Contents

Search

firearm (gun, rifle, handgun)

Also see gunshot wound & gun violence Epidemiology: - 22,000 firearm homicides (3.7 per 100,000 residents) 2009-2010 - 38,000 firearm suicides (7.0 per 100,000) 2009-2010 [1] - access to firearms associated with increased mortality [2] - increased risk of suicide (RR=3.24) - increased risk of being victim of homicide (RR=1.94) [2] - gun-owning guardians of children with psychiatric disease are no more likely to safely store guns than guardians of normal children [6] - 20% of high school students in Colorado report easy access to guns [9] Management: - counsel patients on the risks of firearms in the home, especially with minors, people with dementia, mental illness, or substance abuse in the home [3] - family should be encouraged to contact local law enforcement agency to remove firearm & ammunition from the home of a demented family member [10] - discussions of firearms appropriate when risk factors present [8] Notes: - no validated screening tool to assess whether a cognitively impaired person can safely handle firearms [10] - a 2011 Florida gag law designed to prevent discussions of firearms between patients & physicians [4] - however, firearm ownership is relevant to the health of the patient or others under 3 conditions (even in Florida): - risk for violence to self or others - risk factors for violence or unintentional firearm injury (violent history, substance abuse, serious mental illness) - patient is a member of a group at increased risk for firearm violence (children, adolescents, young black men, middle-aged & older white men) [4] - in Feb 2017, the U.S. Court of Appeals for the 11th Circuit invalidated parts of Florida's Firearm Owners Privacy Act (FOPA) affirming that the First Amendment applies to speech between physicians & patients [5] - decision ensures that physicians may continue to make efforts to protect their patients from gun-related injuries [5]

Related

gun violence gunshot wound

Useful

RIFLE criteria

References

  1. Centers for Disease Control and Prevention (CDC) Firearm Homicides and Suicides in Major Metropolitan Areas - United States, 2006-2007 and 2009-2010. MMWR. August 2, 2013 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6230a1.htm
  2. Anglemyer A et al The Accessibility of Firearms and Risk for Suicide and Homicide Victimization Among Household Members: A Systematic Review and Meta-analysis. Ann Intern Med. 2014;160(2):134-135-135. PMID: 24592495 http://annals.org/article.aspx?articleid=1814430 - Hemenway D Guns, Suicide, and Homicide: Individual-Level Versus Population-Level Studies. Ann Intern Med. 2014;160(2):134-135-135 PMID: 24592499 http://annals.org/article.aspx?articleid=1814430
  3. Butkus R, Doherty R, Downey H et al Reducing Firearm-Related Injuries and Deaths in the United States: Executive Summary of a Policy Position Paper From the American College of Physicians. Ann Intern Med. Published online 10 April 2014 PMID: 24722815 http://annals.org/article.aspx?articleid=1860325
  4. Wintemute GJ et al Yes, You Can: Physicians, Patients, and Firearms. Ann Intern Med. Published online 17 May 2016 PMID: 27183181 http://annals.org/article.aspx?articleid=2522436 - Weinberger SE Curbing Firearm Violence: Identifying a Specific Target for Physician Action. Ann Intern Med. Published online 17 May 2016 PMID: 27183475 http://annals.org/article.aspx?articleid=2523533
  5. Parmet WE, Smith JA, Miller M. Physicians, Firearms, and Free Speech - Overturning Florida's Firearm-Safety Gag Rule. N Engl J Med 2017; 376:1901-1903. May 18, 2017 PMID: 28402707 Free Article http://www.nejm.org/doi/full/10.1056/NEJMp1702516
  6. Scott J, Azrael D, Miller M. Firearm Storage in Homes With Children With Self-Harm Risk Factors. Pediatrics. 2018 PMID: 29467279 http://pediatrics.aappublications.org/content/early/2018/02/19/peds.2017-2600 - Grossman DC Reducing Youth Firearm Suicide Risk: Evidence for Opportunities. Pediatrics. 2018 PMID: 29467277 http://pediatrics.aappublications.org/content/early/2018/02/19/peds.2017-3884
  7. Kegler SR, Dahlberg LL, Mercy JA. Firearm Homicides and Suicides in Major Metropolitan Areas- United States, 2012-2013 and 2015-2016. MMWR Morb Mortal Wkly Rep 2018;67:1233-1237 https://www.cdc.gov/mmwr/volumes/67/wr/mm6744a3.htm
  8. Pallin R et al. California public opinion on health professionals talking with patients about firearms. Health Aff (Millwood) 2019 Oct; 38:1744 PMID: 31589535 https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00602
  9. Brooks-Russell A, Ma M, Brummett S. Perceived Access to Handguns Among Colorado High School Students. Pediatrics. 2021. March 29;e2020015834 PMID: 33782105 https://pediatrics.aappublications.org/content/early/2021/03/25/peds.2020-015834
  10. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  11. Betz ME, McCourt AD, Vernick JS et al. Firearms and dementia: clinical considerations. Ann Intern Med. 2018;169(1):47-49 PMID: 29801058 PMCID: PMC6546108 Free PMC article https://www.acpjournals.org/doi/10.7326/M18-0140
  12. Timmer-Murillo SC, Schroeder ME, Trevino C et al Comprehensive Framework of Firearm Violence Survivor Care. A Review. JAMA Surg. 2023;158(5):541-547 PMID: 36947025 https://jamanetwork.com/journals/jamasurgery/fullarticle/2802862
  13. Laine C, Bornstein SS Firearm Injury: An Escalating Health Crisis Ann Intern Med. 2023 Mar;176(3):398-399. PMID: 36645887 Free article