Toolkit: Reducing Firearm-Related Injuries and Deaths

Published: 10/3/2022

ACP has long advocated for policies that could prevent avoidable firearms-related deaths and injuries. In 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 the sale of assault weapons and requiring universal background checks as well as recommending policies to implement extreme risk protection orders and address domestic violence and child access prevention issues as they relate to firearms. A summary of the paper can be found here.


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Chapter members interested in advocating for policies to reduce firearms-related injuries and deaths in their state should contact their state governor and/or legislators to urge them to introduce and pass legislation, as applicable, that would require the safe storage of firearms and enactment of red flag laws. A sample letter that chapter members can customize is available.

Additional Actions

  • You can promote your efforts on social media, by posting content to your personal Facebook or Twitter pages. If you post on Twitter, we ask that you to tag @ACPinternists, so we are aware of and can retweet your tweets, and use the #ThisIsOurLane hashtag.
  • Please submit any questions regarding this toolkit or policy in your state using the Advocacy Assistance Request Form to ensure we can most efficiently track and respond to inquiries.


According to the Centers for Disease Control and Prevention (CDC) Firearms-related injuries and deaths are a significant public health threat, with 45,222 fatalities in 2020 in the U.S. (suicides, homicides and other intentional shootings, and negligent/accidental shootings combined) – an average of 124 per day and the highest level since the CDC began tracking firearms violence in 1968. The CDC publishes data with a one-year delay, but data collected from other groups and media reports suggest that the death rate from firearms has continued to increase.    

ACP’s 2018 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.

Federal Activity 

ACP strongly supported the enactment of the Bipartisan Safer Communities Act (S. 2938), which was signed into law in June 2022. It represents the first action from Congress in decades to reduce the horrendous toll of injuries and deaths from firearms violence. This legislation includes policies that will enhance background checks, eliminate the “boyfriend exception” from background checks for domestic abusers in a recent relationship, provide funding for “red flag” laws and other crisis intervention programs, strengthen penalties for straw purchases, register more high-volume firearms dealers, and increase funding for mental health care and training and mental health clinicians.  ACP supported this legislation in a letter to the Senate and through advocacy by ACP members in the AIMn program.

In July 2022, the U.S. House of Representatives also passed the Assault Weapons Ban of 2022 (H.R. 1808), which ACP supported but its outlook for passage in the Senate is unlikely. Several other key bills have also 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 has also 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 following:

  • 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.

Although recent action is promising, ACP has called for policymakers to do more, including a declaration of gun violence as an epidemic and public health emergency. ACP has long advocated with Congress on the need for common sense reforms to curb firearms-related injuries and death, and we will continue to call on Congress to enact legislation to require universal background checks and ban assault weapons.

State Activity

Many states have taken up the mantle of firearms safety and there has been a great deal of momentum on the state level to reduce firearms-related injuries and deaths, including through legislative initiatives. Since the tragedy at Sandy Hook Elementary in December 2012, 45 states have enacted more than 465 firearms safety laws.

While much of the national conversation about firearms violence still disproportionately focuses on mass shootings, there is a promising trend among state lawmakers to direct attention and resources to the daily firearms violence that afflicts our nation’s most underserved communities, including through community violence intervention programs, which 12 states and DC have committed significant funding to in 2021.  In total, 27 states and DC enacted 75 firearms safety laws in 2021. 

ACP policy supports state efforts to:

  • Enact Child Access Prevention Laws to ensure safe storage of firearms: The presence of unlocked and/or loaded firearms in homes increases the risk of both unintentional firearms 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 one unlocked firearm. Thirteen percent of households with firearms contain at least one 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 firearms 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 firearms 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 firearms might be prevented if family members could petition a court to remove firearms 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.  The 2022 Bipartisan Safer Communities Act, as enacted, included $750 million in grant funding for states crisis intervention programs.


ACP Policy Papers & Statements

Giffords Law Center to End Gun Violence