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Kiesha Fraser Doh, MD
Sofia Chaudhary, MD
Claudia Fruin, MD
Shreya Gautam, BS
Fozia Eskew, BS
Bolanle Akinsola, MD

80% of unintentional pediatric firearm-related deaths in the US occur in the home often while playing with an unsecured firearm. A survey of Georgia pediatricians indicates that anticipatory guidance (AG) around prevention of firearm injury and deaths within pediatric well child care visits (WCC) is very limited. Although physician counseling can lead to safer firearm storage behaviors, only 40% of previously surveyed Georgia pediatricians feel equipped to provide this guidance. Thus, our primary objective aimed to increase the delivery and documentation of firearm safety anticipatory guidance, along with distribution of firearm storage devices, to 75% from baseline within a 6-month period for families who present for their 3-year-old WCC.

Setting: 6 primary care pediatric practices (PCPP) across rural and urban Georgia participated in this QI project between July 2023 and February 2024.

Interventions included (1) participation in monthly webinars including sessions on general guidance on how to provide firearm secure storage education, types of firearms and secure storage devices; educational sessions on QI methodologies; sessions to address concerns, and a final session to review outcomes and plan future efforts. (2) Appointing practice champions, one physician and one office staff manager to drive improvement. (3) Tracking distribution of gun locks and safes with chart audits for the first 10 days of each month for 6 months. (4) Group practice review and feedback.

QI tools used included a firearm injury prevention algorithm, risk assessments, key driver diagrams, PDSA worksheets, and run charts. Key measures aimed to 1) increase firearm safe storage counseling at 3-year WCC, 2) provide secure storage devices to families with firearms, and 3) complete follow-up calls to confirm use of these devices. We used run charts to track our data.

Three practices increased their AG documentation on 3 y/o WCC from 0% to 33%-50%. Two practices were able to maintain a minimum of 10% improvement throughout the study period. All practices had challenges with distribution of secure storage devices and with follow-up phone calls on utilization of devices distributed. Both firearm secure storage device distribution and follow-up phone call were less than predicted with only 4 families receiving a device and 3 families receiving a follow up phone call at one practice. One practice screened 21% of 3-year-old WCC which was a 19% increase from their baseline

This QI initiative showed that AG on firearm safety can be increased through targeted education, practice support, and use of QI tools. Although the 75% goal was not met, important progress was made in initiating firearm safety discussions that were previously absent. Barriers such as differences in resources, staffing, and administrative support likely contributed to limited overall change. Future efforts should include ongoing training, especially in culturally sensitive counseling, structural racism, and firearm-related equity issues to enhance pediatricians’ comfort and effectiveness in discussing firearm safety.

1. Identify the prevalence and contributing factors of unintentional firearm injuries occurring in the home environment.
2. Explore strategies to establish a structured framework for implementing a firearm safety counseling and storage program within their own community or clinical setting.
3. Evaluate the challenges and benefits of integrating firearm safety screening and secure storage device distribution into pediatric practice policies

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Lindsay D. Clukies, MD, FAAP
G. Hoganson, MD;
N. Agostin, BA, EMT;
S. Wiltrakis, MD; MS;
K. Mueller, MD;
S. Morand MD;
D. Jeffe, PhD

Firearm injuries are the leading cause of death among U.S. children and adolescents, yet little is known about guardians’ receipt of physician-led firearm-safety education. We aimed to assess guardians’ exposure to and attitudes toward firearm-safety education and evaluate the underlying structure of a brief attitudinal questionnaire to guide development of a physician-led educational initiative.

An anonymous electronic survey was administered to guardians of patients being treated in the ED of a Level 1 pediatric trauma center. The survey assessed firearm ownership, prior education about and attitudes toward receiving physician-led firearm-safety education. Ten items measured respondents’ attitudes regarding the importance of and receptivity to such education using a 5-point Likert scale from Strongly Disagree (1) to Strongly Agree (5). Principal component analysis (PCA) was conducted for data reduction and to examine the underlying structure of these items. Cronbach’s alpha measured the internal-consistency reliability of items loading on resulting components. Analyses of variance (ANOVA) tested between-groups differences in receptivity to physician-led firearm-safety education. Chi-square tests examined associations among guardian characteristics and exposure to firearm-safety education.

