Introduction Despite representing fewer than 5% of suicide attempts, firearms account for over half of deaths. Yet there is little clinical information regarding firearm attempts, particularly survivors. We assessed clinical factors differentiating firearm suicide survivors from decedents, firearm attempters from other methods, and firearm attempters from similarly injured trauma patients. Methods We used clinical data from the National Trauma Data Bank (2017) to assess firearm suicide attempts using cross-sectional and case–control designs. We used logistic and multinomial regression to compare groups and assess firearm type and discharge destination. Results Older age, being uninsured, and injury location were associated with increased mortality among firearm attempters. Older age, White race, male sex, and being uninsured were associated with firearm attempts. Major psychiatric disorders were associated with firearm attempts and using a rifle or shotgun. Major psychiatric disorders, female sex, and smoking were associated with psychiatric discharge. Black and other race were associated with law enforcement discharge, and Black race was associated with lower odds of psychiatric discharge. Uninsured patients had lower odds of discharge to long-term care, psychiatric, or rehabilitation facilities. Conclusions This study identifies factors associated with firearm suicide and includes indicators of disparities in health services for patients at high risk of suicide death.