Firearm Injury Survivors

Learn what clinicians can do to prevent survivors of firearm injury from experiencing future firearm-related harm.

When patients are hospitalized with a nonfatal firearm injury, clinicians should provide culturally humble care while also offering information and links to resources to prevent future injuries. This includes patients whose injuries are from self-harm, interpersonal violence, and unintentional injury.

Who’s at Risk

Survivors of assaultive firearm injury have a much higher risk of being shot again than the general population. The risk of a second firearm injury ranges from 1% to 10% within five years, depending on whether the data is from hospital or law enforcement sources.² After ten years, the risk of reinjury goes up to 16%.² Among patients who received hospital-based care and had been shot more than once, 2% subsequently died from firearm homicide.³

Subsequent firearm assault injuries tend to be more severe than initial injuries and have increasingly worse prognoses.⁴ With each successive nonfatal firearm assault injury, the risk of death by firearm increases.^3,4 Recurrent firearm assault injuries disproportionately impact men, Black people, and young people.^2-5

Assaultive firearm injury also plays a role in intimate partner violence (IPV), with research estimating that 10% of US adults are survivors of nonfatal firearm abuse by an intimate partner.⁶ Of intimate partner violence survivors who experienced nonfatal firearm abuse, 5% reported being shot by their partner and 63% reported being threatened by their partner with a firearm.⁶

With regard to suicide, although the vast majority of people who attempt suicide with a gun will die,⁷ survivors of suicide are at continued risk of future attempts.⁸

Consequences of Firearm Injury

When clinicians initially evaluate patients after a firearm injury, their focus is on the immediate treatment of physical harm and patient survival. However, patients may also experience social and emotional problems associated with trauma that require attention and treatment. In a national survey of violent crime victims, nearly three-fourths of people victimized with a firearm reported experiencing moderate to severe distress, problems with family or friend relationships, or problems at work or school as a result of the incident.⁹

Many survivors of firearm violence acquire or begin to carry firearms after being assaulted because they feel unsafe and want more protection.^10,11 However, this is not protective. A study of adolescents in Chicago indicates that exposure to firearm violence, including being shot or shot at or seeing someone shot or shot at, doubles the probability that an adolescent will perpetrate serious violence over the next two years.¹² Among IPV survivors who acquired a gun for protection and to feel safe,¹¹ studies showed that this ownership was not protective.^13,14 In fact, females who buy handguns have a higher risk of firearm homicide for several years following the purchase.^13,14

What You Can Do

Caring for patients after they have sustained a firearm injury should include psychosocial interventions to reduce the risk of future injury.

Clinicians in all specialties should be aware of the wide-ranging impacts of firearm violence on patients, as well as on their friends and families, and can provide referrals to mental health or social services when appropriate.

Clinicians who care for patients with any type of firearm injury should inquire about the contextual factors that may have contributed to the shooting, such as unsecured firearms in the home, domestic violence or other interpersonal disputes, high rates of violent crime where the person lives, and high rates of firearm use among peers and other members of their network. Referrals and other services offered should be tailored to the patient’s individual circumstances and needs.

Clinicians working with patients who present after firearm suicide attempts should discuss the heightened risk of suicide when firearms are in the home. Counseling patients and other firearm owners in the patient’s home on the importance of removing access to guns through safe storage within or outside of the home when risk is increased may be an effective strategy. Following a suicide attempt, the clinician may refer a patient to mental health services; if the risk is still imminent, they should consider whether a 5150 hold is appropriate and how this will affect their patient’s ability to legally own firearms.

Clinicians do not routinely initiate conversations with patients and/or their caregivers about reducing access to firearms for the injury survivors through options such as safe firearm storage in the home or out-of-home at another location. One study found that firearm safety discussions took place in less than 5% of encounters in which pediatric patients presented with gunshot wounds.¹⁵ Such counseling is generally accepted by families: in a study of over 1,200 parents, 75% thought their child’s physician should advise about safe gun storage.¹⁶

Patients presenting with assault-related firearm injuries can be connected with support services and violence prevention groups. For example, clinicians can connect survivors of intimate partner violence to local resources and coalitions, which are searchable on the National Domestic Violence Hotline’s website. Hospital-based violence intervention programs (HVIPs) are another way to connect violently injured patients with resources, such as community services, mentors, employment support, and long-term care, in order to break the cycle of violence.

Dr. Sarah Stokes from the University of California, Davis contributed to this content.

Page last updated August 2025.

For more information, see these peer-reviewed articles.

O’Neill, K. M., Vega, C., Saint-Hilaire, S., et al. (2020). Survivors of gun violence and the experience of recovery. The Journal of Trauma and Acute Care Surgery.

Pear, V. A., Mccort, C. D., Kravitz-Wirtz, N., et al. (2020). Risk factors for assaultive reinjury and death following a nonfatal firearm assault injury: A population-based retrospective cohort study. Preventive Medicine.

Violano, P., Bonne, S., Duncan, T., et al. (2018). Prevention of firearm injuries with gun safety devices and safe storage: An Eastern Association for the Surgery of Trauma systematic review. The Journal of Trauma and Acute Care Surgery.

Carter, P. M., Walton, M. A., Zimmerman, M. A., et al. (2016). Efficacy of a universal brief intervention for violence among urban emergency department youth. Academic Emergency Medicine.

Garbutt, J. M., Bobenhouse, N., Dodd, S., et al. (2016). What are parents willing to discuss with their pediatrician about firearm safety? A parental survey. The Journal of Pediatrics.