5 L’s

Violence Domain:

General Firearm Injury
Suicide

Clinical Setting:

Primary Care
Home Health Visits
Gerontology

Key Staff:

Primary Care Provider
Gerontologist
Home Health Aid

The “5 L’s” is a mnemonic device—Locked, Loaded, Little children, feeling Low, Learned owner—designed to help providers assess firearm access and safety practices among older adults. This discussion-based screening tool begins with the question “Is there a gun in the home?” If the answer is “yes”, then the provider proceeds to inquire about additional risk factors. These additional questions explore:

Storage practices (e.g., “Are any firearms ever kept loaded and unlocked while stored in and around your home?”)
Risk of unintentional injury (e.g., “Are little children present?”)
Risk of suicidal ideation (e.g., “Is the firearm operator feeling low?”)
Level of firearm training (e.g., “Is the firearm operator learned?”)

Screening using the “5 L’s” may occur in person as part of a universal firearm violence screening protocol, or through a phone-based discussion. Unlike some asynchronous screening tools, the “5 L’s” is intended to serve as a discussion guide and is frequently delivered alongside other interventions. Patients reporting keeping firearms unlocked and loaded may be counseled on secure storage practices and provided a free locking device, such as cable locks.

If patients experiencing depression or acute suicide risk also have access to firearms, then screening may lead to lethal means counseling and safety planning to reduce risk. These patients may also be guided to resources such as Lock to Live.

Though the “5 L’s” mnemonic device has primarily been studied in older populations, it may be adaptable for use with other groups. While it has not yet been validated, researchers have noted its potential as part of a healthcare providers’ toolkit to prevent firearm injuries.