What Hospital Active Shooter Response Programs Should Look Like

Here’s a rundown of specific features the NFPA advises hospital officials to include in their active shooter response programs.

What Hospital Active Shooter Response Programs Should Look Like

Hospital active shooter response programs are essential for healthcare facilities to stay prepared for shootings on their campus or in their communities. Hospitals with the ability to receive patients from an active shooter attack have a responsibility to be prepared.

The new National Fire Protection Association Standard, NFPA 3000: Standard for an Active Shooter/Hostile Event Response (ASHER) Program, gives details on what that preparedness should look like.

Specifically, chapter 19 of the NFPA 3000 standard describes different aspects of an effective, scalable hospital active shooter program.

John Montes, an NFPA emergency services specialist who helped write NFPA 3000, believes active shooter response plans should be distinct from hospital officials’ general emergency plans.

“What’s different about active shooter events is they’re dynamic,” Montes explains. “They cause people to take action on their own. People are fleeing the scene, sometimes looking for ways to get to the hospital on their own, and there’s not always a way to gauge how many people will be coming to the facility.”

The standard itself is a 48-page document broken into 20 chapters, but we think healthcare officials can more easily digest it as a list of features the NFPA believes are necessary for hospital active shooter response programs to be successful.

That list is divided into categories below.

Community Active Shooter Planning

During the development phase of your hospital’s active shooter plan, NFPA 3000 states that hospitals shall:

  • Develop and exercise their response programs with the organizations who may send them patients after an active shooter incident.
  • Integrate their emergency management plans with organizations that name the hospital as a primary receiver of patients in their active shooter programs.
  • Develop a protocol for rapid screening of the hospital for devices and weapons if an active shooter incident occurs within or near the facility.
  • Plan to receive spontaneous arrivals.

Active Shooter Communications

Communications are a critical part of any emergency response plan. In regard to active shooters, NFPA 3000 states that hospitals shall:

  • Have at least two means of communication with the public safety agencies responsible for patient disbursement in active shooter incidents included in the hospital’s community communication plan. Written procedures for the use of those communication channels should be developed in conjunction with those agencies.
  • Assign a staff member to communicate with patient distribution coordinators and emergency responders throughout the operational period.
  • Identify victims and share that information with the authority having jurisdiction (AHJ) based on prescribed practices in accordance with applicable laws and regulations.
  • Test communication systems on a monthly basis.

Hospital Access Control

Access control considerations are key to maintaining hospital security during an active shooter response. NFPA 3000 touches on access control only briefly by describing the implementation of restricted access protocols. It states that restricted access protocols shall:

  • Include provisions for existing physical security measures, on-duty staff members, additional first responders and the availability of supplemental staff from external sources.
  • Include information on the people authorized to activate and deactivate restricted access procedures and how to limit access to the entire facility.
  • Address situational risk assessment implementation measures.

Hospital Command Center

Finally, NFPA 3000 briefly outlines the protocols related to the decision making structures and settings necessary for hospital active shooter response. It states that hospitals shall:

  • If a hospital command center is available and capable, activate it to manage the incident.
  • Activate and utilize a Hospital Incident Command System (HICS) to manage the response.
  • Exercise patient distribution measures based on mass casualty incident plans.

In Conclusion

The NFPA’s guidelines are a great resource for hospital officials to consider, but keep in mind that active shooter response programs need to be tailored to each hospital’s specific campus and community. The nature of the attack may also lead to changes in officials’ response.

While the NFPA’s standard is mostly geared toward active shooter incidents occurring outside of healthcare facilities, the FBI has released some guidance on preparing for active shooter incidents occurring within healthcare facilities. The NFPA also has myriad resources related to the new standard available on its website.

As active shooter incidents continue to garner national attention, Montes says we can’t overlook hospitals’ crucial roles in the response.

“Hospitals need to be involved in these planning efforts because they receive the victims,” Montes says. “They’re not necessarily in the same geographic area that first responders are used to thinking about, but they need to be protected and supported as a major part of the incident.”

About the Author


Zach Winn is a journalist living in the Boston area. He was previously a reporter for Wicked Local and graduated from Keene State College in 2014, earning a Bachelor’s Degree in journalism and minoring in political science.

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