Not long ago, a cardiologist was shot at a hospital in Massillon, Ohio, by a gunman who then took his own life. It was one of three active shooter incidents reported by news media in the span of one week. No longer under the delusion that “this type of violence would never happen at our facility,” hospital leaders are increasingly anxious to establish or upgrade their active shooter plan — as they should.

While you’ll find plenty of advice on how to respond to an active shooter, many best practices don’t take into account the unique challenges of a healthcare environment. Faced with an active shooter, health professionals may have to choose whether to abandon patients, visitors and families will be scrambling for cover, and many patients won’t be able to evacuate or hide due to age, injury, illness, or a medical procedure in progress.
To be clear, an active shooter scenario is defined as one or more individuals are actively engaged in killing or attempting to kill others in a confined and populated area. Because these incidents are unpredictable and evolve so quickly, your organization must manage it before law enforcement arrives on the scene.
Below are six steps to help you create a plan suited for a healing environment.
  1. Establish how you’ll notify staff, guests, first responders and other stakeholders that an active shooting is underway.
Research shows warnings do not induce panic, and it’s a mistake to omit or delay information when lives are at risk. Rather, people want and need accurate information and clear instructions. You’ll need a way to disseminate actionable alerts in an instant: Speed and clarity are both critical when people have only moments to react and protect themselves.
Ensure no intended recipient falls through the cracks by layering notifications in various formats. Someone who doesn’t speak English, is visually or hearing-impaired, for instance, should still receive notifications in a way that instantly captures their attention and is easily understood, so they can get out of harm’s way. Text, email, LED displays, sounds and lights are all ways you can achieve that.
Think through various audience segments, their needs and locations, and draft messaging templates and processes accordingly. In doing so, also consider hospital workers in other buildings or remote areas of the hospital grounds, as well as local hospitals and emergency responders.
  1. Define emergency escape procedures and route assignments.
The golden rule: fewer people in the hot zone equals fewer victims. An evacuation policy and procedure, emergency escape procedures and route assignments must be included for your plan to succeed, urges the Healthcare and Public Health Sector Coordinating Council.
Your plan should identify safe areas and provide floor plans to the entire healthcare network. It should also include secondary or even tertiary routes in case primary evacuation routes are unusable.
  1. Establish lockdown procedures for individual units, locations and other buildings.
Hospital grounds normally include multiple buildings and wings. Research by the John Hopkins University of Medicine in Baltimore indicated 40 percent of hospital-based shootings occurred outside of hospital buildings.
In creating your active shooter plan, consider how to effectively lock down patients, visitors and staff to keep them safe, taking into account access to functional safety needs when determining your shelter sites. Shelter-in-place locations should ideally have thick walls, solid doors with locks, minimal interior window, first-aid emergency kits, communication devices and telephones or duress alarms.
  1. Integrate the Active Shooter Plan with your Emergency Operations Plan (EOP) and Incident Command System (ICS).
Your hospital is required to have an EOP, which describes how your facility will respond to and recover from all hazards. It must include six elements corresponding to The Joint Commission’s Emergency Management Standards:
  • Communications
  • Resources and assets
  • Safety and security
  • Staff responsibilities
  • Utilities and clinical
  • Support activities
An ICS is designed to help you effectively manage domestic incidents, integrating facilities, equipment, personnel, procedures, and communications operating within your organization.
Your active shooter plan should be integrated with both.
  1. Define pertinent information for first responders and hospitals.
What information will you need to immediately communicate the active shooting to other local hospitals and emergency response agencies? Identify phone numbers, names, shooter location — any pertinent information you’ll need to accelerate communications and intel sharing.
Being able to access this information easily during an emergency can help teams act quickly and save lives when time is at a premium. Take the time to do so now, so you won’t have to take the time to do it when a gunman is around the corner.
  1. Maintain your plan with ongoing training and periodical reviews.
Ongoing training is vital to ensure staff actually knows what to do when tragedy strikes, and shares the most up-to-date resources.
Don’t limit training to one approach, however. Incorporate training into various opportunities, formats and vehicles, such as annual competencies, employee newsletters, new employee onboarding, annual orientations, on-demand videos, and more.
Patient safety demands safe facilities. We hope yours never has to grapple with an active shooter incident. But if it does, we hope you’ll be well prepared to save the lives under your care.