How hospitals can save lives by planning for the worst

As hospitals around the country strive to prepare for emergencies within their walls, the Department of Health and Human Services (HHS) has issued a guide to help facilities plan for how to handle one of the worst-case scenarios--an active shooter situation.

Mass shootings in the United States have been on the rise since 2000, increasing from an average of 6.4 incidents annually to 16.4, according to a report issued by the FBI. Hospitals are hardly spared from the trend--one 2012 study found there were 154 hospital-related shootings between 2000 and 2011, with 29 percent of those occurring in emergency departments (EDs).

As recently as July, a mental health patient shot and killed his caseworker and wounded a physician--who himself returned fire--on the campus of Mercy Fitzgerald Hospital in Yeadon, Pennsylvania. The incident led the facility, which bans guns on its campus but has no metal detectors, to re-examine its security protocols, officials told the Delaware County Daily Times. 

To address the threat of an active shooter on hospital grounds, the HHS guide says training for hospital personnel should focus on the mantra of "Run, Hide, Fight," which reinforces the order for employee response. 

"Everyone should be trained first to run away from the shooter, if possible, encouraging others to follow. If that is not possible, they should seek a secure place to hide and deny the shooter access. As a last resort, each person must consider whether he or she can and will fight to survive, incapacitate the shooter, and protect others from harm," the guide says, before going into further detail about best practices associated with each response method.

Along similar lines, many mass shooting incidents end in five minutes or less, the FBI report states, so even when law enforcement is able to respond within minutes, "civilians often had to make life and death decisions, and therefore should be engaged in training and discussions on decisions they may face."

For the facility as a whole, the HHS suggests the following framework of an active shooter preparedness plan:

  • Train employees to identify individuals who may commit a violent act
  • Develop a method for reporting active shooter incidents to everyone occupying and/or entering the facility
  • Create an evacuation policy and procedure
  • Establish emergency escape procedures and route assignments
  • Develop lockdown procedures for individual units, offices and buildings
  • Distribute contact information for local area emergency response agencies and hospitals

Other general security suggestions from the HHS guide include: changing entry codes on doors at regular intervals and ensuring they remain closed and locked; requiring all visitors and staff to display ID badge, and creating a "culture of vigilance" that encourages staff to report unusual activity.

The report also echoes previous recommendations that hospitals avoid the use of coded warnings and instead use clear, informative language to tell those on hospital grounds about an active threat.

After a shooting incident has occured, staff must know how to treat and transport the injured, administer psychological aid to bystanders and victims, as well as aid with the investigation, according to HHS.

To learn more:
- check out the HHS guide (.pdf)
- read the FBI report