Preventing Firearm-Related Death and Injury

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Preventing Firearm-Related Death and Injury

Category: Homicide, Injury, Suicide|Journal: Annals of Internal Medicine (full text)|Author: G Wintemute, M Betz, M Ranney, R Pallin, S Spitzer|Year: 2019

Deaths and injuries from firearms are significant public health problems, and clinicians are in a unique position to identify risk among their patients and discuss the importance of safe firearm practices. Although clinicians may be ill-prepared to engage in such discussions, an adequate body of evidence is available for support, and patients are generally receptive to this type of discussion with their physician. Here, we provide an overview of existing research and recommended strategies for counseling and intervention to reduce firearm-related death and injury.

Firearm-related death and injury are significant public health problems in the United States. From 2008 to 2017 (the 10 most recent years for which data are available), there were 342 439 firearm-related deaths in the United States—more civilian deaths from gunshot wounds than from U.S. combat fatalities in World War II—and another estimated 870 000 nonfatal firearm-related injuries. In 2015, for the first time in U.S. history, the age-adjusted firearm-related mortality rate surpassed that related to motor vehicle traffic events (1). The firearm-related suicide rate has increased each year since 2006; firearm-related homicide trended downward from 2006 to 2014 but has since increased (1).

Among industrialized nations, the United States has uniquely high rates of firearm violence. The firearm homicide rate is more than 25 times that of comparable countries, and the firearm suicide rate is 8 times higher (2). The annual total cost of firearm-related death and injury in the United States was estimated at $229 billion for 2012; this includes direct costs of health care and emergency services and indirect costs, such as lost income from victims and caregivers (3). The case-fatality rate for firearm-related injuries has not declined since the early 2000s, and lengths of stay and hospitalization costs have increased (4).

Public mass shootings command the nation’s attention and are changing the character of American public life. However, they account for no more than 1% to 2% of firearm-related deaths and for less than half of all mass shootings.

Clinicians have unique opportunities to prevent all types of firearm-related death and injury—suicide, homicide, unintentional injury, mass violence—through their relationships and interactions with patients. The primary purpose of this article is to aid clinicians in assessing a patient’s risk for firearm injury or death, counseling on firearm safety when appropriate, and intervening in emergency situations. These activities generally involve a patient who already owns or has access to firearms, but much of what we present is applicable to counseling a patient who does not have a firearm and is considering whether to acquire one.

The effort to impede research on firearm violence and prevention has been sustained and often successful (5); as a result, the recommendations made here may not rest on the substantial foundation of scientific evidence that underlies other In the Clinic contributions. Interpretations and recommendations that rely on expert opinion are clearly indicated.