How Practices Should Prepare for an Active Shooter Situation

By: Janet McCrossen, BSN, RN
3 Minute Read

On Nov. 20, 2018, three people were killed after a man opened fire in the emergency department of a Chicago hospital. A few months later on March 4, 2019, nurses at a Wyoming medical center called 9-1-1 to report shots fired in the radiology department as patients hurriedly fled the building. The following month, on April 27, a young man entered an emergency room in Orangeburg with an assault rifle, firing multiple times and gravely injuring the unit secretary before surrendering to law enforcement.

Sadly, these are not isolated incidents. More than 248 mass shooting have occurred in the U.S. so far in 2019, each involving multiple victims of firearm-related violence.

While we may wish to avoid the thought of an active shooter situation, when faced with the unthinkable, nothing is more valuable to a medical practice than preparation.

Be Prepared

The term “active shooter” is used to describe a situation in which an individual is actively engaged in lethal firearm attack with the intent to kill people in a confined and populated area. Medical facilities are often particularly vulnerable to such an attack as both patients and staff are unable to defend themselves while confined to rooms without locks.

Fear, anxiety, and disbelief are natural reactions to this traumatic event, which can often cloud judgement or stifle reactions in a state of panic. The only way to combat this innate response is preparation. We strongly recommend that medical practices work alongside their local police, EMS, and fire company to develop an active shooter plan as part of their emergency response plan.

This plan should state overarching goals and objectives while clearly defining a course of action. Here are some steps to consider:

  1. Provide safety training

    : During an active shooter event there may be alarms, gunfire and explosions, and people shouting and screaming. In the face of this chaos, effective training provides practice staff with the means to regain composure, recall at least some of what has been learned, and commit to action.Training for personnel can focus on the easy-to-remember mantra of “Run, Hide, Fight.” Everyone should be trained first to run away from the shooter, if possible, while encouraging others to follow. If that’s 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.

  2. Establish response protocol for workplace violence: Active shooter events in outpatient healthcare facilities are relatively rare, but workplace violence incidents are still prevalent. As you develop an Emergency Response Plan for your practice, include information and training on how staff should best handle one of these events. There is no one prescribed method to handle an incident, but planning ahead will help staff make the best choice during an active shooter or other violent situation.
  3. Educate staff on the evacuation plan

    : Personnel, patients, and visitors who can evacuate safely should do so. According to the Department of Homeland Security, research shows that the best method to reduce loss of life in active shooter situations is immediate evacuation.How a physician or medical staff member responds during an active shooter incident will be an intensely personal choice that may be influenced by moral, ethical, religious, professional, or other values, but healthcare providers are not obligated to stay and help patients during an active shooter situation.


By following these three principles, practice leaders can help employees better prepare, respond, and recover from an active shooter situation, trusting that staff will rely on their training and knowledge to make quick decisions in the face of danger.

Janet McCrossen, BSN, RN
Janet McCrossen is a Curi Risk Consultant based in Philadelphia, PA.
News & Knowledge