Is Your Staff Prepared for an Active Shooter?

In healthcare settings, staff are typically well-versed in emergency protocols for fires—such as RACE (Rescue, Alarm, Confine, Extinguish) and PASS (Pull, Aim, Squeeze, Sweep). However, when asked about their response to an active shooter situation, many healthcare workers express uncertainty. Responses often include “wait for direction from my manager,” “check the back of my badge,” or simply “hide.” This disparity highlights a critical gap in emergency preparedness.

Despite annual training modules provided through learning management systems, many staff members lack the practical knowledge and confidence needed to respond effectively during an active shooter event. Hospitals must go beyond passive learning and implement active drills, department-specific training, and clear communication protocols to ensure staff readiness.

Understanding the Threat

Hospitals face unique vulnerabilities in active shooter scenarios due to their open-access environments, diverse populations, and complex physical layouts. According to the U.S. Bureau of Labor Statistics, healthcare workers are five times more likely to experience workplace violence than workers in other industries. Between 2000 and 2013, 2.5% of active shooter incidents occurred in healthcare facilities, and the frequency of such events continues to rise.

The “Run, Hide, Fight” protocol, developed by the U.S. Department of Homeland Security, provides a clear framework for responding to active shooter incidents. In a hospital setting, this strategy must be adapted to account for patient care responsibilities and facility constraints.

Run: Evacuate if Possible

  • Assess the situation: If you hear gunshots or receive an alert, determine if it’s safe to escape.
  • Know your exits: Hospital staff should know multiple evacuation routes, including stairwells and emergency exits.
  • Help others if you can: Assist patients and visitors, especially those with mobility issues, but do not delay your escape if it’s unsafe.

Hide: Shelter in Place

  • Find a secure location: Hide in a room that can be locked or barricaded.
  • Silence devices: Turn off lights, silence phones, and remain quiet.
  • Stay out of sight: Avoid windows and doors. If necessary, use furniture or medical equipment to block entry.

Fight: As a Last Resort

  • Act decisively: If escape or hiding is impossible, be prepared to defend yourself.
  • Use improvised weapons: Medical tools, heavy objects, or fire extinguishers can incapacitate the attacker.
  • Commit to your actions: Your goal is to disrupt the shooter’s ability to cause harm.

 Hospital-Specific Considerations

  • Training and Drills: Regular, department-specific active shooter drills are essential.
  • Communication systems: Hospitals must implement plain language emergency alerts to eliminate confusion caused by inconsistent code systems. Studies have shown that traditional color-coded alerts vary widely across facilities, leading to delayed responses and increased risk. Plain language alerts—such as “Active Shooter in Emergency Department”—are recommended by national organizations including the Centers for Medicare & Medicaid Services, Department of Homeland Security, and Institute of Medicine.
  • Protecting patients: Prioritize the safety of patients who cannot evacuate, such as those in the ICU or operating rooms. Protocols should include shelter-in-place strategies and coordination with emergency responders.

Conclusion

Active shooter events are unpredictable and evolve rapidly. Hospitals must adopt a proactive approach that combines education, simulation, and clear communication. By embracing the “Run, Hide, Fight” strategy and tailoring it to the healthcare environment, staff can improve their chances of survival and protect vulnerable patients during a crisis.

References

For questions or to learn more contact the C&A team at 704-573-4535 or email us at info@courtemanche-assocs.com.