Responding to active shooters in hospitals

Perhaps the most feared event for any security director is an act of workplace violence and, in particular, an active shooter scenario. One market that has seen its share of deadly workplace shootings is the healthcare industry.

Last month, a maintenance worker at a Connecticut hospital allegedly shot two of his supervisors after reportedly being disciplined by one of them earlier in the day. The shooting was the most recent incident in what has been an overall trend of rising violent crimes at hospitals across the nation. In a story recently published by the Chattanooga Times Free Press, the Joint Commission, which accredits hospitals nationwide, said that in the last five years, there have been nearly three times as many assaults, rapes and homicides reported to it than in the previous five years.

According to Lisa Pryse, president-elect of the International Association for Healthcare Security & Safety, the heightened stress levels that are inherent with hospitals can make them vulnerable to acts of workplace violence.

"The healthcare setting is an extremely unique environment," said Pryse, who joined SIW on Thursday for a webinar focusing on active shooter best practices for hospitals. "Quite frankly, it's the last place people want to be."

To make matters worse, Pryse said that there is no way to predict when and where a shooter will strike.

"There is no profile of an active shooter," she explained. "There is not a single variable capable of predicting violence."

However, Pryse said that there are some common characteristics that many active shooters share. A study conducted on active shooter incidents yielded several commonalities including:

  • Most shooters were males and had more than one firearm.
  • The majority of shootings occurred in the daylight hours.
  • Shootings commonly took place in buildings at a well-populated location.
  • The shooting was usually over in two to three minutes.
  • The gunman initially targeted specific people and if they were not present or killed, random people were then targeted.
  • And, the gunman usually takes their own life.

Active shooter perpetrators were also found to have engaged in "covert and overt pre-attack behaviors" that included planning, preparing and sharing their ideas with others. While these incidents may be impossible to predict , Pryse said that lessons learned from past mass killings such as Columbine and Virginia Tech have provided security managers with a blueprint of mitigating actions they can take to help minimize loss of life.

In the healthcare setting, Pryse said that it's important for security managers to remember the "4 A's" acronym, which stands for accept, assess, act and alert.

Accepting the situation means being aware that an active shooter scenario is occurring and not being in denial. Being able to assess means identifying where you are in relation to the threat in the hospital's "rings of security," which Pryse identified as the "hot zone" (immediate danger), "warm zone" (intermediate danger) and "cold zone" (remote danger). Based on this assessment, you can then take action and alert law enforcement immediately.

Of course, the only way that hospital staff can effectively learn to respond appropriately during these situations is through training. Not only can measures taken by untrained staff be dangerous, Pryse said those healthcare facilities that do not train are not meeting their moral obligation. On the bright side, however, training has shown to help people remain calm in chaotic situations and take the proper steps to protect themselves and others.

During active shooter scenarios, the Department of Homeland Security recommends that people evacuate, hide out or as a last resort, take action against the gunman. The IAHSS also has its own guidelines for active shooter response, which includes; having a multidisciplinary team appointed by the healthcare facility to designate, in writing, its plan for responding to an active shooter on its campus in conjunction with local law enforcement authorities; establishing communication procedures that include the creation of a specific announcement and procedure to institute a response; having a campus-wide notification system that alerts staff members to the threat through multiple modes of communications (i.e. text messaging, digital displays, emails, intercoms, etc.); and, education for employees on awareness, reporting and response to an active shooter.

When it comes to alerts sent out to staff members, Pryse emphasized the importance of plain language rather than using a code.

"Probably a few years ago I would have said code... but plain language is where our incident command system has gone," she explained.

In addition to the IAHSS guidelines, Pryse added that the Joint Commission also has suggested actions that healthcare organizations can take to prevent violence, which include:

  • Working with the security department to audit a facility's risk of violence.
  • Identifying strengths and weaknesses to make improvements to the facility's violence prevention program.
  • Taking extra security precautions in the emergency department.
  • Conducting thorough prescreening of job applicants and volunteers.
  • Training for staff members in dealing with patients' families.
  • Having procedures in place for notifying managers and others about workplace violence.
  • And, establishing counseling programs for employees that become victims of workplace violence.

While some people may still take the attitude that "it can't happen here," Pryse said those feelings can be changed through training.

"It really starts with some good training, not scare tactics, just good training," she said.

For more information about the IAHSS' active shooter guidelines, visit Click here to listen to the entire webinar.