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Reducing Firearm-Related Injuries and Deaths

ACP Chapter Action Tool Kit
Prepared by ACP’s Division of Governmental Affairs and Public Policy
February 10, 2022

Call to Action

ACP requests your chapter’s immediate help in advancing legislation in your states that would keep guns away from persons most at risk of harming themselves and others: extreme risk protection orders, child access prevention initiatives, and reforms to close loopholes in the background check system that allow many domestic violence offenders to obtain and possess firearms. These policies, all of which are consistent with ACP policy, are explained in more detail below.

With most state legislatures currently in session (and many will be in session only a few more weeks before adjourning for the year), the time to act is now

(We acknowledge that the political climate in some states may not be favorable to advancing the policies recommended by ACP at this time, while in other states, the environment may be the most favorable in years. ACP leaves it to the discretion of each chapter to decide the extent to which it is able and timely to implement this action plan, although we encourage all to consider participating).

This tool kit provides practical resources that can be readily used by your chapter to take action, customized to the unique circumstances of your state.

Why should your chapter take action now?

Firearms-related injuries and deaths are a significant public health threat, with 39,707 fatalities in 2019, according to the Centers for Disease Control and Prevention in the U.S. (suicides, homicides and other intentional shootings, and negligent/accidental shootings combined) – an average of 109 per day.  The CDC publishes data with a one-year delay, but data collected from other groups and media reports suggests that the death rate from firearms in 2020 may have increased beyond 2019 levels. 

ACP has long advocated for policies that could prevent these avoidable deaths and injuries. On Oct. 20, 2018, Annals of Internal Medicine published “Reducing Firearm Injuries and Deaths in the United States,” an update and expansion of ACP's 2014 position paper.  The paper reaffirms many of ACP's 2014 recommendations, such as banning sales of assault weapons and requiring universal background checks, and proposes new policies on issues including extreme risk protection orders, domestic violence, child access prevention, and others that are found to be effective in reducing gun-related injuries and deaths. A summary of the paper can be found here.  

ACP’s paper sparked the This Is Our Lane movement from physicians, in response to a National Rifle Association tweet “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”  Within hours, thousands of physicians tweeted about the reasons why firearm violence was in their lane, accompanied by the hashtags #ThisIsOurLane and #ThisIsMyLane.

Your chapter can help sustain the This is Our Lane movement by taking the actions suggested later in this tool kit.

Federal and State Activity

Federal Activity:  At the federal level, firearms-related legislation is expected to be advanced by the new Democratically-controlled House of Representatives; however, the climate for passage of these initiatives in the Senate is less favorable, with only a one vote Democratic majority.  Several key bills have already been introduced in the House and Senate, with ACP’s support that would strengthen the accuracy and reporting of the National Instant Criminal Background Check System (NICS), as well as, expand Brady background checks to cover all firearm sales, including unlicensed firearms sellers currently not required to use background checks.   

ACP applauded the actions taken by President Biden, via Executive Orders, to address this public health epidemic by dedicating specific time, resources, and funds to the issue. Specifically we support:

  • Regulating “ghost guns,” which are difficult to track and trace.
  • Applying National Firearms Act regulations to stabilizing brace devices that could alter a pistol into a short-barreled rifle, which can make a concealable firearm more dangerous by making them more stable and accurate.
  • Developing model “red flag” legislation for states to use. Extreme risk protection orders allow family or law enforcement to intervene when there are warning signs that a person is experiencing a temporary crisis, helping to keep the individual and those around them safer.
  • Increased funding for community violence intervention programs as proposed in the American Jobs Plan.
  • Requiring that the federal government issue a new annual report on firearms trafficking. More research is needed on firearm violence and on intervention and prevention strategies to reduce injuries caused by firearms and additional data from the Department of Justice would help in that effort.

In addition to the measures released by President Biden, ACP has long advocated with Congress on the need for common sense reforms to curb firearms-related injuries and death. We call on Congress to enact legislation to require universal background checks and to also ban assault weapons.

State Activity: While the prospect for advancement of firearms-related legislation in the new 117th Congress is still uncertain, ACP urges chapters to engage with their state legislatures on such initiatives (if appropriate) to achieve meaningful action to reduce gun violence at the state level. In the wake of federal inaction, a number of states have taken up the mantle of gun safety. Since the tragedy at Sandy Hook Elementary in December 2012, 45 states have enacted more than 350 gun safety laws. 

There has been a great deal of momentum on the state level to reduce firearms-related injuries and deaths, including through legislative initiatives. In the first few months of 2021, state legislators have introduced bills to strengthen background check requirements, fund proven community violence intervention programs, improve domestic violence prohibitions, and enact or strengthen extreme risk protection order laws in 31 states and the District of Columbia.

The climate for common sense laws to prevent injuries and deaths from firearms is more favorable in many states than it has been in the past, with the election of many governors and lawmakers who campaigned in favor of such laws replacing those who were opposed to them.

