Background There is a concern that firearm injuries are very common reported at lady Reading hospital Peshawar MTI, but the there are no contemporary studies. Gunshot wound are persistent burden on community as well as on hospitals Aim: To evaluate trends of firearm injuries reporting to LRH their anatomical distributions and their outcomes. Methods: This prospective randomized study (a pilot project for public health alert) was conducted in Accident & Emergency Department of Lady Reading hospital MTI, Peshawar KPK, from 1st May, 2020 to 1st October, 2020. Hundred patients with firearm injuries to different region shot were included in this study. Data collected on predesigned proforma and entries in HMIS used after stabilizing the patient. A prospective pilot study done over a period of six months from 1st May, 2020 to 1st October, 2020 in trauma section of Accident Emergency department of Lady Reading hospital MTI Peshawar. Results: Patients of all age groups with firearm injuries were included in this study from May 2020 to October 2020. Data was collected on predesigned proforma as well as HMIS (health management information system) of ED department. A total of 100 patients presented to LRH with firearm injuries during six months. Males outnumbered female by 6:1 accounting for 100(85%) of injured. : Domestic violence was found to be the most common reason for the firearm use 44(44%), Don't know or refuse to share was 29(29%), rivalry 12(12%), land and property conflict 9(9%), street fight 3(3%) accidental gunshots 2%, (n=25) and robbery 1.1% (n=1).The most common firearm used for inflicting injury was pistol (70%), shot gun (2.2%), curiously 16% were either reluctant or were never knowing about the weapon Conclusion: Firearm injuries are common public health problem globally, in our set up situation is more grievous and less highlighted, the most common cause being domestic violence, lack of education, easy availability of arms, illegal or legal weapon ownership making situation worst in the form of premature deaths and disability. Understanding the nature of problem can prevent this violence