Special Report: Responding to Active Shooters in Hospitals

TORRANCE, Calif.—In June, the Joint Commission issued a Sentinel Event Alert, urging hospitals to pay greater attention to violence issues and to control access to facilities. When the alert was first released, healthcare facility security practitioners believed the alert’s impact would not be significant.

Or will it? In recent months, hospitals throughout the nation have experienced active shooter and hostage incidents. For example, just last week, a disgruntled visitor, upset with the treatment his mother was receiving at Johns Hopkins Hospital, shot a doctor before killing his mother and then himself. A few weeks prior to that incident, a former soldier, seeking mental health care, took three people hostage at Winn Army Community Hospital in Georgia. Furthermore, numerous hospital workers nationwide have expressed concerns about violent assaults against healthcare workers.

To add to the aforementioned woes, the recent results of Campus Safety’s “How Safe Is Your Campus” survey show that 40 percent of hospital respondents believe they would not be able to respond effectively if an active shooter or bomber came onto their campuses.

Though no one can truly be prepared for an active shooter attack, there are ways that hospital staff can be better prepared if such a situation occurs.

Improve Access Control and Visitor Management

Because hospitals allow open visiting for patients, oftentimes it’s hard to decipher if a visitor has plans to do harm. In many hospitals, a visitor is asked to sign in and state the reason why he/she is at the facility. However, healthcare facility security consultant Russell Colling believes access control should be improved.

“By access control, a lot of people think it just means a lot of locked doors that people can’t get through, but it goes beyond that,” he explains to Campus Safety. “Access control is asking [visitors] what their business is. Once people get in the medical care facility, we need to pay more attention to them. It’s not just screening them at the front door and finding out their business once they are inside because although [hospitals] have locked areas that control access to a degree, in general, [patients and visitors] can wander into lots of areas.”

Colling adds that monitoring visitor activity is not the sole responsibility of security personnel; rather, it is a group effort, especially with 41 percent of survey respondents stating that they don’t have enough security staff to handle incidents.

He maintains that various hospital workers in all departments should be aware of their surroundings and take note if they notice any suspicious behavior of unknown persons. If a staff member notices that a person appears agitated or is acting strangely, Colling suggests that employee ask for assistance from another staff member to further examine the situation, or to discuss concerns with other team members instead of simply dismissing the problem.

Don Alwes, a lead instructor for the National Tactical Officer Association (NTOA), agrees that writing off an initial concern could lead to more extreme issues. Thus, he suggests designing a threat management group or committee so hospital employees can voice their concerns, if one is not already in place.

International Association for Healthcare Security and Safety (IAHSS) President and Memorial Hermann Health System Assistant Executive for security Joe Bellino concurs.

“Security staff is not solely responsible for safety and security,” he says. “Every employee is responsible, and training everyone is key to ensuring they understand their role in these types of situations as well as other traditional security emergencies.”

Non-Security Staff Must Receive Training

Speaking of training, 32 percent of respondents stated they don’t believe their hospital’s security officers have received enough instruction. Bellino does not take this response lightly.

“[There are] no excuses for security not receiving proper training in today’s environment,” he exclaims. “The IAHSS provides a great foundation for the training component. Certified, well trained officers are one of the key factors in these events in order to respond effectively and efficiently.”

To an extent, Colling agrees with Bellino’s statement, explaining that in his experience, security officers often complain about not having enough/proper training, but when the classes are offered, no one shows up. To combat this, Colling says training will have to be mandated in order for staff members to receive the most up-to-date information.

As Bellino stated, training ALL employees on what to look out for is essential, but Alwes notes that the hardest task is getting hospital staff members outside of security personnel to realize that hospital protection is their responsibility, not just the security department’s. Alwes explains that while emergency departments are one of the most dangerous work environments in the United States, outside of that area, most hospital departments don’t really deal with those issues. Thus, it is harder for those staff members to grasp the potential threats of an active shooter hospitals can face.

“We’ve got to get everyone onboard with the idea of, ‘We’re trying to give the best patient care possible, but we have to be aware that someone connected to the patient, or someone totally disconnected with the hospital can walk in this door and start killing people,’” he says.

Alwes suggests hospital employees should be trained to look out for indications that a person will become violent.

“I think one of the best things that you can do is to train your staff on what to look for and how to recognize someone who might present a problem so you get as much early notification as possible,” he says. “[Hospital administrators] can spend a lot of money on camera systems and metal detectors – and it does buy you some level of protection – but it doesn’t seem to buy as much protection as people think. Training an alert staff that knows what to look for and feels [comfortable alerting] someone when there may be a dangerous situation developing, is probably just as much bang for the buck in security.”

Build Your Relationships With Law Enforcement

With 44 percent of survey respondents stating they don’t have enough and/or the right type of lethal and less lethal weapons, it is critical to build relationships with local law enforcement agencies, especially in regards to active shooter events

Bellino recommends administrators reach out to law enforcement agencies and other jurisdictions before an incident occurs. He suggests sharing all policies and procedures with agencies, and allowing for criticism and feedback.

“In the past, I have had police and fire departments approve my various security and life-safety plans,” Bellino says. “It is all about building relationships resulting in mutual respect and trust.”

It should be mentioned, however, that it can be challenging for hospitals to team up with law enforcement. As mentioned before, hospital security personnel are often short-staffed, but it should also be noted that police departments are also lacking in their workforce due to budget cuts, so it might not be as simple as calling a department and exchanging ideas.

Alwes, who is currently training law enforcement officials on responding to active shooters, has urged police to go out into their communities and work with potential active shooter targets, such as hospitals, K-12 schools and universities. However, he stresses that it’s not just the law enforcement agencies’ responsibility to make the relationship work or even get it started. Alwes encourages hospital officials to make the first move by simply picking up the phone and contacting the agency.

“If you call and get a watch commander who doesn’t get back to you, don’t take no for an answer,” he says. “Call the chief’s office and say, ‘We want to work with you.’ Make sure they know they lines of communication are open.”

Look for the full results of Campus Safety’s “How Safe Is Your Campus” survey in the 2011 Yearbook.

Ashley Willis is associate editor of Campus Safety Magazine.


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