Toolkit: Reducing Firearm-Related Injuries and Deaths

Published: 4/20/2023

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


ACP members can access members-only actionable materials.


According to the Centers for Disease Control and Prevention (CDC) Firearms-related injuries and deaths are a significant public health threat, with 48,830 fatalities in 2021 in the U.S. (suicides, homicides and other intentional shootings, and negligent/accidental shootings combined) – an average of 134 per day and an increase of 8% over 2020’s record-setting levels.  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 not abated.      

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. 

ACP has continued to work with other medical organizations to address firearms violence using a public health approach.  In September 2022, ACP convened with 43 other medical organizations for the Second Medical Summit on Firearm Injury Prevention to review evidence on policy interventions and identify consensus-based, non-partisan strategies for reducing firearms violence, work that will be ongoing through the Healthcare Coalition for Firearm Injury Prevention that was formed at the Summit.  In January 2023, ACP and the Annals of Internal Medicine held its first firearm violence forum for physicians to provide practical advice for discussing firearms safety with patients. 

Federal Activity 

ACP strongly supported the enactment of the Bipartisan Safer Communities Act, which was signed into law in June 2022 and represents the first action from Congress in decades to reduce the horrendous toll of injuries and deaths from firearms violence.  This legislation included policies to 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. 

Congress also made the largest ever federal investment in community violence intervention programs in the Consolidated Appropriations Act of 2022, dedicating $50 for the establishment of the Community Based Violence Prevention and Intervention Initiative intended to support communities in developing evidence-based violence intervention and prevention programs.  Lawmakers appropriated an additional $45 million in Congressionally Directed Spending, commonly known as earmarks, to support at least 67 community violence intervention projects.  Although the political landscape of the 118th Congress makes further legislation unlikely at this time, ACP will continue to advocate for common sense reforms to curb firearms-related injury and death.  In March 2023, ACP wrote a letter in support of the Handgun Permit to Purchase Act (S. 117) that would authorize grants for states to support handgun purchaser programs.  ACP has also applauded actions taken by President Biden, via Executive Orders, to address this public health crisis, including a March 2023 order addressing red flag laws and other issues that ACP saw as important progress.  Still, as the toll of firearms violence continues to rise, ACP will continue to call on policymakers to do more, including to declare gun violence an epidemic and public health emergency and to pass legislation implementing universal background checks and banning 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 525 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 14 states and DC have committed significant funding to in 2022.  In total, 21 states and DC  enacted 91 firearms safety laws in 2022.   

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. Thirteen of these states and DC allow family or household members as well as law enforcement to submit a petition for an ERPO. Maryland and DC also allow mental health providers to petition, while New York allows school administrators and certain categories of health care workers to petition and Hawaii allows medical professionals, coworkers, and educators 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