While much of the national conversation about gun violence still disproportionately focuses on mass shootings, there is a promising trend among state lawmakers to direct attention and resources to the daily gun violence that afflicts our nation’s most underserved communities in 2019. States enacted laws that added a background check requirement or improved on an existing background check law (NM, NV, NY and WA); strengthened laws that help keep unattended guns out of the hands of minors (CA, CT, NV, NY); banned all trigger activators (NY); banned bump stocks (DC); passed laws regulating untraceable or undetectable firearms (CA, CT, NJ, NY, WA); and enacted or strengthened extreme risk protection orders (CA, CO, DC, HI, IN, NV, NY, WA). States passed 43 gun safety laws in 13 states in 2020, bringing the total number of laws enacted since the 2018 Parkland shooting to 180. Despite the limitations imposed by COVID-19, the progress made by courageous legislators has been transformative.

ACP Chapter Advocacy

ACP urges chapters to engage with their state legislatures and state governors (if appropriate) on the need to enact policies on the state level designed to:

  • Enact Child Access Prevention Laws to ensure safe storage of firearms: The presence of unlocked and/or loaded guns in homes increases the risk of both unintentional gun injuries and intentional shootings. Child access prevention laws hold firearm owners accountable for the safe storage of firearms by imposing criminal liability on those who negligently store firearms under circumstances where minors could or do gain access to them. According to the American Academy of Pediatrics, about 1/3rd of American children live in homes with firearms, and of these households, 43 percent contain at least 1 unlocked firearm. Thirteen percent of households with guns contain at least 1 firearm that is unlocked and loaded or stored with ammunition.
  • Enact Extreme Risk Protection Orders (ERPO) to empower families, household members, or law enforcement officers to ask a judge to temporarily remove a person’s access to firearms who is found to be at imminent risk of using them to harm themselves or others: Depending on the state, family members or law enforcement can go to court and seek an order that would allow police to remove guns from an individual’s home and restrict their ability to purchase firearms if that individual poses a threat to himself/herself or others.  If the judge agrees that this person is a threat then those guns would be temporarily removed from the home of the individual – for as few as several weeks to up to a year.  According to a recent study, 54 percent of mass shooters exhibit warning signs before committing their crimes. Many deaths and grievous injuries from suicides and attempted suicides using guns might be prevented if family members could petition a court to remove guns from a loved one who they know to be at imminent risk of harming themselves.  Nineteen states and DC currently have ERPO laws. Twelve of these states and DC allow family or household members as well as law enforcement to submit a petition for an ERPO, including Maryland, which also allows mental health providers to petition. Five states limit the category of petitioners to law enforcement only. Additionally, two states have risk-based firearm removal laws that are similar to ERPOs.
  • Close loopholes in the background check system that enable many domestic violence offenders to obtain firearms: Federal law prohibits abusers who have been convicted of domestic violence misdemeanors and abusers subject to certain domestic violence protective orders from purchasing or possessing guns.  However, federal laws intended to prevent access to firearms by domestic abusers have significant limitations, in that they do not apply to many abusers who victimize non-spouse partners or family members other than a child, and they do not apply to persons with temporary, versus permanent, domestic violence restraining orders.  ACP calls on these domestic violence loopholes to be closed by prohibiting sales and possession of firearms by persons convicted of domestic violence offenses on persons outside of their own household, as well as for any person with a temporary restraining order during the time when the restraining order is in effect.

The items in the tool kit have been developed to help interested chapters take action with their state legislatures in support of enactment of ACP-supported policies as described above.  This includes a sample letter that chapters can customize according to their state circumstances.  We also provide chapters with a myriad of resources below on the various laws/initiatives in their states intended to address firearms-related violence.   


Giffords Law Center to End Gun Violence:


Chapters interested in advocating for policies to reduce firearms-related injuries and deaths in their state should contact their state governor and/or legislators and urge them to introduce and pass legislation, as applicable, that would require safe storage of firearms, red flag laws, and protections for non-spouse partners and family members in cases of firearms-related domestic violence. A sample letter that chapters can customize is available.

Additional Suggested Chapter Actions

  • The above sample letter could be customized for all chapter members to send to their elected state lawmakers (changing the introduction and closing so it is coming from the individual member rather than the chapter and its governor) and distributed with your membership to urge them to take action.
  • A news release could be drafted and sent to local media when your chapter letter is sent to lawmakers and your state’s governor.  If you would like to do this, ACP’s communications staff can help.
  • You can promote your efforts using social media, by posting content to your chapter’s Facebook or Twitter pages.  If you post on twitter, we encourage you to include @ACPinternists so we are aware of, and can retweet, your tweets; as well as the #ThisIsOurLane hashtag.
  • Please let Shuan Tomlinson know what you are doing.  She can also address any questions you may have or put you in touch with one of our policy experts on firearms violence.