Firearm Storage Maps: A Pragmatic Approach to Reduce Firearm Suicide During Times of Risk
Authors: Timothy Kelly, Sara Brandspigel, Evan Polzer, Marian E. Betz
Journal: Annals of Internal Medicine (2020)

Ideas and Opinions3 March 2020Firearm Storage Maps: A Pragmatic Approach to Reduce Firearm Suicide During Times of RiskFREETimothy Kelly, BA, Sara Brandspigel, MPH, Evan Polzer, MA, and Marian E. Betz, MD, MPHTimothy Kelly, BAUniversity of Colorado School of Medicine, Aurora, Colorado (T.K., E.P.), Sara Brandspigel, MPHColorado School of Public Health, Aurora, Colorado (S.B.), Evan Polzer, MAUniversity of Colorado School of Medicine, Aurora, Colorado (T.K., E.P.), and Marian E. Betz, MD, MPHUniversity of Colorado School of Medicine and Colorado School of Public Health, Aurora, Colorado (M.E.B.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2944 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinicians are increasingly recognizing the utility of clinical screening, informed patient conversations, and counseling about safe firearm storage to reduce firearm injury and death (1). But preventing firearm-related injury and death requires pragmatic, community-based solutions to promote safer storage of firearms during periods of risk. Is it feasible to act locally to improve the safety of our patients? Is it practical, and will it work? Here, we describe our experience to date with a pragmatic effort in our community.Temporary, voluntary storage of firearms outside the home is recommended for persons at risk for suicide (2) because firearm access increases the likelihood of a fatal suicide attempt and firearms are responsible for half of all suicide deaths in the United States (3). Because suicide rates are increasing (4)—and 60% of firearm-related deaths are suicides (3)—outreach to firearm owners about suicide prevention has increased. This has included "gun shop projects" (partnerships between public health professionals and firearm retailers) for development and dissemination of education about suicide warning signs and the rationale for reducing access to lethal means during times of risk (5).How to facilitate out-of-home storage for persons at risk is an important question. Prior work found that 47.6% of firearm retailers and 74.8% of law enforcement agencies (LEAs) in the Mountain West region offered temporary, voluntary storage, and many retailers (49.8%) and LEAs (64.6%) reported having received storage requests in the past year (6). Yet, no published information existed on specific locations for firearm storage, which could pose a real-time barrier for individuals and families seeking options.So, to support lethal means safety efforts in Colorado, we developed an online resource for the public and for clinicians who counsel at-risk patients. The statewide map displays firearm retailers and LEAs willing to consider requests for voluntary, temporary gun storage. This work was completed with input from the Colorado Firearm Safety Coalition, an organization made up of clinicians, public health researchers, and gun shop owners focused on suicide prevention and gun safety.In total, 46 retailers (45 firearm retailers and 1 safe deposit box company) and 15 LEAs agreed to be listed on the map (Figure). Once the map was built, we disseminated our resource to targeted Colorado stakeholders, including medical and behavioral health providers, hospital groups, the crisis system, professional organizations, and the population at large (through media outreach). We specifically sought opportunities to disseminate the information through trusted messengers within the firearms community (7). Since the map's release (8), additional firearm retailers (n = 3) and LEAs (n = 2) have asked to be added.Figure. Online map of Colorado locations willing to consider voluntary, temporary firearm storage.Circles with a badge represent law enforcement agencies (LEAs). Circles with an armed person represent firearm retailers or ranges. Circles with a target represent other storage locations (e.g., safe deposit box sites). To identify firearm retailers, we purchased a Dun & Bradstreet state registry and supplemented it with a Google Maps search for gun shop(s), firearms, armory, shooting range, and firing range. We called each identified retailer twice during business hours. If the telephone number was disconnected, we sought alternate contact information from Federal Firearms Licensee listings and Web searches. We excluded national