Analysis of 1.5 million emergency department records reveals women injured by firearms face an 89-fold higher risk of death compared to those injured through other assault mechanisms. Despite overall decreases in assault-related ED visits from 2018-2021, firearm injuries became proportionally more severe, with increased hospital admissions and mortality rates during the pandemic period. This dramatic mortality differential underscores the lethal nature of firearm violence against women, extending beyond existing research on domestic violence patterns. The finding carries profound implications for emergency medicine protocols and violence prevention strategies. While domestic violence typically involves repeat patterns of escalating harm, firearm involvement transforms these encounters into potentially fatal events with little opportunity for intervention. Healthcare systems may need to reassess triage protocols and safety planning for women presenting with assault injuries, particularly given that firearm violence often represents an endpoint rather than a step in an abuse cycle. The study's limitation to ED presentations means it cannot capture the full scope of violence against women, as many incidents never reach medical attention. However, the stark mortality difference suggests that when firearm violence does occur, emergency departments become critical intervention points where rapid recognition and response protocols could mean the difference between survival and death.