Doctors Propose ‘Secure, Preserve, Fight’ Strategy for Hospital Active Shooters

A recent editorial published in the New England Journal of Medicine recommends the new strategy for areas of hospitals with incapacitated patients.

Doctors Propose ‘Secure, Preserve, Fight’ Strategy for Hospital Active Shooters

The authors developed the new strategy after studying data on hospital shootings.

Certain areas within hospitals should transition from the “run, hide, fight” strategy for active shooter response to the “secure, preserve, fight” strategy, according to a team of physician experts.

Dr. Ken Mattox, a Texas Medical Center trauma surgeon, along with three other experts, wrote in a recent editorial for the New England Journal of Medicine that a “secure, preserve, fight” active shooter strategy would help address both practical and ethical concerns in certain locations within healthcare facilities, reports The Chronicle.

“For professionals providing essential medical care to patients who cannot run, hide, or fight owing to their medical condition or ongoing life-sustaining therapy, a different set of responses should be considered — secure the location immediately, preserve the life of the patient and oneself and fight only if necessary,” reads the editorial.

The authors developed the strategy after reviewing data on hospital shootings between 2000 and 2011. The strategy, according to the authors, focuses on preparation with designated areas having devices that can lock and secure doors and entry points.

In the editorial, Mattox refers to the 2017 false report of an active shooter at Houston’s Ben Taub Hospital, where he is chief of staff. Parts of the hospital were evacuated but some staff followed the well-known strategy and chose to run and hide.

“If you run, you’re abandoning your patient,” Mattox said. “And if you abandon your patient and a shooter comes in, then that person is a ready-made target. If you stay, then you risk making your child an orphan.”

Although physicians, staff, patients and visitors should follow the “run, hide, fight” strategy if they can, the authors argue that the strategy does not work for incapacitated patients.

The experts propose the “secure, preserve, fight” strategy in these particular situations, where critical rooms with incapacitated patients serve as secure areas where staff and security personnel can gather, according to Houston Public Media.

Mattox hopes the modified strategy will become a national campaign led by the American College of Surgeons and the Department of Homeland Security.

Two of the authors, who are physicians turned-SWAT officers, have shown the editorial to law enforcement officials, said Mattox.

If you appreciated this article and want to receive more valuable industry content like this, click here to sign up for our FREE digital newsletters!

About the Author


Amy is Campus Safety’s Executive Editor. Prior to joining the editorial team in 2017, she worked in both events and digital marketing.

Amy has many close relatives and friends who are teachers, motivating her to learn and share as much as she can about campus security. She has a minor in education and has worked with children in several capacities, further deepening her passion for keeping students safe.

Leading in Turbulent Times: Effective Campus Public Safety Leadership for the 21st Century

This new webcast will discuss how campus public safety leaders can effectively incorporate Clery Act, Title IX, customer service, “helicopter” parents, emergency notification, town-gown relationships, brand management, Greek Life, student recruitment, faculty, and more into their roles and develop the necessary skills to successfully lead their departments. Register today to attend this free webcast!

One response to “Doctors Propose ‘Secure, Preserve, Fight’ Strategy for Hospital Active Shooters”

  1. Chris says:

    This “new” strategy is simply, “Shelter-in-Place,” which has been a long standing protocol within Active Threat responses in addition to, and before, one decides to Run, Hide, Fight.The last thing that we all need, is yet another acronym or set of steps that are not clear, to add to the growing list of “things to do in an active shooter event.” Dr. Mattox states, “If you run, you are abandoning your patient.,” which is absolutely incorrect and is such a damaging thing to say. Doctors, nurses and other healthcare workers are not trained, equipped or required to stand or engage with an Active Shooter at any time, in any degree of Duty to Act as held up by the courts, CMS and other regulatory bodies. Dr. Mattox’s comment is not only incorrect, but reckless. Being a trauma surgeon, does not make you a tactical expert in combat or active threat events.
    You cannot legislate or dictate they way a person will respond under fire, you may educate, train and exercise while encouraging and supporting your staff’s self-determined choice of action as to whether to Run, Hide or Fight and armed person. The preservation of ALL LIFE is of the utmost importance to include the patients and the lives of those that will care for the injured for many years to come. The 3 action verbs RUN-HIDE-FIGHT have absolutely been proven in shooting after shooting to save lives. Not to convolute the discussion as if you must stay and get shot.
    If you can shelter in place and secure the campus, perfect. If some self-perceives that the danger is too close and must decide to Run-Hide or Fight, then they should be encouraged and not admonished and told they are abandoning their patient.
    What hospital shootings took place where the shooter went into incapacitated patient areas and shot or killed the patients? A number of the shootings that took place where loved ones that, in their own minds, looked to “end the suffering” of the victim loved one. In these instances, the Secure, Preserve, Fight message would have been completely useless, as the event ended prior to any of the step he lays out. Further, if a care taker did, they would have to move into the threat area to do so. Thus not only having the first victim(s) but also making victims uselessly out of the very people that can save the lives of other victims.
    Dr. Mattox refers to the 2017 false report of an active shooter at Houston’s Ben Taub Hospital, where he is chief of staff. Parts of the hospital were evacuated but some staff followed the well-known strategy and chose to run and hide. This comes back to the education of Shelter-in-Place and Run, Hide, Fight. In a large multi-story facility like a hospital, you lock the doors, barricade the entrances and don’t evacuate down as you will more than likely run into the actual event. This isn’t new, but demonstrates Dr. Mattox’s lack of knowledge of prove practices and well as demonstrates his lack of engagement within his own medical facilities’ responses and training, yet he want to educate others. But the greatest egregious remark is stating that care providers are abandoning their patients, that is a careless remark that may cost someone their life if they are fearful of protecting themselves in an active threat situation, because they fear criminal or civil repercussions for not getting shot.

Leave a Reply

Your email address will not be published. Required fields are marked *

Get Our Newsletters
Campus Safety HQ