Half of Patients Expect Physicians, Nurses to Protect Them Against Hospital Shootings

Under what circumstances do you lock down doors and stay versus run and take patients with you? Lead author, Lenworth M. Jacobs, MD, reviews scenarios and hospital preparedness.

More than half of the general public and healthcare providers expect that physicians and nurses in hospitals should protect patients from harm if an active shooter enters a hospital, according to survey data from nationwide study published online ahead of print in the Journal of the American College of Surgeons.

black woman at hospital crime scene calling 911Previous research shows that 154 shooting incidents in which at least one person was injured occurred on hospital premises and resulted in 235 injuries or fatalities. Photo Source: 123RF.com.A total of 160 active shooter events (ie, defined by the Federal Bureau of Investigation as one or more persons attempting to or killing people in a populated area) occurred between 2000 and 2013; however, the rate of these events increased from 6.4 to 16.4 events per year between 2000-2006 and 2007-2013 (Figure).1 Within that 13-year period, 4 shooting events (2.5%) occurred in a healthcare setting, resulting in 10 fatalities and 10 injuries.1 Using a broader definition of shooting events, previous research shows that 154 shooting incidents in which at least one person was injured occurred on hospital premises and resulted in 235 injuries or fatalities.2

Chart shows a study of 160 active shooter incidents in the US, 2000-2013Figure. A Study of 160 Active Shooter Incidents in the United States Between 2000-2013. Source: Federal Bureau of Investigation, 2014.(1)The present study is based on data from 1,017 adults who were surveyed over the phone and an online survey of 684 health professionals, majority of whom were physicians (92%) and worked in hospitals (95%).

The following are key findings from the survey:

  • Healthcare professionals were more likely to assess the risk of an active shooter even in a hospital as “high” or “very high” than the general public was (33% vs 18%).
  • Healthcare professionals were less likely than the public to rate hospitals as “somewhat” or “very prepared” for an active shooter event (72% vs 55%).
  • The majority of both the general public and healthcare providers (61% and 62%, respectively) believe that physicians/nurses are obligated to protect patients during active shooter events; however, fewer respondents believed that healthcare professionals should accept a “high” or “very high” degree of personal risk to help patients who cannot get out of harm’s way (39% and 27%, respectively).
  • For patients in an operating room (OR) or intensive care unit (ICU), more professionals believe they should assume a “high” or “very high” level of personal risk (45% and 36%, respectively for each setting) as opposed to patients who may be less vulnerable (eg, ambulatory patients; 22%).

Improving Hospital Preparedness

“Strategies to improve hospital preparedness for an active shooter event should consider both physical and philosophical aspects,” said lead author Lenworth M. Jacobs, MD, Vice President, Academic Affairs, Hartford Hospital, and Director, Hartford Hospital Trauma Institute, Hartford, Connecticut.

“Physical aspects to consider include where will staff go in the event of an active shooter,” Dr. Jacobs told SpineUniverse. “Under what circumstances do you lock down doors and stay versus run and take patients with you? This decision is different depending on whether you have a patient who is mobile versus if the patient is in the ICU where the patient may be on a respirator or on sedative drugs, or in the OR where the patient is not awake. This is particularly relevant for patients undergoing spine surgery, who are in the OR for hours and cannot be moved or abandoned in 5 minutes.”

“On a philosophical level, the conflict is: how much danger do you put yourself in to help patients versus to protect yourself and your family, especially if you have small children at home?,” Dr. Jacobs said. “What is your plan going to be, and how will you carry out that plan to maximize patient safety and your safety?”

Dr. Jacobs said that both hospital clinical leadership (ie, heads of surgery, emergency medicine, and psychiatry departments) and administrative leadership (ie, CEO, COO, and head of security) have a joint responsibility to stimulate discussion on this topic and develop a clear plan of action. In addition, he believes that these discussions should be a mandatory part of medical and nursing school curriculum.

Dr. Jacobs and coauthor Karyl J Burns, RN, PhD, presented a list of discussion points for hospital staff to use to stimulate conversation on how to prepare for a shooter attack, including the following:

  • Who should be designated to stay and care for patients, and who should be able to leave in the event that an active shooter enters a hospital?
  • If a professional or other worker decides to stay, should they be allowed to stay or should they follow instructions to leave? Who should give the instructions?
  • If the shooter event is a false alarm, who should bear the liability if patients are abandoned and have untoward outcomes?

Dr. Jacobs concluded that hospitals should put active shooter policies in place immediately so that, in the event of an active shooter incident, staff are not left wondering why they didn’t have a detailed system in place, but rather, how could they improve the process.

Updated on: 09/17/19
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