II. Background

  1. Active Shooter
    1. Perpetrator picks a highly concentrated group of unprotected people in a confined space (target-rich, threat poor)
    2. Shooter attempts to kill or injure as many people as possible
    3. Shooter is typically mentally ill with a carefully pre-planned strategy for inflicting harm on others
  2. Hospital as a target (especially emergency departments)
    1. Emergency departments frequently harbor the mentally ill for long periods while arranging disposition
    2. Prisoners are often cared for in emergency departments (escape attempts are common)
    3. Family members of patients with medical adverse events may target health workers as revenge

III. Management: General

  1. Maintain constant awareness of surroundings and disruptions
  2. Plan for violent events in the hospital
    1. Pre-planned strategy offers best chance of survival
    2. Active Shooter situations are a rapidly developing "fight for your life"
    3. Survival relies on individual decisions made in seconds (while police are at least minutes away)
  3. Perpetrators with knives
    1. Potentially more dangerous than with guns (especially within 25 feet of perpetrator)
    2. Knives are more likely to strike their target
    3. Learning to disarm a perpetrator with a knife requires significant training

IV. Management: "Run. Hide. Fight."

  1. Run First
    1. Escape the situation if possible
    2. Run as fast and as far as possible from the shooter
    3. Evacuate mobile patients and staff immediately to safety if possible
    4. Do not stay with patients who are not quickly evacuated
  2. Hide Next (if unable to exit)
    1. Find a safe place to hide
    2. Close and lock door
    3. Turn off lights
    4. Silence phones, pagers, voceras, two way radios
  3. Fight Last (if unable to run or hide)
    1. Decide immediately whether fighting is only option
      1. Face time with perpetrators are less than 25 seconds
      2. If deciding to stay and fight, do so decisively and with all possible force
      3. All who decide to fight should attack the perpetrator in concerted effort
    2. Fight if taken hostage
      1. Perpetrators kill 70% of hostages
      2. Do not die quietly, defend yourself

V. References

  1. Clumpner and Claudius in Herbert (2013) EM:Rap 13(12):2-3

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window