Beyond the Bullet Points
Firearm Safety Counseling for Military Pediatric Providers
Daniel Ferman, MD
February 2026
Firearm injury is the leading cause of death for children and adolescents in the United States.
children every day
12
01. Scale of the Issue
Leading Cause of Death for U.S. Children
Motor vehicle
Percentage of all causes
Firearm
Cancer
Suffocation
Poisoning
01. Scale of the issue
30 million children
4.6 million live in a home with at least one firearm unlocked and loaded
of u.s. households
02. access
Bedroom: 30%
Access locations in pediatric fatalities
Closet: 20%
Furniture: 10%
- Most firearms used in adolescent suicides are obtained from the home.
- Most unintentional firearm-related deaths occured while playing with the firearm.
Stored loaded and unlocked
3/4
Bag, purse, clothing: 9%
Vehicle: 12%
Kitchen: 9%
These are not acts of aggression. They are acts of curiosity.
03. Knowledge gap
2/5
1/4
Handling Misconception
Location Misconception
Children have handled a firearm in their home without parents knowing
Parents incorrectly believe their child does not know where a firearm is kept
1/2 caregivers would consider locking to prevent access by children
This is a modifiable risk factor.
04. ownership
Reasons for ownership
- Protection
- Hunting
- Inheritance
- Collection
- Sport shooting
- Profession
Global Ownership
1st
The U.S. has more civilian-owned guns than any other country worldwide.
05. Protection
- Accessibility
- Proximity
- Readiness
06. Military
Providers and the military family
Health professionals rarely counsel on firearm safety
- Military families have higher risk / exposure
- Increased training = Increased safety
07. Solution
Polls show that a majority of the public and gun owners are receptive to discussing firearms in healthcare settings
Firearm injuries are preventable
Modifiable risk
- Safe firearm storage
- Health professional counseling
08. Storage
UNLOAD
lock
separate
Store ammunition in a separate, locked location away from firearms.
Ensure all firearms are completely unloaded before storage.
Secure all firearms with an effective locking device.
08. Storage
Out of home Storage options
- Family, Friend, Neighbor (free)
- Gun Dealers ($)
- Shooting Range ($$)
- Commercial Storage Facility ($$$)
- Pawn Shop ($$$)
- Police / Sheriff (free)
- Base Armory (free)
08. Storage
in home Storage options
CABLE LOCK$0 - $50
TRIGGER LOCK$10 - $75
GUN CASE $10 - $150
LOCK BOX / LOCKER$25 - $350
ELECTRONIC LOCK BOX$50 - $350
FULL-SIZE GUN SAFE$200 - $2,500
08. Storage
in home Storage options
CABLE LOCK$0 - $50
TRIGGER LOCK$10 - $75
GUN CASE $10 - $150
LOCK BOX / LOCKER$25 - $350
ELECTRONIC LOCK BOX$50 - $350
FULL-SIZE GUN SAFE$200 - $2,500
WIRELESS GUN SAFE MONITOR $150 - $200
ELECTRONIC HOLSTER $200 - $300
CONSOLE STORAGE $250 - $300
CARGO AREA STORAGE $500 - $1,500
09. Counseling
Assess existing knowledge, current practices, risk factors, and readiness to engage.
Assess
Share information, make tailored recommendations.
Advise
Check understanding, reflect change talk, ask importance ruler questions.
Ask
Provide resources, continue to revisit, escalate when necessary.
Act
09. Counseling
How are they stored?
What knowledge do they have?
Who is in the home?
Do children have access to firearms at home?
What about elsewhere?
Adolescent -> Ask about ideation
Do parents own firearms?
Assess
- Risk factors
- Current practices and knowledge
- Access to firearms
- Willingness to collaborate
09. Counseling
Stages of Change (Transtheoretical Model)
Pre-contemplation
Maintenance
Assess
- Risk factors
- Current practices and knowledge
- Access to firearms
- Willingness to collaborate
Contemplation
Action
Preparation
The goal is incremental change.
