Should Teachers Carry Guns? An Emergency Room Survey of Parents of Two New York Communities.

INTRODUCTION: The purpose of this study was to compare parents' perceptions of threats and solutions to school gun violence in two different communities. METHODS: Parents of school-aged children visiting emergency rooms of two large trauma centers in Upstate New York (UNY) and New York City (NYC), between October 2019 and December 2020, were surveyed (UNY: n=202, NYC: n=100). Responses were compared by site, firearm experience, and concern for school safety. RESULTS: Respondents from the two sites differed by sociodemographic characteristics. Of the 302 respondents, 64% feared a school shooting incident, but UNY respondents were less likely to report concern (46.5% vs 99%, p<0.001). UNY respondents were more likely to feel safe for their children (75.3% vs 7%, p<0.001) and to report feeling safer if guns were available to teachers (22.3% vs 6%, p <0.001). Both sites' respondents agreed on the need for armed police presence (76.7% vs 74%, p=0.11). Of the 193 parents concerned about a school shooting, 11.9% indicated feeling safer if guns were available to teachers versus 25.7% of those who were not (p=0.002). Agreement on solutions for making schools safer differed by the site. NYC respondents were unanimously supportive, but UNY support ranged from 52% for metal detectors to 84.5% for controlled entry points. CONCLUSION: Although perceptions of child safety and experience with guns varied by location, most parents agreed on potential solutions, that it should be the security officers, not teachers, who should be carrying firearms and that armed police should be present in schools to provide safety.

Time to Loss of Preoxygenation in Emergency Department Patients.

BACKGROUND: In patients requiring emergency rapid sequence intubation (RSI), 100% oxygen is often delivered for preoxygenation to replace alveolar nitrogen with oxygen. Sometimes, however, preoxygenation devices are prematurely removed from the patient prior to the onset of apnea, which can lead to rapid loss of preoxygenation. OBJECTIVE: We sought to determine the elapsed time, on average, between removing the oxygen source and the loss of preoxygenation among non-critically ill patients in the emergency department (ED). METHODS: We conducted a prospective, crossover study of non-critically ill patients in the ED. Each patient received two identical preoxygenation trials for 4 min using a non-rebreather mask with oxygen flow at flush rate and a nasal cannula with oxygen flow at 10 L/min. After each preoxygenation trial, patients underwent two trials in random order while continuing spontaneous breathing: 1) removal of both oxygen sources and 2) removal of non-rebreather mask with nasal cannula left in place. We defined loss of preoxygenation as an end-tidal oxygen (exhaled oxygen percentage; EtO2) value < 70%. We measured EtO2 breath by breath until loss of preoxygenation occurred. RESULTS: We enrolled 42 patients, median age was 43 years (interquartile range [IQR] 30 to 54 years) and 72% were male. Median time to loss of preoxygenation was 20 s (IQR 17-25 s, 4.5 breaths) when all oxygen devices were removed, and 39 s (IQR 21-56 s, 8 breaths) when the nasal cannula was left in place. CONCLUSIONS: In this population of non-critically ill ED patients, most had loss of preoxygenation after 5 breaths if all oxygen devices were removed, and after 8 breaths if a nasal cannula was left in place. These data suggest that during ED RSI, preoxygenation devices should be left in place until the patient is completely apneic.