Preparing For The Unthinkable: Hospitals And Active Shooters

Hospitals are complex structures with many departments and patient populations, and unfortunately, they are not immune to violence and shooting events. Gun violence in healthcare facilities is a tragic reality, with 39 reported shootings resulting in 39 deaths between 2010 and 2020. As such, hospitals must develop preventive measures and preparedness strategies to counter the threat of an active shooter. This includes implementing lockdown procedures, training staff, and coordinating with law enforcement to develop effective response plans.

Identify high-risk areas like the emergency department, operating rooms and pharmacy

Hospitals are complex structures with multiple departments, each with unique patient populations and responsibilities in patient care. This makes planning for active shooter scenarios particularly challenging. To prepare for such events, hospitals should identify high-risk areas, including the emergency department, operating rooms, and pharmacy.

The emergency department is a critical area to secure, as it is often the first point of contact for patients and visitors, and can be crowded and chaotic, providing potential cover for an assailant. Hospitals should consider implementing measures such as metal detectors, security personnel, and access control to mitigate the risk of an active shooter entering through the emergency department.

Operating rooms are also high-risk areas due to the presence of anaesthetised patients who are unable to evacuate quickly. Hospitals should establish procedures to secure operating rooms, such as locking doors, increasing security personnel, and implementing evacuation protocols that prioritise patient safety.

Pharmacies within hospitals are another area of concern, as they often contain controlled substances that can be targeted by active shooters with substance use disorders. To mitigate this risk, hospitals should improve pharmacy security with measures such as restricted access, surveillance systems, and the secure storage of medications.

Additionally, hospitals located in food-scarce regions or treating patients with psychiatric diseases may be at higher risk for active shooter incidents. These hospitals should be particularly vigilant in their security measures and staff training to identify and respond to potential threats.

By identifying these high-risk areas and implementing tailored security strategies, hospitals can enhance their preparedness for active shooter situations and improve the safety of patients, staff, and visitors.

Develop processes to lock down the building and prohibit walk-in traffic

Hospitals are vulnerable to active shooter incidents due to their complex structures and diverse patient populations. To enhance security and protect patients and staff, implementing robust lockdown procedures and restricting walk-in traffic is essential. Here are some detailed measures to achieve this:

Firstly, hospitals should establish clear protocols for locking entrances and exits to prevent unauthorized entry. This includes implementing a controlled access system, where visitors and staff must be granted permission, such as via intercom or visual identification, before entering the building. All entrances should be monitored by security personnel or surveillance systems, ensuring that any potential threat is identified before entry.

Secondly, during an active shooter incident, it is crucial to have procedures in place to quickly secure each department or ward. This involves training staff to recognize the signs of a potential threat and activating an emergency lockdown. The lockdown procedure should include steps to secure all doors, windows, and other potential entry points to restrict the shooter's access and movement within the building. Drills and simulations can be conducted regularly to ensure that all staff and patients are familiar with the lockdown process, reducing confusion and panic during an actual event.

Additionally, hospitals should consider implementing a system to prohibit walk-in traffic during normal operations. This could involve requiring all visitors to make appointments in advance, allowing staff to screen visitors and control the flow of people entering the building. A central reception or security desk can be utilized for this purpose, where visitors are required to check-in and provide identification before being granted access.

Furthermore, hospitals should establish clear protocols for managing deliveries, maintenance, and other external services that require temporary access to the building. This includes creating designated loading and unloading areas away from main entrances, implementing strict identification checks, and ensuring that external personnel follow predetermined routes within the hospital, minimizing their access to sensitive areas.

By developing and practicing these comprehensive lockdown procedures and access control measures, hospitals can significantly enhance their preparedness for active shooter incidents, improving the safety and security of patients, staff, and visitors.

Train all employees on how to report and respond to active shooter events

Unfortunately, gun violence in healthcare facilities is a reality. Hospitals are complex structures with many departments, each with unique patient populations and responsibilities. Hospitals must develop preventive measures against all possible scenarios to counter the threat of an active shooter. Active shooter situations are unpredictable and fast-evolving, and healthcare organizations must prepare their staff for such an eventuality.

Training all employees on how to report and respond to active shooter events

Training should be provided to all employees, including ongoing training on how to report and respond to active shooter events. This training should be tailored to the specific circumstances of the healthcare organization, considering its patient population, location, size, and other variables. For example, hospitals located in food-scarce regions or treating patients with psychiatric diseases may be at higher risk for active shooter incidents.