09. Counseling
Assess risk
- Presence of firearm within any home
- Unsafe storage
- Adverse childhood experiences
- Mental illness
- Previous firearm injury
- Recent stressors
- Weak state-level firearm legislation
Post-Injury
Emergency Visit
Surgical Clinic
Primary Care
The goal is incremental change.
09. Counseling
Advise: approach matters
Be informed
Be respectful
Firearms: use, terminology, ownershipSafety options and resources
Acknowledge role of firearms and ownershipAsk permission when possible Use autonomy-supporting language
The exception is immediate or imminent danger
Focus on harm reduction
Be individualized
Neutral, non-stigmatizing languageRedirect
Find solution that worksLong-term relationship mindset
09. Counseling
Advise: misconceptions
Child play with replica/toy firearms increase riskYoung children do not have the physical strength to pull a trigger Child-focused firearm education (e.g., trigger discipline) reliably reduces risk Hiding a firearm out of sight is as effective as securing it safely Quick access to a firearm prevents violence Local / state laws can prohibit providers from discussing firearms
09. Counseling
Case
You are seeing a 10-year-old for a routine well-child visit. She lives with her parents, both of whom are active duty military, and her two brothers, ages 6 and 17. Firearm safety has not been discussed previously and no concerns are raised.
think
SHARE
REVISE
Share Statement:Write/paste your statement into the group chat
Individual Reflection:Consider an opening statement to introduce firearm safety in this visit
Reflect & Revise:Consider how to revise statement to be respectful, preserve autonomy, reduce defensiveness, focus on harm reduction, and acknowledge known risk factors and identity without assumptions
09. Counseling
REFLECT
Strong characteristics
- Compassionate acknowledgement of injury without assigning blame
- Normalizes conversation, framed as standard of care
- Collaborative over corrective tone
- Respect for autonomy while addressing elevated risk
- Focuses on safety, not ownership, politics, or policy
Examples
- “Many families in our community own firearms. Can we talk about what storage looks like at home?”
- “I like to go over a few routine safety topics with all families - things like car seats, helmets, and firearms. Would it be okay if we talked about that for a minute?”
- “I ask all families about safety at home, including firearms - can you tell me how they’re stored where your child lives / What’s your approach to storage?”
- “Would it be helpful to look at a few options / Would it be okay if I shared what we know about the safest options?”
- “Kids often spend time at friends’ houses. Have you considered asking about firearm storage when your child goes somewhere new?”
09. Counseling
Case
You are seeing a 10-year-old for a routine well-child visit. She lives with her parents, both of whom are active duty military, and her two brothers, ages 6 and 17. Firearm safety has not been discussed previously and no concerns are raised.
Examples
- Compassionate acknowledgement of injury without assigning blame
- Normalizes conversation, framed as standard of care
- Collaborative over corrective tone
- Respect for autonomy while addressing elevated risk
- Focuses on safety, not ownership, politics, or policy
- “Many families in our community own firearms. Can we talk about what storage looks like at home?”
- “I like to go over a few routine safety topics with all families - things like car seats, helmets, and firearms. Would it be okay if we talked about that for a minute?”
- “I ask all families about safety at home, including firearms - can you tell me how they’re stored where your child lives / What’s your approach to storage?”
- “Would it be helpful to look at a few options / Would it be okay if I shared what we know about the safest options?”
- “Kids often spend time at friends’ houses. Have you considered asking about firearm storage when your child goes somewhere new?”
Examples
09. Counseling
Ask
- Check understanding
- Invite reactions
- Reflect change talk
- Use importance rulers
Change talk
sustain talk
I'd like to store my gun securely but still want to be able to defend myself.
Open to change
I wish things were different.
I could store my guns differently, but I'm not so sure I want to.
My partner is frustrated with me about carrying.
I really don't want my kid to find my shotgun; he's been going through a rough time.
maintain the status quo
My child doesn't know where my gun is kept.
They can't pull the trigger anyways.
I feel safe with a loaded gun at home.
