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Standing AFFIRM: Gun counseling can be surprisingly simple… : Emergency Medicine News


gun tips, gun safety, injury prevention


I recently saw a patient who had intentionally overdosed, a common occurrence in the daily work of an emergency physician. I spoke to him after a psychiatric guard was signed by law enforcement.

She had overdosed on ibuprofen, which had minimal adverse effects at the dose she took. Our psychiatric social worker said she had been in contact with the patient’s family, who said the patient’s firearm had already been stored with them in a secure location during her acute mental health episode. This situation made me think how different this second meeting could have been.

More than 45,000 gun deaths occurred in the United States in 2020 alone. (Centers for Disease Control and Prevention. 2022; Most of them (54%) were suicides and 43% were homicides. Firearms are not the most common method of attempting suicide, but they are the deadliest: around 85% of attempts result in death. (Prev Med. 2015;79:5;

Increased lethality when using firearms is observed for all intents – suicides, homicides, and unintentional events – as firearm fatality rates are significantly higher than injury rates for other devices . (Prev Med. 2015;79:5; This does not indicate causation, but describes a highly lethal mechanism that requires appropriate public health measures to reduce it, as described earlier in this column. (

A survey found that over 390 million firearms are privately owned in the United States, which means we have more guns than people in our country. (Small Arms Survey. June 2018; Since then, gun purchases have skyrocketed, thanks in part to an estimated 13.8 million first-time buyers in 2020 and 2021. (National Shooting Sports Foundation. Jan. 25, 2022;

That equates to about 44% of U.S. households owning at least one gun, which means nearly half of the patients we see in the ER have access to them. A recent study found that a gun risk assessment was only documented for half of patients who presented to the emergency department with suicidal thoughts, but 11% had ready access to a gun, and those who had this access were much more likely to view it as a method. for self-harm. (Depress anxiety. 2016;33[6]:502; It is therefore important for physicians to better discuss gun safety and risk mitigation with patients at risk of interpersonal acts or self-harm and their families.

Safety tips

Why don’t we have better, meaningful conversations with our patients about gun safety? Like many of my colleagues, I have never owned or even owned a gun, but we have harbored prejudices against the gun community. Some of that may come from vicarious trauma from a gunshot wound we suffered in the ER, but some of it comes from a lack of understanding of gun culture and a lack of education in medical communities on proper advice for storage and safety.

Patients are willing to discuss firearms and their safe storage if done in an open and non-judgmental manner. (Depress anxiety. 2016;33[6]:502; But research indicates that patients who own guns are less likely to follow doctor’s advice on safe storage or consider removing guns from their homes during a risky period. (Epidemiol Rev. 2016;38[1]:87; So how do doctors, especially those who know less about guns than their patients, bridge that gap from the bedside?

Building a relationship of trust based on mutual respect and understanding is key to any counseling in an acute care setting. Patients are more open to discussing gun safety with physicians when they focus on wellness and safety, when physicians are knowledgeable about the topic, and when discussions are more individualized, not prescriptive or forced. (Ann Medical Intern. 2016;165[3]:205;

Physicians can increase this confidence by having knowledge of safe storage systems for firearms and their cost, as well as a basic understanding of specific state laws for transferring a firearm – such as give them to friends, family members, or a shooting range or a store – while dealing with a mental health crisis. (Ann Medical Intern. 2016;165[3]:205;

We can educate ourselves by working with trusted firearms experts and finding educational resources such as Stanford Medicine’s Physicians and Firearms program that can help us better understand options and patient safety. (Stanford Medicine. 2021; We can’t prevent all suicide attempts, but we can help ensure that those who attempt suicide, like my recent patient, will have a second chance. Armed with education and an objective mind, preventing gun deaths can be surprisingly simple.

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Dr. Yatesis a second-year emergency medicine resident at the University of Cincinnati. Read past Standing AFFIRM columns at, find more information about AFFIRM at, and follow the foundation on Twitter@ResearchAffirm.