A hospital is supposed to be a safe place where anyone can receive care. Traditionally, this has meant healthcare facilities did not have a demonstrated need for metal detectors or armed security guards. But violent events have crept into medical facilities and offices, and workers and patients have lost their sense of security.
Workplace violence is a major problem in healthcare, with the US Bureau of Labor Statistics stating that healthcare workers are five times more likely to experience violence than other occupations. In these types of events, 93% of assaults are committed against healthcare workers.1
Earlier this year, the husband of a woman being treated at a hospital in Pennsylvania shot and killed a police officer and wounded five others. According to news reports, he was upset with the care his terminally ill wife received and was removed by hospital security the night before the incident after being told there were no other treatment options to pursue.
This tragic event underscores a growing trend of violence being committed against healthcare workers. These incidents can have devastating, long-lasting effects on the victim and the people who are actively or passively involved in the event.
A study by Texas State University and the Federal Bureau of Investigation examined active shooter events in the US from 2000 to 2013.2 According to the study, active shooter events increased to an average of 16.4 events per year from 2007 to 2013—up from the 6.4 average events per year from 2000 to 2006. These events have continued to escalate, and the healthcare environment has not been immune to this phenomenon. A total of 160 active shooter events occurred between 2000 and 2013, with 2.5% occurring in healthcare facilities.3
More and more healthcare workers are calling for stronger security protocols to better protect frontline staff from harm. Workplace violence can happen in any type of healthcare facility, including medical offices. Therefore, it is critical for office staff also to be able to recognize signs of an event beginning to escalate. Attempting to de-escalate the situation and rapidly summoning assistance are critical to containing and controlling the incident before people are injured or killed.
In a hospital setting, these events can pose a significant challenge, as some patients may not be physically able to run or hide. In certain parts of the hospital, like the intensive care unit (ICU) or the OR, the patient may be immobile, unconscious, and completely dependent on the healthcare personnel and medical equipment.
The Hartford Consensus, the result of the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events, which was sponsored by the ACS, surveyed the public and healthcare personnel on how they would react to an active shooter event in a hospital. Of the respondents, 61% of the public and 62% of the doctors and nurses said they had a special duty to protect patients, and most of the public said it was important for hospitals to be prepared to mitigate any event that would disrupt the safety of the hospital.4
The recommendation from the Hartford Consensus was that all hospital employees should think through their response to an active shooter for managing patients in all types of environments, and there should be training and drills on active shooter situations to reduce potential indecision and inaction.
What can administrators and healthcare personnel do to prepare for such an event? First, know your options. The concept of “run, hide, fight” may be relevant in some situations, but may not be the best course of action in others. For example, in an ICU or OR where healthcare personnel and the patient cannot leave, one way to prevent a shooter or person committing violence from entering the space may be to turn off the lights and secure the OR door with a wedge or activate a locking system to block entry. Some of these options may be financially significant or may require assistance from local law enforcement and other agencies to ensure proper building or safety codes are met.
A key to all these strategies is to have a clear set of policies and procedures already in place and practice implementing them to ensure continuity of care for the compromised patient. To help in this process, The Joint Commission recently revised and added new requirements addressing workplace violence prevention for office-based surgical practices, which went into effect this month. These requirements align with similar updates that were already made to the Critical Access Hospital Accreditation programs, including:
- Defining workplace violence and developing processes and procedures
- Outlining leadership’s oversight role
- Giving information on reporting systems, data collection, and analysis
- Suggesting how to implement post-incident strategies
- Providing guidance on training and education
While this topic can be emotionally challenging, it is extremely important to have active shooter planning in place. It is better to have the conversation now and develop a plan of action that can be practiced and implemented in the event of a major violent event. Keeping staff informed and trained about what to do when these events arise may be the difference between life and death for staff members and patients.
For more information on workplace violence, read the ACS Bulletin article, “Violence Escalates against Surgeons and Other Healthcare Workers” in the October 2024 issue, and the September 2023 Executive Director’s column, “How the ACS Can Help Surgeons Address Workplace Violence.”