Of 591/765 (77%) guardians who completed the 10 items assessing receptivity to physician-led firearm-safety education, PCA yielded a single-component solution. All items loaded highly on the component (range: .74-.93), and internal-consistency reliability was high (Cronbach’s ? =.96). Mean (SD) receptivity scores were higher among guardians with (vs. without) a 4-yr college degree (3.5 [1.0] vs. 3.2 [1.0]; p <.001) and who never (vs. ever) received firearm-safety education (3.5 [1.0] vs. 3.1 [1.0]; p < .001), but scores did not differ significantly by firearm ownership (p =.18). A lower percentage of guardians with a 4-yr college degree knew someone injured or killed by a firearm (33.2% vs. 53.5%; p <.001); but a higher percentage reported firearm ownership (45.4% vs. 35.6%; p <.02) and no prior firearm-safety education (57.2% vs. 47.6%; p =.02).

Guardians receptivity to physician-led firearm-safety education differed by educational attainment and exposure to firearm-safety education, but not by firearm ownership. The receptivity measure demonstrated strong internal-consistency reliability, supporting its use in future interventions. These findings can inform development of tailored educational initiatives aimed at reducing pediatric firearm injuries.

1. Describe guardian attitudes toward physician-led firearm-safety education in a pediatric emergency department setting, including how these attitudes vary by education level and prior exposure to firearm-safety education.
2. Interpret the psychometric properties of a newly developed receptivity scale, including its internal-consistency reliability and results of principal component analysis.
3. Apply findings to inform the design of targeted physician-led firearm-safety education initiatives aimed at reducing pediatric firearm injuries.

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Angelica M. Baker, BA

Safe storage of medications and firearms are a critical injury prevention strategy. Unsecured medications and firearms are linked to unintentional poisonings, overdoses and suicides. While injury prevention programs recommend the use of lock boxes, bags and firearm safes, there is minimal guidance and standards to determine which products are effective. Currently, standardized testing, rating or requirements do not exist to help consumers choose appropriate storage solutions. To ensure that products distributed by an injury prevention program at a Level-1 Pediatric Trauma Center are both safe and effective, a hands-on evaluation was conducted.

This was a hands-on product evaluation of commercially available medication lock boxes, bags, and firearm lock boxes from a large online retailer based on top-selling items, reviews, and recommendations from other injury prevention programs. Products were evaluated for durability, locking mechanisms, tamper resistance and ease of use by a team of injury prevention specialists, injury prevention program manager and trauma program manager.

Several medication lock boxes and firearm safes were tested for child resistance, ease of use, lock integrity and durability. Only one medication lock box and one firearm safe was found to meet all safety requirements. Most medication lock boxes and bags failed child-resistance testing opening with simple household tools. In addition, most firearm safes failed and did not maintain structural integrity. These findings suggest that not all commercially available storage products offer reliable protection and injury prevention programs may unknowingly distributing ineffective devices. Results support the need for independent and standardized testing, especially in homes with children and teens experiencing a mental health emergency.

Not all medication lock boxes, bags and firearm safes on the market effectively protect against access and unauthorized use. The testing revealed significant differences in product quality, accessibility, and integrity. These findings highlight the importance of guiding injury prevention programs and families towards tested and reliable storage options, especially for homes with individuals experiencing suicidal ideation. Injury prevention professionals should be aware of the differences in product and should include these recommendations into home safety counseling. Additional efforts are needed to establish consumer safety standards and promote standardized product testing.

1. Ensure the safety and quality of commonly distributed medication lock boxes and firearm safes.
2. Identify product strengths and weaknesses through hands-on testing.
3. Provide recommendations to inform injury prevention professionals and families about safe storage items.

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Sofia Chaudhary, MD
Mark Zamani, MS
Christian Pulcini, MD, MEd, MPH
Elizabeth R. Alpern, MD, MSCE
Peter Ehrlich, MD, MSc
Joel Fein, MD, MPH
Monika Goyal MD, MSCE
Matthew Hall, PhD
Stephen Hargarten, MD, MPH
Rachel K. Myers, PhD, MS
Karen Sheehan, MD, MPH
Bonnie Zima, MD, MPH
Jennifer Hoffmann, MD, MS
Eric Fleegler, MD, MPH

Firearms are the most common and lethal means of suicide for youth ages 10-24 years. To inform youth suicide prevention efforts, it is crucial to understand ownership and storage patterns of these firearms. To address this knowledge gap, we describe ownership and storage patterns of firearms used in youth suicide and examine the sociodemographic and clinical characteristics of decedents associated with firearm ownership by the decedent or the parent.

We conducted a retrospective cohort study of firearm suicides by youth aged 10-24 years from 2018-2021 using the CDC National Violent Death Reporting System. We included data from states that report firearm ownership for ?70% of cases (AZ, CT, DE, KS, ME, MT, NH, ND, HI). We described firearm ownership by age group (10-17, 18-24 years) and among decedents with known mental health (MH) problems. We used multivariable logistic regression to estimate the association of age group and firearm ownership by (1) the decedent and (2) the parent, adjusted for sex, race, ethnicity, rural/urban location, and clinical characteristics. Among cases with non-missing firearm storage data, we described whether firearm was locked and/or loaded by age group.

