Firearm injuries and deaths in the United States remain among the most urgent public health challenges of our time. In response, the Healthcare Coalition for Firearm Injury Prevention (HCFIP) has emerged as a dedicated, multi-specialty, multidisciplinary, collaborative initiative to bring together health care professionals to reduce firearm‐related harm. This article traces the Coalition’s origins, highlights its present functions, and outlines the opportunities and challenges that lie ahead.

Origins: From Summit to Coalition

The genesis of HCFIP lies in a series of summits convened by major medical and public health organizations. The inaugural Medical Summit on Firearm Injury Prevention took place in 2019, drawing more than 45 organizations seeking a consensus-based, nonpartisan, public-health approach to firearm injury prevention.¹ At that summit, participants identified key components of a public health framework including secure storage, lethal-means counseling, hospital-based violence-intervention efforts, and research agendas, as well as persistent gaps in data and funding. Following a second summit in 2022, co-hosted by ACEP, the American Academy of Pediatrics,  the American College of Physicians, the American College of Surgeons (ACS), and the Council of Medical Specialty Societies, the participating organizations resolved to establish a durable structure to sustain and coordinate their shared efforts.² Thus, the Healthcare Coalition for Firearm Injury Prevention (www.hcfip.org) was formally founded as a multidisciplinary, nonpartisan coalition committed to advancing a public health approach to firearm-injury prevention.

The American College of Surgeons and the “Common American Narrative”

The work of the ACS laid crucial groundwork for the creation of the Coalition. Well before the summit meetings, the ACS Committee on Trauma (COT) had undertaken a systematic examination of firearm injury as a preventable cause of death. Under the leadership of Dr. Ronald M. Stewart, then chair of COT, the ACS convened national discussions with trauma surgeons, public health experts, firearm owners, and community leaders to identify points of agreement and shared values. From this process emerged the conceptual framework of the “Common American Narrative” — an inclusive framework recognizing both the constitutional right of firearm ownership and the shared moral responsibility to prevent needless injury and death.³

Rather than approaching firearm injury prevention as a political debate, Dr. Stewart and his colleagues reframed it as a unifying public health issue rooted in compassion, science, and mutual respect. This approach resonated with many other U.S. medical professional organizations who were simultaneously advocating for practical measures such as universal background checks, secure firearm storage, research funding, and hospital- and community-based violence intervention programs. This ethos of respectful dialogue and evidence-driven collaboration embodied in the Common American Narrative proved instrumental in shaping the tone, scope, and eventual coalition-building that gave rise to HCFIP.

Mission, Structure, and Activities

The mission of the HCFIP is to reduce firearm injuries and deaths through a public health approach that empowers health care professionals, hospitals, and systems to act as agents of prevention. Membership is open to professional organizations and societies representing medical, nursing, and public health disciplines. HCFIP’s explicitly nonpartisan framing — viewing firearm injury through the lens of health, not politics — has allowed it to foster cooperation among specialties ranging from pediatrics, surgery, emergency medicine, and internal medicine.

HCFIP advances its work through three primary pillars:

1. Health Professional Education: Providing resources to help clinicians identify patients at risk, integrate firearm-safety discussions into routine care, and counsel on secure storage.
2. Advocacy and Policy: Providing evidence-informed guidance and resources on policies such as secure storage and child access prevention laws and extreme-risk protection orders.
3. Community Engagement: Supporting expansion of hospital-based violence intervention programs, partnering with health systems and local community-based organizations to enhance integrated access to services and promote secure storage initiatives.

ACEP’s role in these efforts is particularly vital. Emergency physicians are often the first and sometimes the only medical professionals to encounter patients at risk of or after a firearm injury. Whether counseling families on secure storage, identifying suicide or homicide risk, or participating in hospital-based intervention programs, emergency physicians are uniquely positioned to translate coalition principles into everyday clinical practice.

Why the Coalition Matters

The formation of the HCFIP coincides with a critical inflection point in U.S. public health. During the first year of the COVID-19 pandemic, firearm deaths increased by nearly 30 percent, and nonfatal injuries by more than a third.⁴ Firearms have surpassed motor-vehicle crashes as the leading cause of death among children and adolescents.⁵ Against this backdrop, a coalition anchored in health care systems adds a vital voice. Health care professionals see firsthand the human toll of firearm injury on individuals and their communities. They occupy a trusted space to counsel patients, mobilize data, and influence community norms around safety and prevention. Emergency departments bear the front-line burden of these injuries and their ripple effects on patients, families, and communities. For ACEP members, participation in this coalition amplifies emergency medicine’s leadership role in these national injury-prevention strategies.

