Preparing For An Active Shooter In A Healthcare Setting


Active shooter incidents throughout the country have prompted individuals and organizations, including hospitals and other healthcare facilities, to consider response plans for an “active shooter”. An “active shooter” is defined by the U.S. Department of Homeland Security as “an individual actively engaged in killing or attempting to kill people in a confined and populated area, typically through the use of firearms.”

Nurses should be aware if their workplace has a plan for how to handle an active shooter and they should be prepared to protect themselves and their patients.

A Deadly Problem 

A 2012 Johns Hopkins’ study found that 154 hospital-related shootings occurred from 2000 to 2011, with 91 occurring inside the hospital and 63 outside, on hospital grounds. Although rare, these shootings can be deadly, particularly to the perpetrator, who was the victim in nearly half (45 percent) of cases. Nurses and physicians accounted for 5 percent and 3 percent of victims, respectively.

Most perpetrators (91 percent) were men, and motivations included a grudge, suicide, euthanizing an ill relative, and prisoner escape. Keep in mind, however, that according to the U.S. Department of Homeland Security, active shooters typically have no pattern or method for selecting their victims. Because of this, shooting events are often unpredictable and difficult to prevent. However, that doesn’t mean there aren’t steps nurses can take to be prepared to react in the event a shooting incident occurs where they work.

Stay Vigilant

An active shooter could be an employee, a patient or client, a physician, or someone else. Nurses should remain alert to people acting suspiciously, for example appearing nervous when asked simple questions. Some people may exhibit signs of potentially violent behavior such as depression or withdrawal, repeated violations of a facility’s policies, explosive outburst of anger, previous incidents of violence, etc. Report any concerns and document objective observations in the medical record.

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule does not prevent a nurse from disclosing necessary information about a patient to law enforcement, family members of the patient, or other persons, when it is believed the patient presents a serious danger to himself or other people. HIPAA recommends clinicians be aware of state laws related to disclosure of patient information to prevent or lessen the risk of harm.

An active shooting is typically over within 10 to 15 minutes, so advance preparation on how to react quickly is essential. Having an emergency plan that covers active shooters and includes areas of responsibilities, emergency phone numbers, and response plans is crucial. The Emergency Nurses Association’s workplace violence resources, although hospital-focused, has several principles that also may be helpful in clinic settings:

  • Have a code specific to these situations, such as “Code Silver”, which prevents people rushing to the scene to help and being placed in harm’s way.
  • Set up a command center to establish clear lines of communication, including how to notify people when the crisis is over. In some cases, social media may be appropriate for public updates.
  • Participate in training exercises, and prepare to recognize the sound of gunshots, how to react, and how to adopt a survival mind set. Ideally, security in a facility and local law enforcement will participate in the training.

Nurses—and their patients—could easily be in the line of fire should an active shooter enter their facility. By being prepared and alert, nurses can help mitigate a tragic situation.

Nurses can visit the following websites for more resources on how to prepare for an active shooting situation.

About the author

David Griffiths is senior vice president of Nurses Service Organization (NSO), where he develops strategy and oversees execution of all new business acquisition and customer retention for the group’s allied healthcare professional liability insurance programs. With more than 15 years of experience in the risk management industry, he leads a team covering account management, marketing and risk management services. More at

This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 650,000 nurses since 1976. INS endorses the individual professional liability insurance policy administered through NSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to or call 1-800-247-1500.

This article is provided for general informational purposes only and is not intended to provide individualized business, risk management or legal advice.  It is not intended to be a substitute for any professional standards, guidelines or workplace policies related to the subject matter.

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