chain retailers and pawn shops not included in the purchased registry. To identify LEAs, we purchased a National Public Safety Information Bureau state registry. We contacted LEAs primarily via e-mail. In all telephone or e-mail conversations, we asked if the contact provides (or would consider providing) temporary, voluntary firearm storage on request. For those responding yes, we asked if they were willing to be listed on an online map intended to be used by persons in times of suicide crisis, among other reasons. We explained that inclusion in the map was nonbinding and that they could still consider requests on a case-by-case basis. Over approximately 100 hours between June and August 2019, we contacted 471 firearm retailers or businesses (274 identified via Google Maps searches) and 215 LEAs. Among contacted sites, 171 firearm retailers and 42 LEAs did not offer storage or declined to be listed; the remainder could not be reached. The online map was built with publicly accessible Google Maps software. The project did not meet the definition of human subjects research and therefore did not require the approval of an institutional review board. (Map data from Google.) Download figure Download PowerPoint This map is an example of a novel tool to support lethal means safety approaches for suicide prevention, and it was built through collaboration with firearms retailers and LEAs. To the best of our knowledge, it is the first resource of its kind in the nation that specifically lists options for voluntary, temporary gun storage. Ongoing evaluation of the map's effects is needed, but—with adequate dissemination—it could help translate safe storage counseling into action. It may also be useful in other scenarios when individuals might want to store firearms away from home, such as home rental, visitors, or extended travel.The project highlighted several unaddressed concerns that warrant further attention from scholars and practitioners. Some firearm retailers and LEAs who supported the goal of suicide prevention declined participation because of perceived legal liability of offering gun storage to at-risk persons—an understandable position given the lack of clarity surrounding temporary transfer of firearms at a state and national level (9, 10). Standardized guidance or waivers might be useful in encouraging retailers to offer storage; issues to address include storage costs and deadline for pickup, whether background checks are required at pickup, and release of liability for damage during storage. A more difficult, yet critically important, issue is liability after the firearm is returned (for example, if the owner subsequently uses it in a suicide attempt). Likewise, the psychological toll on retailers and LEAs if they were to return a firearm that was then used in a suicide attempt is unknown. Even as these issues persist, it is encouraging that a substantial number of private businesses and LEAs believed that the existing legal framework was not so burdensome that it prevented participation.Our experience provides proof of concept that developing a statewide map of locations that may offer temporary, voluntary firearm storage is feasible. The map was released in August 2019, so data about changing frequencies or patterns of gun storage requests are not yet available, although future evaluation is planned. However, since the map was released, physicians, public health practitioners, and firearm retailers from 11 states have expressed interest in creating similar resources in other regions. We are sharing guidance and lessons learned from our effort, as well as step-by-step instructions on how to build a similar map. Stakeholders from the medical, public health, and gun-owning communities have the potential to advance suicide prevention initiatives through innovative safe storage programs. We hope that our experience encourages others to champion creative and pragmatic efforts to eliminate firearm-related injury and death.References1. Pallin R, Spitzer SA, Ranney ML, et al. Preventing firearm-related death and injury. Ann Intern Med. 2019;170:ITC81-96. [PMID: 31158880]. doi:10.7326/AITC201906040 LinkGoogle Scholar2. Simonetti JA, Rowhani-Rahbar A. Limiting access to firearms as a suicide prevention strategy among adults: what should clinicians recommend? JAMA Netw Open. 2019;2:e195400. [PMID: 31173116] doi:10.1001/jamanetworkopen.2019.5400 CrossrefMedlineGoogle Scholar3. Centers for Disease Control and Prevention. WISQARS Data Visualization. 