Megan Ranney, MD, MPH, is a respected researcher, speaker and advocate in the field of injury prevention and digital health. She is an Associate Professor of Emergency Medicine at Brown University, and the co-founder of AFFIRM, the American Foundation for Firearm Injury Reduction in Medicine. Kian Preston-Suni MD, MPH sits down with SocialEMpact’s Spotlight guest to reflect on her career in injury prevention, the outlook of the field, and how open-minded communication is paramount to effective leadership.

How did you become interested in injury prevention?

“I became interested in injury prevention in a couple of different ways. I worked in public health in general and violence prevention in particular for a very long time, initially through sexual assault and violence prevention. And so, when I found out that injury prevention was a thing, it felt like a good fit for me. The second reason is just because of working in the emergency department, where every day people come in with injuries, with different presentations, it became very apparent to me that these injuries were usually related to the social determinants of health. Through studying injury prevention I realized I could use it as a lens to address the social determinants of health.”

What are you working on currently that you’re most excited about?

“There are so many things. I have two big ongoing initiatives. One, I have a few NIH funded grants that are looking at how we can use technology to better screen and develop injury prevention interventions in the emergency department. With the underlying theory, the understanding that in the ED we have an implicit role to play in public health, but we simply don’t have the time, and for many of us we don’t have the training. And so trying to use technology to mitigate some of the barriers. That’s one thing that we’re super excited about.

Then the other thing is of course my work around gun violence prevention, very little of which is funded externally due to the current political environment, but the work that I’m doing with collective leaders across the country largely through AFFIRM, the research foundation that I co-run. It is something that just really motivates me and excites me and that I think has huge potential for impact in society.”

What do you envision firearm violence prevention looks like in 10-20 years?

My hope is that, I’m actually pretty confident that within 10-20 years that we’re going to talk about firearm injury prevention in the way that we talk about any other kind of injury prevention. Just as the public health problem that it is. And that we will talk about it as a success story. That we will talk about a disease in which we have come together as physicians to decrease unintentional and intentional injury and that we’ve brought in people from every state.  And of every political persuasion. And we are well on our way there. It’s funny, you were asking me about challenges before, I don’t even think of that part as a challenge, that’s just the whole point of the work to bring people on board together. That’s my hope, my vision. But what I really think is going to come to pass is that we’ll be there in 15 or 20 years. That my kids and my grandkids won’t live in a society that has the injuries that we do. And that the next generation of emergency physicians will put up slides showing decreases in firearm injury the same way that I put up slides right now showing decreases in HIV deaths and decreases in car crash deaths as public health success stories.

What innovations in social EM and injury prevention have you seen that you think have the most potential for impact?

“Work around integrating information on social determinants of health and social risk factors for injury in general and violence in particular and all of the related behavioral health problems, integrating all of that information into the electronic health record so we can use more transformative approaches. Because it’s really tough in this profession. Here I am as a true believer in social emergency medicine, and yet when I am on a busy night shift trying to take care of these thirty patients and make sure I don’t miss any critical diagnoses, and make sure I don’t send anyone home who I shouldn’t, and that I save the lives of those who come in acute distress, having the time to talk in depth to a patient about some of these social risk factors is a great challenge. And if I feel that way then I think about how much more overwhelmed people who are not trained in this must feel.

Making it easy to address social risk factors and social determinants of health, that’s a critical innovation. There a lot of people working on different aspects of that right now, across the country. “

How would you recommend others get involved in your field if they’re interested?

“There are a few things, but the first to reach out to me or to Emmy Betz, Rebecca Cunningham or Jahan Fahimi or to any of us across the country who are doing this work. Most of us are eager to mentor. The next thing is just is to take the time to learn the background. We are creating a collection of articles on AFFIRM Research that provide the background of the field. It’s important to have a good grasp of what’s happened before as well as the methods that are needed. One of the biggest dangers in the field is research that is inaccurate because for now it’s an area that’s still such a sensitive topic. It’s important that we don’t draw conclusions in one direction or another that aren’t supported by evidence. Also getting really good training in the research methods is so important.“

Can you tell me about someone whose work in the field you admire?

“There are so many. Besides Emmy, I admire the work of Garen Wintemute at UC Davis, he’s working on firearm injury prevention despite the lack of funding, and he’s done great work in California. I admire the work of Rebecca Cunningham at the University of Michigan. She has been one of my friends and mentors throughout my academic career, and she’s done some amazing work with violence and injury prevention. I admire the work of Deb Houry, who is now the director of CDC's Center for Injury Prevention and Control. I admire the work of Doug Curry, who is now the director of CDC Center for Injury Prevention. For suicide prevention in particular I’d like to highlight the work that Emmy Betz is doing at University of Colorado. And there are so many more, I can’t tell you all the people I admire it would probably fill 3 pages. There are so many great scientists who’ve come before me, and so many people who are just getting started but are already having an impact.”

What have you learned in your work with AFFIRM?

“Well I’ve learned a lot of things that you don’t pick up in fellowship, about creating a team, and about working virtually and about how social change happens. It sometimes appears that things happen spontaneously, organically, but there’s a lot of hard work that goes into getting things ready to the point where something could be studied, but also have the true potential for change. And that really keeps me going. It’s so empowering to know that we have together the ability to really make significant changes.” 

You’ve been successful in communicating about a topic as divisive as firearms, what lessons can you share about building consensus?

“I think the biggest thing is coming at discussions with an open mind in particular, coming at discussions from an expert viewpoint. It’s really important to frame your work in the knowledge and experience that you have. One of my greatest joys with AFFIRM has been coming together with a variety of communities from across the typical political and specialty divide. We’ve gotten together everyone from surgeons, to nurses, to psychiatrists; getting them all together with a shared mission is the first part. Also making sure that everyone feels heard and that their voices can give back because, I think, what makes them part of a team is that idea of mutual respect. When you come at a discussion with an open mind then you can allow integration of those often-good ideas.”

Can you tell me about a challenge you’ve faced in your work with AFFIRM and how have you addressed it?

“It’s a constant learning process. One of the big challenges, is that being someone who’s very results-oriented is a little challenging sometimes. Trying to serve as a spokesperson while also maintaining a sense of equity, has been sometimes hard for me. Learning how to handle that in a way where I can represent everyone’s voices and also try to give other people the opportunity, to get them into the spotlight as well.”

What do you think are some of the advantages and potential pitfalls for advocacy on social media?

“I think that engaging in social media is really critical because if we’re not there then the voices of people who aren’t actually caring for patients dominates. It’s critical to promote and demystify expert opinion. When we look at the decline in vaccination rates, it’s partly because we weren’t out there talking about the scientific evidence behind vaccines. We were there kind of in general, but not in the channels where misinformation was infecting certain groups through some channels in social media, and I think that our presence on social media allows us to combat that misinformation early. It also allows us to build coalitions. Some of my favorite collaborators are people that I’ve met through Twitter. And it’s also so much fun. I think both for extroverts and introverts it has value, kind of getting you out of your own head space after a busy shift or work week.”

Have you read any good books recently?

“I am actually reading a book right now called Dare to Lead by Brené Brown, and it is so cool. it’s about coming to leadership from a place of vulnerability and honesty. I highly recommend that in the non-fiction world.

And then in in the fiction world the last great book that I read was “The Hate U Give” by Angie Thomas. I read it with my 10 year-old daughter. Her friends had read it and so I read it along with her and it was one of the most moving books that I’ve read in a while. I highly recommend it.”