Accreditation & Regulatory Journal
February 2023


Active Shooter “what if”

By: Don Roush
Hospitals have not been immune to shooting events and workplace violence has become more prevalent in hospitals over the past several years. This rise in violence has been attributed to such things as suicide, gang fighting, disgruntled employees, euthanizing of ill relatives/spouses, prisoner escapes, and the overflow of violence from the community. Active shooter events in a hospital setting presents unique challenges due to the vulnerability of the patient population within the hospital.
Many hospitals have specialty services such as hyperbaric chambers and Magnetic Resonance Imaging (MRI) equipment and locked areas such as pharmacies, mental health units and maternity floors. If there was an active shooter in these areas, there is no single best method to respond to an incident. What is important is having prior planning in place that will allow you and your staff to determine the best option if an active shooter situation was to occur. Essentially, staff must always be prepared to respond to an active shooter situation. This is traditionally accomplished using an Emergency Action Plan (EAP) and conducting ongoing active shooter educational awareness and exercises. These exercises prepare your staff to effectively respond and assist in minimizing loss of life. However, certain locations within the hospital take additional preparation in the event of an active shooter.
If you evaluate your hospital’s exercises or events related to active shooter responses, most likely you will discover shortcomings such as staff being unaware of lockdown procedures or warnings, escape options, or knowing what to do with patients. What is commonly not evaluated or discussed are the “what if” situations. Let’s look at some of the “what ifs”.
  • What if an active shooter occurs in intensive care units? Patients in this area are, in most cases, unable to fend for themselves and protecting them will be left up to the staff in the area. Evacuation of these patients becomes extremely complicated depending on the evacuation egress path required for such patients. Additionally, these areas may be locked down hindering response by acting authorities.
  • What if an active shooter occurs in nuclear medicine or radiation laboratories? Dangerous materials are commonly housed in these areas such as radioactive sources or high does rate brachytherapy units (Gamma Knife). Coordination between law enforcement personnel and hospital staff is critical to the security of personnel and the hazardous materials maintained in these areas. Securing these rooms during an active shooter should be priority to prevent access to the radioactive material and prevent the release of such material within the hospital and surrounding community.
  • What if an active shooter occurs in maternity, newborn, or neonatal intensive care units? These areas are particularly vulnerable to an active shooter threat since it is very difficult to evacuate the units; not to mention the additional concerns surrounding newborn babies such as custodial disputes, domestic situations, or kidnappings. If an active shooter was to gain access to one of these areas, it creates a challenge for law enforcement personnel to access the areas even with the assistance of security staff.
  • What if medical gases are affected by an active shooter? Hospital operations utilize a magnitude of medical gases and law enforcement personnel should be aware of these areas and the dangers related to them. Gases such as oxygen, nitrous oxide, nitrogen, carbon dioxide and waste anesthesia gas disposal that are in the piping systems within the walls, stored in rooms, or on medical equipment carts. All these present hazards if compromised by responding law enforcement personnel. In larger facilities, some of these gases are stored outside of the hospital which can complicate reaction time if an active shooter was to gain access to such an area and barricade themselves within the enclosure where these gases are maintained
  • What if you have high profile patients in the hospital during an active shooter? Your hospital at any time has the potential to be visited from patients of all walks of life including high profile personalities. These personalities tend to draw crowds or select company that can heighten the active shooter potential at your hospital. These types of situations are extremely difficult to plan for since at any given time they could seek medical attention at your hospital. It is important that hospital security staff have been trained to effectively communicate with private or governmental protection details that may be providing security for this person.
  • What if an active shooter occurs when prisoners are being treated? What if the active shooter was a diversion tactic needed to assist in the escape of the prisoner. As a rule, these prisoners will be guarded by law enforcement or correctional personnel, and therefore, unaware of an active shooter within the hospital, and depending on the situation, may not be able to assist in an active shooter situation.
  • What if an active shooter occurs in the kitchen? The kitchen is not commonly thought of when discussing an active shooter event. What most people forget is that there are several ignition points within a kitchen and if staff evacuate the area during an active shooter and leave items on the stove, in the oven, in the deep fryer or on a grill, they have the capability of starting a fire. If a fire was to occur law enforcement personnel responding are now challenged with not only an active shooter but individuals responding to the fire.
At any given time, staff may be required to make life-changing decisions. During an active shooter situation, they will rarely have all the information they need to make a fully informed decision about the choices they have chosen. The goal in all cases is to survive and protect the patients, visitors, and coworkers when making decisions pertaining to the “what ifs” during an active shooter event.