Firearm Injury Risk Screening

Screenings are a cornerstone of clinical practice to promote the early identification and management of numerous physical and mental health conditions, as well as environmental risks.¹ As with other health conditions, the healthcare sector has an important role in preventing firearm-related injuries— including through assessing the risk of firearm injuries and reinjuries. For example, given the elevated risk of suicide and unintentional shootings at homes with children, pediatricians have an important role to play in the prevention of firearm injuries.² While the U.S. Preventive Services Task Force has not yet issued guidelines, firearm injury risk screenings should be tailored according to feasibility, clinical setting, and patient population. ​Regardless of firearm ownership, many clinicians emphasize the importance of providing safety messaging about firearm access and secure storage.^3,4 The acceptability of discussing firearm ownership—including the language used and how conversations are approached—varies widely depending on sociocultural factors.

Screening in Primary Care​

​Primary care can be an ideal setting for addressing firearm injury risk, as many individuals—children and adults alike—attend routine annual visits and often have established rapport with their providers. The feasibility of discussing firearm risk with patients in primary care settings is promising. In 2024, about 3 in 4 pediatricians indicated they always or sometimes asked about firearms at home, and a vast majority considered violence prevention a pediatric priority.⁵ Firearm risk assessment can be incorporated into these visits, alongside other preventive health promotion conversations.​
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Key recommendations for firearm injury risk screening include: ​

1. Establishing rapport between the patient and family members with the clinician, and
2. Normalizing firearm-related questions by equating them to other routine health and safety discussions (e.g., second-hand smoke or lead exposure) and discussing them in a nonjudgmental manner.^6,7

Using the same principles of Screening, Brief Intervention, and Referral to Treatment (SBIRT), clinicians can ask targeted questions to identify individual or family risk (e.g., access to firearms, storage behaviors), which can lead to brief interventions. These can include exploring potential risks, identifying motivations for behavior change, providing guidance on safe storage, and connecting patients with appropriate resources and/or referrals (e.g., “We have safety locks in the office available to everyone”). ​
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Incorporating firearm safety discussions into routine clinical care helps normalize and destigmatize the conversation—for both patients and clinicians.⁸ ​

Screening in Specialty Care​

Firearm-injury risk conversations can also be incorporated into routine services provided in specialty settings— such as mental health clinics, OB-GYN practices, geriatric care, emergency departments, and trauma centers. While primary care offers the advantage of regular and frequent access across diverse patient populations, specialty care and emergency settings may provide a unique opportunity to address risk among populations with specific characteristics or diagnoses that increase their risk of firearm-related harm (e.g., depression, previous firearm-related injuries). For example, there is a need for providers to discuss firearm access among older adults experiencing permanent progressive cognitive decline8 and gerontologists may utilize the 5 L’s mnemonic device to help assess the risk of firearm-related injury among these patients, or emergency physicians may assess a patient’s risk of experiencing community violence in the future by utilizing the SaFETy Score.