When a young person is in suicidal crisis, a safety conversation may not be enough. This emergency department added something families could take home immediately: a lockbox for a firearm. Firearm injuries are the second leading cause of death in American youth aged fifteen to twenty-four, and over half of these deaths are suicides.

Self-harm deaths in Wisconsin among adolescents have increased since two thousand six. Each year, the pediatric emergency department cares for over one thousand one hundred children and adolescents who present with suicidal thoughts or self-harming behaviors.

So the department implemented a program to improve the education given to families and provide firearm storage devices, with the goal of reducing access to lethal means. Firearms are a predominant method for suicides nationally and in the state, and the emergency department has over one thousand one hundred visits per year for suicidal thoughts or attempts.

The goal was to provide safe firearm storage in the homes of adolescent patients who had suicidal thoughts or had attempted suicide. For children and adolescents at risk for suicide, clinicians have an opportunity to counsel families about reducing access to firearms, medications, or sharp objects.

That counseling has been recommended by national physician groups, and earlier studies found that parents accepted it and reported improved firearm storage. But most emergency medicine physicians surveyed said they had not received firearm-safety training and would not be a credible resource for discussing firearm safety.

Hospital social workers, injury prevention specialists, pediatric residents, and a pediatric emergency medicine physician collaborated to develop the program. They built a bundle around the kind of help a family can use at the hospital and after discharge: an education sheet, recommendations for removing or storing firearms safely, and firearm lockboxes.

The team had previously advised families to remove all firearms from the home, but families often could not find a place to move them on short notice and were reluctant to use relatives’ homes or a police station. So the program supplied firearm lockboxes to families at no cost.

The lockboxes use a combination lock and can hold one handgun. The small lockbox takes little space and does not need to be bolted to the floor or wall, making it a storage option where housing cannot be modified. Creating the firearm lockbox program led to increased education and awareness among social workers about prevention and safe firearm storage.

Because the lockboxes are provided promptly, families can put them into use immediately after a traumatizing event. Education alone would leave families to find the time and funds to purchase a lockbox themselves, while this program supplies one during the child’s emergency department visit.

The program also has limits. Families may not use the lockbox, may leave it unlocked, give it to someone else, or lose it, so education about the lockbox and safe storage is given when it is distributed. The lockbox stores only one handgun.

Families with more or larger firearms are advised to use a larger safe, and social workers provide guidance to help them select an appropriate storage device. Temporary storage locations in the community may not be immediately accessible to families, and the emergency department also has limited space for keeping lockboxes.

Next steps include providing medication lockboxes, assessing social worker satisfaction, and following up with families to assess lockbox use and satisfaction. Counseling during an emergency department visit gives caregivers an opportunity to prevent a tragic event, while a lockbox and education provide a concrete safety device and reminder to reduce lethal means at home.

Families are in crisis after learning that their child has considered or attempted suicide, and emergency department providers have a responsibility to offer both medical care and injury-prevention strategies. The program paired guidance with a practical safety device at the moment families needed it.

That could make reducing access to a firearm possible even when removing it from the home is not.