We've explained that guns aren't toys.
Everyone I know stores them this way.
09. Counseling
Ask
- Check understanding
- Invite reactions
- Reflect change talk
- Use importance rulers
Why not lower? What would help move it higher?
09. Counseling
Act
Provide handouts / resourcesRevisit at future visits Escalate when risk is high
Education: safe storage counseling, safety devices, resources.
Low risk
Consider temporary transfer to trusted person, additional safety devices, or out-of-home storage.
Mod risk
Mental health hold, civil protective order, urgent temporary transfer.
High risk
10. Key Takeaways
- Firearm injury is the leading cause of death for U.S. children - 12 die every day, mostly from accessible guns taken from the home.
- Parents frequently underestimate children’s access, but most are open to safer storage.
- Military families have unique stressors and risk factors.
- Safe storage and counseling are effective strategies to reduce firearm injuries.
Knowledge / practicesRisk factorsMotivational interviewing
Assess
Be informed & respectfulFocuse on harm reduction Individualized solutions
Advise
Check understandingReflect change talk Importance ruler
Ask
Provide resourcesContinue to revisit Escalate when necessary
Act
11. Resources
Military
- Military One Source
- Free armory firearm storage
- Family readiness center
- Installation safety office
Families
- Be SMART Campaign
- Brady United
- A.S.K. (Asking Saves Kids) Campaign
- BulletPoints Project
- Project Child Safe
- End Family Fire
- Everytown for Gun Safety
- Lethal means restriction
- Hospital- and Community-based prevention programs
- Community training / safety classes
- Free safety device provision
- Unwanted firearm disposal
Providers
- National Organizations, e.g. AAP, ACS, CDC
- Safer: Storing Firearms Prevents Harm Video Series
- CALM for Pediatric Providers: Counseling on Access to Lethal Means to Prevent Youth Suicide Course
- Referrals for social services, substance abuse, mental health
Beyond the Bullet Points
Firearm Safety Counseling for Military Pediatric Providers
Online Toolkit
Daniel.Ferman@usuhs.edu Naval Medical Center Portsmouth
https://sites.google.com/usuhs.edu/peds-firearm-injury-toolkit/home
Bibliographic references
Evidence-based firearm safety recommendations / resources
Less-effective or not recommended practices
Routine firearm safety counseling during specialty encounters with the healthcare system
Relying on supervision in household with unlocked firearms
Ammunition stored separately from firearms
Trigger discipline education for children
Firearms stored unloaded
Routine firearm safety counseling as part of well-child care
Storing firearm in locked glovebox
Ammunition stored locked
Firearms stored locked
Storing firearm hidden out of sight of child (e.g. under mattress or high shelf in closet)
Storing firearm loaded but magazine removed
Relying on children being too young to know
Lethal means restriction
Use of locked gun safe or lockbox
Video game parental controls
Biometric or keyed lock
Temporary off-site storage
Use of cable lock or trigger lock
Relying on children being too young to pull trigger
Using fear-based or graphic injury examples
Threatening punishment for handling firearms
Teen hunting license course
Community provision of free safety devices
Family readiness center or installation safety office
Referrals for social services, substance abuse, mental health
Community-based youth violence prevention programs
Hospital-based violence prevention programs / anticipatory guidance and community outreach
Military exchange firearm lock rebate program
DoD installation armory storage
Accidental injuries are rare and unavoidable
Military One Source (educational counseling, crisis support, etc)
DoD installation adult firearm training / safety programs
Temporary transfer of firearm to person outside home
TRICARE-covered firearm lock benefit
Unwanted firearm disposal
03.knowledge gap
04.ownership
02.location & mechanism
01.scale of the issue
TABLE OF CONTENTS
07.solutions
05.protection
08.safe storage
06.military
11.Resources
12.bibliography
10.key takeaways
09.counseling
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Transcript
Beyond the Bullet Points
Firearm Safety Counseling for Military Pediatric Providers
Daniel Ferman, MD
February 2026
Firearm injury is the leading cause of death for children and adolescents in the United States.
