The incidence of homicide by firearm was significantly higher in San Diego County compared to Adelaide, but with a higher proportion of murder-suicides occurring in Adelaide. There were significantly more accidents and suicides that involved males in Adelaide and a significantly higher number of male homicide victims in San Diego County compared to females. Rifles of 0.22-caliber were the firearms used in South Australia, compared to handguns in San Diego County. Reasons for the alarming numbers of gunshot fatalities in the United States compared to countries such as Australia and the United Kingdom have been extensively discussed, but without consensus; however, the availability and access to firearms must be considered a potential contributor to higher rates of firearm deaths in the United States. The current study concludes that the much lower number of firearm deaths in children in South Australia compared to San Diego County most likely relates to differences in cultural and legislative practices related to weapon availability. Further studies of predisposing and precipitating factors for pediatric firearm deaths in areas with low death rates may assist in the formulation of strategies for reducing the death toll from this preventable type of childhood trauma in areas with higher death rates. 1 table and 30 references