A firearm injury risk screening tool developed by Northwell Health's Centre for Gun Violence Prevention is launching across major hospital systems in the United States through the Epic electronic health record platform. The protocol, funded through a National Institutes of Health grant, distils the clinical assessment into two questions and is intended to make firearm safety evaluation a standard part of emergency department care.

The screening asks patients whether they have access to a firearm inside or outside their household and whether, in the past six months, they have heard gunshots or had a weapon pointed at them. The separation of these two inquiries is intentional. The first targets firearm access, which informs safe-storage counselling and helps reduce risks associated with accidental injury and suicide. The second functions as a community violence indicator, with researchers noting it carries approximately 95 per cent predictive accuracy for prior exposure to violence in the surrounding community. That category of risk is associated with social factors including unemployment and isolation, and calls for a different set of interventions than those applied to household firearm safety.

The scale of need for such a tool is not difficult to establish. Data from 2019 showed fewer than 8 per cent of adults in gun-owning households had ever spoken to a medical provider about firearm safety, pointing to a long-standing gap in clinical practice. Northwell's own implementation, running since 2020, has screened more than 250,000 emergency department patients across New York. Of those, roughly 15 per cent tested positive for firearm injury risk or community violence exposure and were subsequently connected to intervention resources.

The decision to embed the protocol within Epic is central to how its developers expect it to take hold nationally. Epic is the largest electronic medical records platform in the United States, and integrating the screening directly into existing clinical workflows removes a significant practical barrier to adoption. Rather than requiring separate systems or additional steps, the tool appears within the record environment clinicians already use. The integration also enables standardised data collection across participating hospitals, producing a national dataset that researchers can use to measure how consistently the questions are being asked and to assess the broader impact of prevention efforts over time.

Hospitals deploying the tool are required to have intervention pathways in place before the screening goes live. Facilities must identify applicable local resources, which may include the distribution of gun locks or referrals to community-based violence intervention programmes, and must co-ordinate across departments to ensure patients who screen positive receive a substantive response. Northwell's developers have been direct on this point: screening should not proceed unless a hospital has a concrete plan to act on the results. The instrument is not designed to generate data in isolation.

Northwell is preparing to publish outcome data tracking patients at three and six months following their emergency department visit, intended to measure whether the interventions prompted by the screening produce lasting behavioural change. On the policy side, New York Governor Kathy Hochul has announced a state-funded pilot to extend the protocol to emergency departments across New York, with training and technical support provided by Northwell's Centre for Gun Violence Prevention. Whether other states move to adopt similar frameworks may depend in part on what those forthcoming outcome figures show.

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