In today’s health care world, hospitals must be prepared, not just to mend the victims of violence in their community, but also to respond if an armed individual enters their doors.

Violent crimes taking place in such institutions have risen from two such events per 100 beds in 2012 to almost three in 2015, according to the Joint Commission. About 50 percent of all workplace assaults occur in the health care setting, according to the Bureau of Labor Statistics. Earlier this month in Texas, for example, a man pulled a gun at suburban Houston hospital, irate over having to wait for a doctor.

With all that in mind, the American Society for Healthcare Engineering hosted a webchat earlier this week to share some of the field’s best practices in responding to an active shooter within the hospital. Hospitals cannot think of themselves as exempt from such scenario planning, says Kevin Tuohey, board president-elect of the International Association for Healthcare Security and Safety.

“While hospitals have always been looked at as places of refuge, as places that were really safe, I think in the last 10 years that’s changed, and I think that they are no longer exempt,” says Tuohey, who is also executive director of research compliance at Boston University. 

As part of the webinar, which is available to view on demand, Tuohey and other IAHSS experts offered seven steps that hospital leaders can take to better prepare their institutions for an active shooter:

  1. Assess risks and vulnerabilities: Those can include performing annual risk assessments, determining potential vulnerabilities, developing emergency plans and forming teams to assess potential threats.
  2. Prevention and response: Understand what actions it would take to keep a threat at bay, and your ability to perform them, and to stabilize the situation while transitioning to recovery. Who is part of your crisis response team if a situation snowballs?
  3. Reducing workplace violence: Train for whatever potential incidents may arise, and then press forward with even harder challenges. Work in concert with security and emergency management, and gain leadership support early in the process.
  4. Plan a mock drill exercise and training: Such as demonstrating your ability to manage casualties, practicing your response to the media, and putting in place an employee support plan.
  5. Collaborate with outside law enforcement: Understand the availability of external responders who may assist in an emergency, and ensure that they have given input into your planning process.
  6. Communication and crisis awareness: Hospitals must use common terms for first responders to avoid confusion, and test their incident command system as frequently as possible. IAHSS experts also urged hospitals to use the three-step response of running/escape if possible, hiding if not, and fighting the attacker only as a last resort.
  7. Recovery and debriefing: This last step would include preparing to speak with the media, compiling “after action” reports, staying in constant communication with staff and patients, and determining which spaces should stay closed and for how long.

There’s lots more in the webinar, including several guides that you can read to help develop your preparedness plans. Plus, there are elements to incorporate in the design of a new or remodeled hospital facility to ensure that it is safe from an active shooter.

Tuohey emphasized hospitals must think proactively about preparing for a gunman within their walls, rather than reactively after an incident has occurred.

“When one has an act of violence at an institution, that’s not the time to think about safe rooms,” he says. “That’s not the time to think about whether you know the local law enforcement officials. It’s not the time to think about whether your incident command structure is trained on how to coordinate and make decisions. And so, our viewpoint on this is really that it starts with design when it comes to the physical space, and it starts as soon as possible when it comes to the coordination among the responders.”

And include the entire hospital staff in emergency preparedness and not just one little section. “This really does rely on folks working together. It really is everyone’s’ problem,” he says. 

For more on how hospitals are working to both prevent and treat violence in their communities, be sure to check out the American Hospital Association’s resource page on the topic. Plus, watch for continuing coverage on the AHA’s Hospital’s Against Violence initiative in the print edition of Hospitals & Health Networks, and at