Of 1,021 youth firearm suicide decedents, most were White (82%), non-Hispanic (80%), ages 20-24 years (63%), and male (89%). Firearm ownership was missing for 23% of decedents. Of the remaining cases (n=788/1021 (77%)), firearms were most often owned by the decedent (56%) or a parent (27%). Among 10-17-year-old decedents (n=166/788 (21%)), 5% owned the firearm and 72% used a firearm owned by a parent. Among 18-24-year-olds (n=622/788 (79%)), 69% owned the firearm and 14% used a firearm owned by a parent. Of decedents with known MH problems (n=307/788 (39%)), 60% owned the firearm and 25% used a firearm owned by a parent. There were lower adjusted odds of firearm ownership by the decedent for 10-17-year-olds compared to 18-24-year-olds (aOR 0.03, 95% CI 0.02, 0.07). There were higher adjusted odds of firearm ownership by the parent for 10-17-year-olds compared to 18-24-year-olds (aOR 10.99, 95% CI 7.50, 16.10). Among decedents 10-17 years of age with known locked (n=135) and loaded (n=105) status, 60% were stored unlocked and 70% were stored loaded. Among decedents 18-24 years of age with known locked (n=327) and loaded (n=350) status, 69% were stored unlocked and 81% were stored loaded.

Approximately three-quarters of 10-17-year-old suicide decedents used a parent’s firearm, while two-thirds of 18–24-year-olds used their own. Although storage data are limited, among decedents with known firearm storage practices, most firearms were stored unlocked and loaded, regardless of age group. Suicide prevention strategies should focus on reducing access to firearms owned by youth, in addition to caregivers.

1. Learn ownership patterns of firearms used in youth suicide in the United States.
2. Understand firearm storage patterns for firearms used in youth suicide by age group.
3. Recognize the need for suicide prevention interventions that are directed towards youth in addition to their parents.

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Ashley Mahnke, MBA, CHES, CPST-I
Latoya Stamper, MSW, CPST
Mackenzie Rose, CHES, CPST

Rising unintentional firearm injuries, ingestions, and suicides in our community have prompted a long-standing hospital-based home safety program to evolve and address these concerns. Enhancing our focus on general home safety, the program now includes safe gun and medication storage solutions to prevent injuries. Each year, the hospital's emergency department and mental health services care for a high rate of children and teens presenting with unintentional firearm injuries and suicide ideation. The purpose of this program is to enhance education and provide safe storage devices to these patient’s families, reducing access to lethal means. Proper storage of firearms and medications is a critical strategy in preventing unintentional injury, suicides, and death.

Beginning in 2022, the program initiated the distribution of gun locks (trigger and cable locks) and medication lock bags through collaborations with social work and mental behavioral health teams. In 2024, a multidisciplinary workgroup was formed to integrate these efforts for a cohesive approach to firearm and medication safety. Program optimization involved: 1) identifying families of at-risk patients in the emergency department and trauma center for participation; 2) integrating documentation into the electronic health record with updated flowsheets and a bilingual liability agreement; 3) developing a data report to track product distribution; 4) creating and implementing a digital gun safety teaching sheet; 5) expanding the range of available safe storage products (lockboxes with key and biometric lockboxes) sourced from approved vendors and managed through a centralized warehouse; and 6) launching a two-part staff training program, including evidence-based Counseling on Access to Lethal Means (CALM) training. In 2025, the team plans to create a standardized screening practice integrated into the hospital's social determinants of health assessment to further identify eligible families. Data analysis for this program evaluation included descriptive statistics on product distribution.

In 2024, 70 safety products were distributed to families across 10 counties, including 45 lock boxes, 2 cable locks, 2 trigger locks, and 21 medication lock bags. Ingestions and suicide were the leading complaint with 64% being female. So far in 2025, 46 safety products have been given to 32 children, and 43 staff participated in the CALM training. Program educators noted positive feedback from families receiving education and safety products.

Initial data indicates a significant need for continued expansion of this safe gun and medication storage program across the health system. The program's development highlights the value of clinical integration and multidisciplinary collaboration. This has been well-received by staff, leadership, and families. Future efforts will focus on quality improvement and further program expansion.

1. Participants will understand the key components of a successful safe storage program and be able to implement a similar program.
2. Participants will learn how to integrate a safety program into the electronic health record to facilitate system-wide implementation.
3. Participants will learn about clinical integration in establishing a safe storage program.