Toolkit: Reducing Firearm-Related Injuries and Deaths

Published: 10/7/2025

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 previous 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.

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Background

Firearms-related injuries and deaths are a significant public health threat, with nearly 47,000 fatalities in the U.S. 2023.  Firearms have become the leading cause of death for children and youth under age 24.  While homicides and mass shootings draw the most media attention, suicides continue to comprise the majority of firearm deaths, including 58% of firearm fatalities in 2023.  In 2024, the U.S. Surgeon General published an advisory report declaring firearms violence as a public health crisis and documenting how it affects Americans’ health and well-being.

ACP’s 2018 paper sparked the This Is Our Lane (member login required) 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 regularly works with other medical organizations to address firearms violence using a public health approach.  Along with over 45 major medical and public health organizations, ACP has convened the Healthcare Coalition for Firearm Injury Prevention, bringing together the medical community to identify and address opportunities to advance firearm injury prevention.  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 

The Trump administration has taken several actions that undermine efforts to address the public health crisis of firearms violence.  On the first day of his second term, President Trump closed the White House Office of Gun Violence Prevention, established under the Biden administration to coordinate the federal government’s efforts to respond to and prevent firearm injuries and deaths.  In February 2025, Trump signed an executive order directing a review of all firearms-related actions and reports issued under the previous administration and calling for action to remove barriers to firearm access.  The administration also terminated over $158 million in grants to community organizations working on community violence intervention projects across the country.  The majority of these grants were funded through the 2022 Bipartisan Safer Communities Act and supported violence prevention efforts such as outreach teams to de-escalate and mediate conflicts or hospital-based programs for victims of firearms violence.

While the political landscape of the 119th Congress makes new policies unlikely to pass, there is a need to protect existing programs and investments in firearm injury prevention.  The Trump Administration’s Fiscal Year 2026 budget request proposed eliminating all funding for Firearm Injury and Mortality Prevention research at the National Institutes of Health and Centers for Disease Control and Prevention.  ACP strongly supports this research and works with the Gun Violence Prevention Research Roundtable to promote these investments by the federal government. The Senate version of the FY 2026 appropriations bill does continue funding firearms prevention research while the House version of the bill unfortunately does not. The House bill additionally contains text restricting this research from receiving any federal funds.

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 700 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.  In total, 28 states enacted 88 firearms safety laws in 2024.  At least 15 states have also established a state Office of Gun Violence Prevention or similar entities dedicated to reducing firearm injuries and deaths in their states.

ACP encourages states to adopt policies that have been proven to reduce firearms-related injuries and deaths, including:

Safe and Secure Storage of Firearms

The presence of an unlocked and/or loaded firearm in a home increases the risk of both unintentional firearms injuries and intentional shootings, including suicide.  In total, 26 states and DC have enacted requirements related to secure storage.  But with more than half of U.S. firearm owners storing their guns unlocked, states have considered various policies to promote safe and secure storage. 

  • Safe storage laws that require firearm owners to lock their firearms when not in use, sometimes with provisions related to ammunition storage as well. While most of these laws focus on storage within the home, some states have also examined laws related to storage in cars.
    • Child access prevention laws are a type of safe storage law that impose criminal penalties on firearms owners who do not comply with storage requirements.  With about one third of American children living in homes with firearms, secure storage of firearms can prevent unintentional injury and youth suicide.
  • Some states have created options for voluntary and temporary storage where firearms owners can store their firearm outside of the home, such as at a gun shop or range, when the firearms owner or a member of their household is at increased risk for suicide or harm to others.
  • At least seven states have sought to encourage safe storage by making gun locks and safes tax exempt.
  • Some studies have shown that the most effective way to improve safe storage is to provide free gun locks/safes alongside information about their importance.  Some states have supported these behavioral interventions, including by funding physicians and health departments to distribute free gun locks and safes.

Extreme Risk Protection Orders (ERPOs) or “Red Flag Laws”

Often, individuals who use firearms to harm themselves or others exhibit warning signs.  Firearm removal laws empower families or law enforcement officers to ask that a judge order the temporary removal of a person’s access to firearms who is found to be at imminent risk of harm to themselves or others.

ACP has prepared a member resource to help understand what ERPO laws are, the evidence of their effectiveness, who can petition for them, and the process in the 21 states and DC that have enacted ERPO laws.

References

ACP Resources, Policy Papers, and Statements

Giffords Law Center to End Gun Violence Resources

Johns Hopkins Bloomberg School of Public Health Center for Gun Violence Solutions