Training should cover the following:

• How to recognize the signs of an imminent active shooter event and the appropriate reporting procedures, including designated emergency contacts.
• Implementing lockdown procedures to prohibit walk-in traffic and secure the building. This includes determining how to account for employees and patients, handle critical patients, and manage evacuation if necessary.
• Awareness of high-risk security-sensitive areas, such as the emergency department, operating rooms, and pharmacy, and understanding how to implement mitigation strategies in these areas.
• Understanding the role of law enforcement and the importance of immediate deployment to stop the shooting and mitigate harm. This includes coordinating with law enforcement prior to an event to discuss the organization's response plan.
• Psychological preparation for the impact of an active shooter event, including the potential loss of services and access to critical operations for an extended period.

By providing comprehensive training that addresses both practical and psychological aspects, hospitals can empower their employees to respond effectively and mitigate the impact of active shooter incidents.

Prepare for loss of services and access to critical operations for up to 10 hours after the event

Hospitals should prepare for the loss of services and access to critical operations for up to 10 hours after an active shooter event. This is because the hospital and any adjacent spaces will become a crime scene, requiring a lockdown of the building and a prohibition on walk-in traffic.

To prepare for this, hospitals should develop processes and procedures to account for employees and patients during the incident, including any critical patients who may require evacuation with a police escort. Hospitals should also consider how to maintain operations without access to certain areas and services. This may include cross-training staff to cover additional roles, setting up alternative care sites, and establishing clear chains of command for decision-making.

In addition, hospitals should provide ongoing training for all employees on how to respond to an active shooter event, including how to implement lockdown procedures and mitigation strategies. They should also be aware of high-risk security-sensitive areas, such as the emergency department, operating rooms, and pharmacy, and know how to secure these areas to protect patients and staff.

Furthermore, hospitals should meet with law enforcement prior to any incident to discuss their organisation's plan and determine how to best work together to stop an active shooter and mitigate harm. This includes understanding the role of law enforcement in securing the crime scene and how hospitals can support their investigation while maintaining essential operations.

Meet with law enforcement to discuss response plans

Unfortunately, gun violence in healthcare facilities is a reality. Hospitals must develop preventive measures and prepare their staff for an active shooter situation. Meeting with law enforcement to discuss response plans is a crucial step in this preparation process. Here are some detailed instructions and considerations for hospitals when collaborating with law enforcement:

Risk Assessment and Planning:

Start by conducting a comprehensive risk assessment of the hospital's premises and operations. Identify high-risk areas such as the emergency department, operating rooms, and pharmacy. Develop a detailed plan that outlines the specific roles and responsibilities of both hospital staff and law enforcement officers in an active shooter situation. Consider the unique challenges posed by the hospital's patient population, location, size, and other variables.

Training and Drills:

Collaborate with law enforcement to design and conduct realistic training programs and drills for hospital staff. These drills should simulate various active shooter scenarios, including single and multiple assailants, and cover different areas of the hospital. Training should focus on practical skills such as identifying and responding to suspicious behaviour, implementing lockdown procedures, and providing first aid to victims.

Information Sharing and Intelligence:

Establish a close working relationship with local law enforcement agencies to share information and intelligence. Hospitals should provide law enforcement with detailed floor plans, security protocols, and access to relevant technologies such as surveillance systems. Law enforcement can offer insights into threat assessments, active shooter profiles, and best practices for response and mitigation.

Coordination and Communication:

Develop clear protocols for coordination and communication between hospital staff and law enforcement during an active shooter incident. Determine the command structure, designated meeting points, and methods of communication. Ensure that hospital staff are familiar with law enforcement response procedures, including the potential use of force, to avoid confusion or conflict during a real event.

Post-Incident Support:

Discuss the role of law enforcement in providing support and assistance after an active shooter incident. This includes securing the crime scene, conducting investigations, and offering resources for victims and their families. Hospitals should also collaborate with law enforcement to review and evaluate the response to identify areas for improvement and incorporate lessons learned into future planning.

By working closely with law enforcement and following these comprehensive guidelines, hospitals can enhance their preparedness and improve their ability to respond effectively to active shooter incidents, ultimately saving lives and mitigating harm.

Frequently asked questions