Perpetrator picks a highly concentrated group of unprotected people in a confined space (target-rich, threat poor)
Shooter attempts to kill or injure as many people as possible
Shooter is typically mentally ill with a carefully pre-planned strategy for inflicting harm on others
Hospital as a target (especially emergency departments)
Emergency departments frequently harbor the mentally ill for long periods while arranging disposition
Prisoners are often cared for in emergency departments (escape attempts are common)
Family members of patients with medical adverse events may target health workers as revenge
III. Management: General
Maintain constant awareness of surroundings and disruptions
Plan for violent events in the hospital
Pre-planned strategy offers best chance of survival
Active Shooter situations are a rapidly developing "fight for your life"
Survival relies on individual decisions made in seconds (while police are at least minutes away)
Perpetrators with knives
Potentially more dangerous than with guns (especially within 25 feet of perpetrator)
Knives are more likely to strike their target
Learning to disarm a perpetrator with a knife requires significant training
IV. Management: "Run. Hide. Fight."
Escape the situation if possible
Run as fast and as far as possible from the shooter
Evacuate mobile patients and staff immediately to safety if possible
Do not stay with patients who are not quickly evacuated
Hide Next (if unable to exit)
Find a safe place to hide
Close and lock door
Turn off lights
Silence phones, pagers, voceras, two way radios
Fight Last (if unable to run or hide)
Decide immediately whether fighting is only option
Face time with perpetrators are less than 25 seconds
If deciding to stay and fight, do so decisively and with all possible force
All who decide to fight should attack the perpetrator in concerted effort
Fight if taken hostage
Perpetrators kill 70% of hostages
Do not die quietly, defend yourself
Clumpner and Claudius in Herbert (2013) EM:Rap 13(12):2-3
Images: Related links to external sites (from Bing)
These images are a random sampling from a Bing search on the term "Violence in the Hospital." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images
FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6546 interlinked topic pages divided into a tree of 31 specialty books and 722 chapters. Content is updated monthly with systematic literature reviews and conferences.
Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians.
This page was written by Scott Moses, MD, last revised on 3/8/2016 and last published on 3/3/2018.