in proportions. In addition, cross tabulations were performed to determine which factors were associated with access to guns, having fired a gun, and firearm possession at school. Results: The mean age of participants was 16.1 years. Seventy-seven (45%) were male, 121 (69%) Hispanic, and 171 (94%) were of middle income. Four participants (2.3%) admitted to gang involvement, 47 (26.7%) had fired a gun. Those more likely to have fired a gun appeared to be non-Hispanic males (p= 0.001). Seventy-five (43%) reported access to a gun. Older students and those in grades 9 to 12 were more likely to have access to a gun (p= 0.01), which they stated could be obtained from their homes, friends or relatives (4.5% to 22%). No students admitted to bringing a gun to school. Two (1.1%) students stated that they had thought of using a gun at school. One hundred one students (62%) were taught firearm safety by their parent(s). Conclusion: Almost half of the students in this study acknowledged that they could gain access to a gun and two students had thought about using a gun at school. Firearm education, safety and counseling are of paramount importance to ensure safety among school youths.

A 28-year-old female presented to the Emergency Department (ED) with a chief complaint of strings protruding from her vagina. The patient also complained of recurrent symptoms of cystitis and occasional hematuria over the past five months without resolution after treatment. The patient underwent ED evaluation and was noted to have strings coated in calculus protruding from her urethral meatus. On AP abdominal film a T-shaped intrauterine device (IUD) with calculus was noted in the pelvis. By computed tomography (CT) scan the object was shown to be extruding from the vagina into the bladder. Of note the patient had a history of IUD use with supposed removal five years prior to presentation. The diagnosis of IUD perforation of the bladder with calculus formation was confirmed by cystoscopy, and the IUD and calculi were successfully removed without complication.