4 guiding principles for managing an active-shooter scenario

Following four key principles--"avoid, deny, defend, treat"--will help hospitals deal with having an active shooter on site, a disaster preparedness expert told the American College of Emergency Physicians meeting in Boston last week.

Those closest to the shooter will need to quickly decide whether to run, hide or fight, David Callaway, M.D., director of operational and disaster medicine at Carolinas Medical Center in Charlotte, North Carolina, said, according to an article in Medscape Multispecialty. A U.S. Department of Health and Human Services (HHS) guide issued last year said training for active-shooter scenarios should focus on the "run, hide or fight" mantra to reinforce the order in which hospital staff should respond during the incident..

Hospitals are prime locations for shootings, according to Callahan. Since 2000, the U.S. reported 193 hospital-related shootings, more than half of which resulted in at least one death. Motivations ranged from grudges and revenge to ending a sick relative's life and trying to free prisoners receiving medical care, according to the article.

In one highly publicized case earlier this year, a cardiac surgeon at Brigham & Women's Hospital in Boston was shot and killed by a man whose mother had died a few months earlier following heart surgery.

To avoid danger, remove potential targets by running, hiding and calling 911 as soon as safely possible, Callaway said. Staff should lock or block doors with heavy objects or IV poles, turn off the lights and turn off their phones, he said.

The longer staff and patients can deny the gunman access to them as targets, the better chance they have of surviving, since more than one-third of shooting incidents are over in less than 5 minutes, according to the article.

Those in hiding should prepare to defend themselves by arming themselves with whatever heavy weapons they can find, according to the article, such as a fire extinguisher. They should hide near the door so they can hit the shooter or the gun out of his or her hand if the shooter does get into the area, Callaway said.

Hospital staff also should provide detailed, site-specific plans for how they will treat critically injured victims, according to the article. The plan should keep in mind issues of restricted access and crime-scene investigations as well as how to integrate first-care providers, medical and nonmedical first responders, hospital support staff, families and patients.

For more information:
- read the Medscape article
- download the HHS planning guide (.pdf)