children every day
12
01. Scale of the Issue
Leading Cause of Death for U.S. Children
Motor vehicle
Percentage of all causes
Firearm
Cancer
Suffocation
Poisoning
01. Scale of the issue
30 million children
4.6 million live in a home with at least one firearm unlocked and loaded
of u.s. households
02. access
Bedroom: 30%
Access locations in pediatric fatalities
Closet: 20%
Furniture: 10%
Stored loaded and unlocked
3/4
Bag, purse, clothing: 9%
Vehicle: 12%
Kitchen: 9%
These are not acts of aggression. They are acts of curiosity.
03. Knowledge gap
2/5
1/4
Handling Misconception
Location Misconception
Children have handled a firearm in their home without parents knowing
Parents incorrectly believe their child does not know where a firearm is kept
1/2 caregivers would consider locking to prevent access by children
This is a modifiable risk factor.
04. ownership
Reasons for ownership
Global Ownership
1st
The U.S. has more civilian-owned guns than any other country worldwide.
05. Protection
06. Military
Providers and the military family
Health professionals rarely counsel on firearm safety
07. Solution
Polls show that a majority of the public and gun owners are receptive to discussing firearms in healthcare settings
Firearm injuries are preventable
Modifiable risk
08. Storage
UNLOAD
lock
separate
Store ammunition in a separate, locked location away from firearms.
Ensure all firearms are completely unloaded before storage.
Secure all firearms with an effective locking device.
08. Storage
Out of home Storage options
08. Storage
in home Storage options
CABLE LOCK$0 - $50
TRIGGER LOCK$10 - $75
GUN CASE $10 - $150
LOCK BOX / LOCKER$25 - $350
ELECTRONIC LOCK BOX$50 - $350
FULL-SIZE GUN SAFE$200 - $2,500
08. Storage
in home Storage options
CABLE LOCK$0 - $50
TRIGGER LOCK$10 - $75
GUN CASE $10 - $150
LOCK BOX / LOCKER$25 - $350
ELECTRONIC LOCK BOX$50 - $350
FULL-SIZE GUN SAFE$200 - $2,500
WIRELESS GUN SAFE MONITOR $150 - $200
ELECTRONIC HOLSTER $200 - $300
CONSOLE STORAGE $250 - $300
CARGO AREA STORAGE $500 - $1,500
09. Counseling
Assess existing knowledge, current practices, risk factors, and readiness to engage.
Assess
Share information, make tailored recommendations.
Advise
Check understanding, reflect change talk, ask importance ruler questions.
Ask
Provide resources, continue to revisit, escalate when necessary.
Act
09. Counseling
How are they stored?
What knowledge do they have?
Who is in the home?
Do children have access to firearms at home?
What about elsewhere?
Adolescent -> Ask about ideation
Do parents own firearms?
Assess
09. Counseling
Stages of Change (Transtheoretical Model)
Pre-contemplation
Maintenance
Assess
Contemplation
Action
Preparation
The goal is incremental change.
09. Counseling
Assess risk
Post-Injury
Emergency Visit
Surgical Clinic
Primary Care
The goal is incremental change.
09. Counseling
Advise: approach matters
Be informed
Be respectful
Firearms: use, terminology, ownershipSafety options and resources
Acknowledge role of firearms and ownershipAsk permission when possible Use autonomy-supporting language
The exception is immediate or imminent danger
Focus on harm reduction
Be individualized
Neutral, non-stigmatizing languageRedirect
Find solution that worksLong-term relationship mindset
09. Counseling
Advise: misconceptions
Child play with replica/toy firearms increase riskYoung children do not have the physical strength to pull a trigger Child-focused firearm education (e.g., trigger discipline) reliably reduces risk Hiding a firearm out of sight is as effective as securing it safely Quick access to a firearm prevents violence Local / state laws can prohibit providers from discussing firearms
09. Counseling
Case
You are seeing a 10-year-old for a routine well-child visit. She lives with her parents, both of whom are active duty military, and her two brothers, ages 6 and 17. Firearm safety has not been discussed previously and no concerns are raised.