2019. Accessed at https://wisqars-viz.cdc.gov:8006 on 3 September 2019. Google Scholar4. Stone DM, Simon TR, Fowler KA, et al. Vital signs: trends in state suicide rates — United States, 1999–2016 and circumstances contributing to suicide — 27 states, 2015. MMWR Morb Mortal Wkly Rep. 2018;67:617-24. [PMID: 29879094] doi:10.15585/mmwr.mm6722a1 CrossrefMedlineGoogle Scholar5. Barber C, Frank E, Demicco R. Reducing suicides through partnerships between health professionals and gun owner groups—beyond docs vs glocks. JAMA Intern Med. 2017;177:5-6. [PMID: 27842187] doi:10.1001/jamainternmed.2016.6712 CrossrefMedlineGoogle Scholar6. Runyan CW, Brooks-Russell A, Brandspigel S, et al. Law enforcement and gun retailers as partners for safely storing guns to prevent suicide: a study in 8 Mountain West states. Am J Public Health. 2017;107:1789-94. [PMID: 28933926] doi:10.2105/AJPH.2017.304013 CrossrefMedlineGoogle Scholar7. Edwards C. This new gun storage map is designed to save lives in Colorado. Bearing Arms. 27 August 2019. Accessed at https://bearingarms.com/cam-e/2019/08/27/new-gun-storage-map-designed-save-lives-colorado on 8 November 2019. Google Scholar8. Colorado Firearm Safety Coalition. Gun storage map. 2019. Accessed at https://coloradofirearmsafetycoalition.org/gun-storage-map on 7 September 2019. Google Scholar9. McCourt AD, Vernick JS. Law, ethics, and conversations between physicians and patients about firearms in the home. AMA J Ethics. 2018;20:69-76. [PMID: 29360029] doi:10.1001/journalofethics.2018.20.1.hlaw1-1801 CrossrefMedlineGoogle Scholar10. McCourt AD, Vernick JS, Betz ME, et al. Temporary transfer of firearms from the home to prevent suicide: legal obstacles and recommendations. JAMA Intern Med. 2017;177:96-101. [PMID: 27842186] doi:10.1001/jamainternmed.2016.5704 CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: University of Colorado School of Medicine, Aurora, Colorado (T.K., E.P.)Colorado School of Public Health, Aurora, Colorado (S.B.)University of Colorado School of Medicine and Colorado School of Public Health, Aurora, Colorado (M.E.B.)Acknowledgment: The authors thank Carol Runyan, Ashley Brooks-Russell, participating gun retailers and LEAs, and members of the Colorado Firearm Safety Coalition.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2944.Corresponding Author: Timothy Kelly, BA, 2154 North Lafayette Street, Denver, CO 80205; e-mail, timothy.[email protected]edu.Current Author Addresses: Mr. Kelly: 2154 North Lafayette Street, Denver, CO 80205.Ms. Brandspigel: Colorado School of Public Health, 13001 East 17th Place, Mail Stop B119, Aurora, CO 80045.Mr. Polzer and Dr. Betz: University of Colorado School of Medicine, 12469 East 17th Place, Mail Stop F423, Aurora, CO 80045.Author Contributions: Conception and design: S. Brandspigel, E. Polzer, M.E. Betz.Analysis and interpretation of the data: E. Polzer.Drafting of the article: T. Kelly, E. Polzer.Critical revision of the article for important intellectual content: S. Brandspigel, M.E. Betz.Final approval of the article: T. Kelly, S. Brandspigel, E. Polzer, M.E. Betz.Obtaining of funding: M.E. Betz.Administrative, technical, or logistic support: T. Kelly, S. Brandspigel, E. Polzer, M.E. Betz.Collection and assembly of data: T. Kelly, S. Brandspigel, E. Polzer.This article was published at Annals.org on 21 January 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDevelopment of an online map of safe gun storage sites in Maryland for suicide preventionUnited States trends in healthcare charges for pediatric firearm injuriesLethal Means Safety Approaches for Suicide PreventionLethal means counseling for suicide prevention: Views of emergency department cliniciansRural–Urban Differences in Suicide Mortality: An Observational Study in Newfoundland and Labrador, Canada: Différences de la Mortalité Par Suicide en Milieu Rural-Urbain: Une Étude Observationnelle à Terre-Neuve et Labrador, CanadaSuicidal ideation in the context of prospective firearm ownershipFirearms, pesticides, and suicide: A look back for a way forward 3 March 2020Volume 172, Issue 5Page: 351-353KeywordsConflicts of interestDisclosureFire safetyFirearm injuriesForecastingInformation storage and retrievalInstitutional review boardsPrevention, policy, and public healthSafetySuicide ePublished: 21 January 2020 Issue Published: 3 March 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. 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