Once considered places of sanctuary from violence, hospitals are now becoming desecrated by the ravages of a society where polite discourse seems to be easily forsaken in favor of gunpowder and lead. Surveys show that emergency department personnel are assaulted on a far-too-frequent basis.¹ Data also demonstrate that patients and visitors are arriving armed to the teeth.^{2, 3} How can we prepare ourselves to survive when the mean streets spill into our corridors and bullets fly?

There are steps that can be taken to prevent gun violence in the ED. It’s well past time to examine the risks and learn how to react if you find yourself in the middle of the nightmarish scenario of an active shooter in your department.

Prevent the Problem

Data are remarkably clear on two points. First, our patients and their visitors are armed. They arrive carrying knives, Tasers, mace, brass knuckles, and guns.^{2, 3} Second, and not surprisingly, the amount of firearms brought to a facility drops after metal detectors are installed.³

Surprisingly, however, data demonstrate that more than one-quarter of all shootings on hospital grounds involved a law enforcement officer shooting at a perpetrator.⁴ The most common reason for police shootings in hospitals and EDs was that a perpetrator disarmed a law enforcement officer and a second officer engaged with deadly force.⁴ The number of law enforcement-involved shootings is even higher in the ED—as many as one half of all ED shootings occurred in this manner.⁵

Given the effectiveness of metal detectors in reducing the number of guns brought to the ED, they should be standard equipment in all EDs.³ Given the frequency of law enforcement officers being disarmed, leading to shootings, the presence of armed security officers in the ED should be thoughtfully discussed and examined.

Hospital security and ED staffs need to coordinate when prisoners, forensic, or mental health patients are brought into the facility. Scalpels, pocket knives, or other sharp instruments might be taken by prisoners or psychiatric patients as weapons to use in escape attempts, so you should remove these items from your person prior to examining these patients.

Understand the Risks

It’s important to understand the patterns and risks of shootings in EDs. The definition that the FBI uses for an “active shooter” (the type of shooting highlighted in the news, including events like the tragedies at Sandy Hook Elementary School; Aurora, Colorado; or Orlando, Florida) is: “An individual actively engaged in killing or attempting to kill people in a confined and populated area.” Implicit in the definition is the use of a firearm.