think
SHARE
REVISE
Share Statement:Write/paste your statement into the group chat
Individual Reflection:Consider an opening statement to introduce firearm safety in this visit
Reflect & Revise:Consider how to revise statement to be respectful, preserve autonomy, reduce defensiveness, focus on harm reduction, and acknowledge known risk factors and identity without assumptions
09. Counseling
REFLECT
Strong characteristics
Examples
09. Counseling
Case
You are seeing a 10-year-old for a routine well-child visit. She lives with her parents, both of whom are active duty military, and her two brothers, ages 6 and 17. Firearm safety has not been discussed previously and no concerns are raised.
Examples
Examples
09. Counseling
Ask
Change talk
sustain talk
I'd like to store my gun securely but still want to be able to defend myself.
Open to change
I wish things were different.
I could store my guns differently, but I'm not so sure I want to.
My partner is frustrated with me about carrying.
I really don't want my kid to find my shotgun; he's been going through a rough time.
maintain the status quo
My child doesn't know where my gun is kept.
They can't pull the trigger anyways.
I feel safe with a loaded gun at home.
We've explained that guns aren't toys.
Everyone I know stores them this way.
09. Counseling
Ask
Why not lower? What would help move it higher?
09. Counseling
Act
Provide handouts / resourcesRevisit at future visits Escalate when risk is high
Education: safe storage counseling, safety devices, resources.
Low risk
Consider temporary transfer to trusted person, additional safety devices, or out-of-home storage.
Mod risk
Mental health hold, civil protective order, urgent temporary transfer.
High risk
10. Key Takeaways
Knowledge / practicesRisk factorsMotivational interviewing
Assess
Be informed & respectfulFocuse on harm reduction Individualized solutions
Advise
Check understandingReflect change talk Importance ruler
Ask
Provide resourcesContinue to revisit Escalate when necessary
Act
11. Resources
Military
Families
Providers
Beyond the Bullet Points
Firearm Safety Counseling for Military Pediatric Providers
Online Toolkit
Daniel.Ferman@usuhs.edu Naval Medical Center Portsmouth
https://sites.google.com/usuhs.edu/peds-firearm-injury-toolkit/home
Bibliographic references
Evidence-based firearm safety recommendations / resources
Less-effective or not recommended practices
Routine firearm safety counseling during specialty encounters with the healthcare system
Relying on supervision in household with unlocked firearms
Ammunition stored separately from firearms
Trigger discipline education for children
Firearms stored unloaded
Routine firearm safety counseling as part of well-child care
Storing firearm in locked glovebox
Ammunition stored locked
Firearms stored locked
Storing firearm hidden out of sight of child (e.g. under mattress or high shelf in closet)
Storing firearm loaded but magazine removed
Relying on children being too young to know
Lethal means restriction
Use of locked gun safe or lockbox
Video game parental controls
Biometric or keyed lock
Temporary off-site storage
Use of cable lock or trigger lock
Relying on children being too young to pull trigger
Using fear-based or graphic injury examples
Threatening punishment for handling firearms
Teen hunting license course
Community provision of free safety devices
Family readiness center or installation safety office
Referrals for social services, substance abuse, mental health
Community-based youth violence prevention programs
Hospital-based violence prevention programs / anticipatory guidance and community outreach
Military exchange firearm lock rebate program
DoD installation armory storage
Accidental injuries are rare and unavoidable
Military One Source (educational counseling, crisis support, etc)
DoD installation adult firearm training / safety programs
Temporary transfer of firearm to person outside home
TRICARE-covered firearm lock benefit
Unwanted firearm disposal
03.knowledge gap
04.ownership
02.location & mechanism
01.scale of the issue
TABLE OF CONTENTS
07.solutions
05.protection
08.safe storage
06.military
11.Resources
12.bibliography
10.key takeaways
09.counseling