Extreme Risk Protection Orders: An Opportunity to Improve Gun Violence Prevention Training

Acad Med. 2019 Nov;94(11):1649-1653. doi: 10.1097/ACM.0000000000002935.


States are increasingly enacting extreme risk protection order (ERPO) laws, also known as "red flag" or gun violence restraining order laws, as one part of a multidisciplinary approach to address the national gun violence epidemic. Passed into law in more than 10 states and under consideration by legislatures in approximately 30 others, ERPO laws create a legal process to temporarily remove firearms from people who may pose a risk to themselves or others. By enabling family or household members, law enforcement, and, in some cases, health care professionals to petition courts when they are concerned about a potential crisis, these laws can potentially prevent firearm-related violence and save lives. Most states with ERPO laws do not give health care professionals a direct role in filing petitions; still, physicians may serve as a resource for patients or their families by counseling on firearm safety and raising awareness of this legal pathway. In this way, the success of ERPO laws depends, in part, on the ability of physicians to accurately assess risk. However, physicians are often not proficient in making these types of risk assessments, largely because of insufficient training, particularly in the context of firearm-related violence. The authors review the literature on physician skill in violence-related risk assessment, medical education in gun violence prevention, and the capacity for training to improve such risk assessments. The authors then make recommendations for integrating focused gun violence prevention training into undergraduate, graduate, and continuing medical education, reviewing notable examples.

Publication types

  • Review

MeSH terms

  • Clinical Competence*
  • Education, Medical / standards*
  • Firearms / legislation & jurisprudence*
  • Gun Violence / prevention & control*
  • Gun Violence / statistics & numerical data
  • Humans
  • Physicians / standards*
  • Risk Assessment / methods*
  • United States / epidemiology