How Clinicians Can Prepare for Active Shooter Incidents

Michael T. Hilton, MD, MPH

Disclosures

August 17, 2017

"Disgruntled doctor," "AR-15 rifle," and "rampage in the hospital" are unsettling headlines. On Friday, June 30, 2017, at 2:50 PM, this was a terrifying reality. A 45-year-old physician wounded six people and killed one physician in Bronx-Lebanon Hospital Center in New York City. The shooter, Dr Henry Bello, was a former employee of the hospital and voluntarily left in 2015 after being accused of workplace sexual harassment. A patient, Miguel Mercado, told The New York Times, "Nobody was waiting for this. Who would have thought it would happen in a hospital?"[1] Unfortunately, an active shooter incident is possible at any healthcare facility. We all need to be prepared.

Incidents on the Rise

The US Department of Justice/Federal Bureau of Investigation (FBI), US Department of Homeland Security(DHS)/Federal Emergency Management Agency (FEMA), and the US Department of Education define an active shooter as "an individual actively engaged in killing or attempting to kill people in a confined and populated area."[2] Between 2000 and 2013, there were 160 active shooter incidents in the United States, an average of 11.4 incidents per year, with a trend of increasing number of incidents every year.[2,3,4] Most shooters were male (94%), with an age range of 13-88.[3] The primary motive appears to have been mass murder.[3]

Between 2000 and 2011, there were 154 hospital-related shootings. The majority occurred within the hospital and the most common site was the emergency department (29%). Most events involved a shooter with a strong motive defined by a grudge (27%), suicide (21%), euthanizing an ill relative (14%), or prisoner escape (11%). Hospital employees comprised 20% of the victims, but physicians (3%) and nurses (5%) were infrequently victims.[5]

Police arrive quickly to most events, but most events end without police involvement. It is important that civilians take actions to protect themselves in the few minutes before police arrive. Attacks that resulted in the highest number of casualties had police arrive on scene within 3 minutes.[3]

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