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Firearm-related injuries are an urgent health crisis in the United States, with firearm-related deaths surpassing deaths from motor vehicle crashes in 2017.1 In contrast to other conditions for which clinicians have evidence-based solutions to reduce harm, the 25-year gap in federal research funding2,3 halted substantial advances in the science of firearm-related injury prevention. Yet renewed funding and emerging science continue to highlight the critical role clinicians have in prevention efforts.2,3 Similar to other complex health issues, firearm-related injury is heterogeneous, with multiple causes (Figure 1). Each of these causes has entry points within clinical encounters that represent opportunities to interact, interrupt, and prevent negative outcomes.
The lack of research has resulted in a generation of clinicians currently lacking the training necessary to implement the solutions generated by recent science. As a result, despite clinicians recognizing the need for prevention and agreeing that prevention of firearm-related injury is within their scope of practice,13 few deliver evidence-based interventions even though their patients find such measures acceptable within the context of clinical care.14 This lack of training is compounded by a shortage of adequate health care infrastructure necessary to support the integration of useful approaches into practice. Clinicians note multiple barriers, including a lack of knowledge, guidelines, time, clinical support, and reimbursement, as well as a fear of offending patients or encountering legal trouble.15-17
Clinicians routinely provide harm-reduction measures and anticipatory guidance for a range of complex health issues (e.g., substance use and vaccination), capitalizing on available evidence, their relationships with patients, and their community standing to promote health and safety. Although gaps exist, there remain opportunities to improve the current standard of care for the prevention of firearm-related injury. In this article, we review clinical approaches to prevention, ranging from ones implemented within individual clinical encounters to ones advanced by health care leaders within the systems and communities they serve.
This Patient Page describes safety measures parents can take to protect children from gun violence.
Guns are now the leading cause of death for children in the US.
Guns are even more lethal than motor vehicle crashes. The reasons for this gun violence increase in children are multiple, including a rapid rise in gun purchases, an increase in depression and anxiety in children and adolescents, and widespread stress from a global pandemic. The causes of these injuries and deaths vary by age. Younger children are more commonly injured unintentionally. Curious toddlers can find guns and fire them quickly. Older children and adolescents are more likely to be harmed by homicide or suicide.
The most important factor for children being injured or killed by guns is having a gun in the home where a child lives or the car where a child rides. Adults must make sure their guns are stored safely to prevent access by a child or adolescent. There are gun locks, safes, and other techniques to promote safer storage. As an additional safety measure, caregivers should strongly consider removing guns entirely from the home or vehicle, especially when children are older than about 11 years. These youths know how to find and access guns, even if they are stored safely. Considering the increase in mood disorders and risk of suicidal behaviors in older children and adolescents, they should not be around guns.
Parents and caregivers should follow the Be SMART framework to improve gun safety:
