Perspectives of a Firearm Safety Program in the Pediatric Intensive Care Unit

Introduction: Firearm injury is the leading cause of death among U.S. children and adolescents. Evidence-based interventions—safe storage counseling and gun lock distribution—reduce firearm-related harm but are understudied in the Pediatric Intensive Care Unit (PICU). In 2023, our PICU began offering firearm safety counseling and free cable gun locks to caregivers at the time of patient transfer or discharge. Our objective was to qualitatively study the perspectives of PICU caregivers after receiving firearm safety counseling during PICU hospitalization hypothesizing that their insights will help inform broader implementation strategies.


Methods: We conducted a single-center qualitative study from Jan. to May 2025 with adult caregivers of children admitted to the Children’s Hospital of Philadelphia PICU. Participants received firearm safety counseling and a gun lock. Following counseling, we obtained consent and conducted semi-structured interviews in-person. The interview guide was informed by the Consolidated Framework for Implementation Research. Interviews were audio-recorded, transcribed, and analyzed using a constructivist approach and constant comparative method. We applied both deductive and inductive coding to the data and identified themes.


Results: Twenty caregivers participated (range 26-61 yrs.); 75% female, 40% Black, and 35% White. 35% owned firearms. Three themes emerged: (1) Acceptability of counseling: Caregivers found firearm counseling acceptable in the PICU and appreciated it being timed at transfer or discharge. (2) Community education sharing: Participants described interest in sharing both safety education and gun locks with their communities (3) Awareness of safe storage: Many participants realized firearms are present in environments where their children spend time, influencing their perceptions of and need for safe storage. One person said, “I think everybody needs it. I may not be a gun owner, but I may be sending my son to be watched by somebody who has a gun.”


Conclusions: Caregivers found firearm safety counseling during PICU stays to be acceptable and valuable. Participants highlighted both personal and community benefits of the intervention. These insights can guide effective, family-centered implementation of firearm safety initiatives in critical care settings.