 Looking Ahead: Opportunities and Challenges

As HCFIP moves forward, three opportunities stand out:

1. Scaling Evidence-Based Interventions: Expanding hospital- and community-based violence-intervention programs, routine risk screening, and safe-storage counseling.
2. Strengthening the Research Base: Coordinating multicenter studies and leveraging coalition partnerships to close the persistent research gap in firearm-injury prevention.
3. Advancing Policy Through Public-Health Framing and Messaging: Translating health-system experience into pragmatic policy dialogue, grounded in evidence rather than ideology.

Challenges persist. Political polarization can hinder progress even when interventions are rooted in science and public safety. Funding for rigorous research remains limited, and disparities in firearm injury, especially in historically marginalized communities, demand culturally tailored, root-cause-based, community-informed solutions. The perspective and engagement of those living in communities at greatest risk for violence is vital to this work. Finally, ensuring that coalition principles are translated into institutional practice across hospitals and clinics will require sustained leadership and resources.

Conclusion

The Healthcare Coalition for Firearm Injury Prevention stands as a landmark collaboration across the health professions and embodies the spirit of the Common American Narrative. By uniting medical and public health organizations around education, advocacy, and community engagement, HCFIP provides a durable infrastructure to address one of America’s most persistent sources of preventable harm. Its success will depend on continued commitment to evidence, empathy, and shared purpose — but its emergence marks a pivotal step toward a future where firearm injury prevention is understood not as a divisive issue, but as a collective responsibility for the health of all our patients and communities.

Dr. Bulger is professor of surgery and chief of the Division of Trauma, Burns, and Critical Care at the University of Washington in Seattle, and the surgeon-in-chief at Harborview Medical Center. She is the current medical director for Trauma Programs at the American College of Surgeons. She also served as the president of the American Association for the Surgery of Trauma 2022-2023. Dr. Bulger is a strong advocate for injury prevention and disaster preparedness. She is currently the chair of the Steering Committee for the National Healthcare Coalition for Firearm Injury Prevention and is a medical officer with the NDMS Trauma Critical Care Team.

Dr. James is vice president of Mission, associate chief medical officer, co-executive director, and health equity accelerator at the Boston Medical Center Health System (BMCHS). She is also an associate professor of emergency medicine and director of the Violence Intervention Advocacy Program at BMCHS. She currently serves on the boards of UPSTREAM USA, Blue Cross Blue Shield Foundation, Compass Working Capital, Health Alliance for Violence Intervention, and Community Servings.

Dr. Lee is a pediatric emergency physician at Boston Children’s Hospital and associate professor of pediatrics and emergency medicine at Harvard Medical School. She is chair of the American Academy of Pediatric’s Council on Injury, Violence, and Poison Prevention. She is also an associate program director for public policy, Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion at Boston Children’s Hospital. Her expertise has been recognized with her election as a member of the National Academy of Medicine in 2023. 

Dr. Burstin is the CEO of the Council of Medical Specialty Societies. She formerly served as chief scientific officer of The National Quality Forum and as director of the Center for Primary Care, Prevention, and Clinical Partnerships at the Agency for Healthcare Research and Quality. She serves on the American Society of Hematology Research Collaborative Board of Directors and the Oversight Committee of the National Cardiovascular Data Registry of the American College of Cardiology. Dr. Burstin is a board member of the Coalition for Trust in Health and Science.

Dr. Bornstein is an internal medicine physician who serves as the executive director of the Texas Medical Home Initiative and co-lead of the Texas Primary Care Consortium. She is chair of the American College of Physician’s (ACP) delegation to the American Medical Association (AMA), representing the ACP both on the Healthcare Coalition on Firearm Injury Prevention where she serves as co-lead of the Advocacy and Policy Workgroup, and the AMA Task Force on Firearm Injury Prevention.

References

1. Bulger EM, Kuhls DA, Campbell BT, Bonne S, Cunningham RM, Betz M, et al. Proceedings from the Medical Summit on Firearm Injury Prevention: A Public Health Approach to Reduce Death and Disability in the US. J Am Coll Surg. 2019;229(4):415-430. https://doi.org/10.1016/j.jamcollsurg.2019.05.018
2. Sakran JV, Bornstein SS, Dicker R, Rivara FP, Campbell BT, Cunningham RM, et al. Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach. J Am Coll Surg. 2023;236(6):1242-1260.
3. Stewart RM, Kuhls DA, Rotondo MF, Bulger EM. Freedom with Responsibility: A Consensus Strategy for Preventing Injury, Death, and Disability from Firearm Violence. J Am Coll Surg. 2018;227:281-283. https://www.sciencedirect.com/science/article/pii/S1072751518302758
4. Sun S, Wangnan C, Yang, G. Analysis of Firearm Violence During the COVID-19 Pandemic in the US. JAMA Network. 2022: 5(4):229393. Published April 28, 2022.
5. Goldstick JE, Cunningham RM, Carter PM. Current Causes of Death in Children and Adolescents in the United States. 2022;386:1955-1956.