Preventing Firearm Injuries and Fatalities

Current firearm injury research, involving three large American cities, concludes that a handgun in your home is 22 times more likely to be used to injure or kill a family member or acquaintance than an intruder. Up to 40% of American homes have firearms. In many homes with children, firearms are left unlocked and loaded. Preventing access to firearms by children and criminals is an important strategy to reduce the continuing toll of gun injury and death.

Nationwide, there have been nearly 30,000 firearm fatalities in each of the last four years for which data is available. According to the American Academy of Pediatrics, about one of every eight firearm deaths was a person under age 20. Suicides comprise 55% of all gun-related fatalities. Typical gun safety measures may not therefore be successful with this group. However, better locking mechanisms may prevent access to guns or make impulsive suicides more difficult to commit.

Physicians and medical organizations including the American Medical Society and the American Academy of Pediatrics have developed recommendations for reducing the risk of firearm injuries in the home. These strategies – for those who choose to keep a gun in the home – include safe storage practices, the use of gun locks and the selection of firearms that have built-in safety features.

The Firearm Injury Center at the Medical College of Wisconsin provided a review of handgun safety features in the July 1999 issue of the Journal of Trauma: Injury, Infection and Critical Care. The article described safety devices to prevent unauthorized use, such as trigger locks, built-in locks, lockboxes and “personalized” handguns and also described safety devices that are designed to prevent unintended discharge of a handgun, such as thumb safeties, grip safeties, magazine disconnectors, drop safeties and loaded chamber indicators.

The Firearm Injury Center also contributed to the1998 publication by the American Medical Association entitled “Physician Firearm Safety Guide.” The AMA guide includes 12 key educational points such as assuring that gun owners are fully informed about handling, storing, securing, cleaning, carrying and firing their weapons. Some of these points may appear obvious, but given the potential consequences, they bear repeating.

The mission of the Firearm Injury Center at the Medical College of Wisconsin is to reduce firearm injuries and deaths. This is a mission on which gun owners and non-gun owners find agreement. The Center conducts objective and comprehensive research into firearm injuries to inform policy makers and the public. The Center does not advocate for or against gun policies, but it does evaluate the effectiveness of policies, programs and strategies for reducing firearm injuries. The Center’s programs are based on a public health approach that better data can lead to safer guns and fewer injuries.

Gathering Data
Gathering better information about gun-related events is essential to developing effective prevention efforts. Currently, such data is not collected in a uniform manner. Firearms and tobacco are the only consumer products not subject to national product safety oversight. Toy guns and BB guns have safety oversight, but not firearms.

The Firearm Injury Center has established a model firearm injury reporting system (FIRS) that links law enforcement, medical examiners, coroners and health care providers. The goal is to develop a national data system like the one used in vehicle crashes. Two additional linkages with federal firearms tracing data and with criminal background information have recently been added to the reporting system. The Center, which includes members of the National Rifle Association on its board of advisors, has provided advice and consultation to the US Department of the Treasury, as well as to the United Nations, which continues to address illicit trafficking of firearms around the world.

In Milwaukee, Wisconsin, the center has examined the city’s gun buyback programs in which residents are paid for turning in guns. It found that the types of guns taken out of circulation were usually not the kind associated with firearm fatalities. Thus, the Center recommends that buyback programs consider a focus on handguns with barrels shorter than four inches because they are more highly associated with firearm fatalities.

The Center also examined the effect of the 1994 federal assault weapon ban in Milwaukee County. It found that few of the firearm fatalities involved assault weapons and there was no statistical difference before and after the ban. However, after the ban, there was a significant increase in the number of assault weapons found at the scene of the crime that were not associated with a killing. Assault weapons may have become more popular after the ban as a gun that perpetrators carry for show but not necessarily to use.

Better Design
The Firearm Injury Center takes the position that firearms, like other consumer products, can be more safely designed. For example, a number of makes and models of pistols, as well as long guns, will fire if they are dropped. Devices such as loaded chamber indicators can be inexpensively incorporated into the manufacture of a firearm. And there are other design features such as grip safeties that gun manufacturers have known about for over a century that can make firearms safer. But most firearms do not incorporate grip safeties.

In the 1800s, a pistol was produced by Smith & Wesson and marketed as being safer, particularly in homes with young children, because it had a built-in grip safety. Known as a “lemon squeezer,” the safety lever had to be pressed at the same time as the trigger for the gun to fire. Some of today’s firearms have the same feature. Another safety feature available today is a loaded chamber indicator that lets the user know the gun is loaded and ready to fire. In the case of a semi-automatic pistol, a round of ammunition may remain in the firing chamber even when the magazine is removed. Some firearms today can’t be fired at all if the magazine is removed – even if there’s a round in the chamber.

From the early 1900s to post-World War II, the US Army equipped soldiers with pistols produced by Colt’s Manufacturing Company that had grip safeties, magazine disconnectors and a number of other safety features. This model, the “Colt 1911A,” now out of production, has been widely copied, but not uniformly with the same safety features.

In addition to the design changes described above, there are a variety of devices that can be used to better secure firearms from unauthorized users.

Trigger locks can be purchased in a variety of styles designed to secure the handgun by immobilizing the trigger. The most common design covers the trigger mechanism on either side with two steel or plastic blocks that lock together. Not all firearm designs permit the use of trigger locks. Some locks are so poorly made that they can be removed with a hammer. And there have been reports of unintended firearm discharges when a trigger lock has been applied to a loaded gun. Caution is urged in the appropriate selection and use of trigger-locking mechanisms.

There are also devices that insert into the barrel or chamber and provide a physical barrier against loading a handgun. They are available in locking and non-locking styles. Available in both keyed and combination styles, built-in, grip-mounted locks prevent the handgun from being fired by someone other than the person who has the key or combination. Few handguns come equipped with built-in locks, but such locks can be added.

Personalized guns have a built-in magnetic or electronic locking device. The owner of the weapon wears an identifying magnetic ring or radio transmitter bracelet, which unlocks the trigger. The grip is customized to perfectly fit the owner’s hand, allowing for easy alignment of the ring or bracelet. Personalized guns are not yet available in the consumer market. Several manufacturers have, however, announced plans to provide personalized guns to law enforcement agencies in the near future and several states are considering legislation that will require personalization.

Finally, lockboxes are small, portable, safe-like boxes or cases specifically designed for the storage and/or transport of handguns. The lockbox is the device most often used by police to prevent unauthorized access to a handgun.

Richard L. Withers, JD
Associate Director, Emergency Medicine
Co-director, Firearm Injury Center
Medical College of Wisconsin

For more information on this topic, see the HealthLink article Firearm Injury Center Releases Stats on Violent Deaths in Wisconsin