An active shooter is defined as an individual who is actively
engaged in killing or attempting to kill people in the hospital
or on the hospital campus. In most cases active shooters use a
firearm(s) and display no pattern or method for selection of
their victims. In some cases active shooters use other weapons
and/or improvised explosive devices to cause additional victims
and act as an impediment to police and emergency responders.
Active shooter events in a healthcare setting present unique
challenges: a potentially large vulnerable patient population,
hazardous materials (including infectious disease), locked units,
special challenges (such as weapons and Magnetic Resonance
Imaging (MRI) machines (these machines contain large magnets
which can cause issues with firearms, or remove it from the hands
of law enforcement), as well as caregivers who can respond to
treat victims. There is no single method to respond to an
incident, but prior planning will allow you and your staff to
choose the best option during an active shooter situation, with
the goal of maximizing lives saved. For hospitals and healthcare
care systems, the HSCC has provided the updated guidance document
“2017 Active Shooter Planning and Response in a Healthcare
HASC developed the Security and Safety Active Shooter Drill Tool
Kit to create greater awareness of workplace violence among
hospitals and other health care facilities, and to provide the
tools necessary for each facility to develop a plan that leads to
a safer, more prepared environment.
Based on an active shooter drill held at LAC + USC Medical Center
in March 2013, the materials feature templates, checklists,
industry guidelines, scenarios, safety rules, participant
releases and staffing suggestions for planning a similar event.
This video also provides a firsthand account of the HASC drill
with scenes from the simulated attack in clinical and office
This instructive video demonstrates possible actions to
take if confronted with an active shooter scenario. The video
reviews the choices of evacuating, hiding, or, as an option of
last resort, challenging the shooter. The video also shows how to
assist authorities once law enforcement enters the scene.
Terrorist attacks have a profound emotional and physical effect
on a community. While preventing these attacks would
be preferred, agencies must work swiftly and cohesively to
improve patient outcome when an attack does occur.
Read full discussion paper.
The Centers for Disease Control and Prevention (CDC) recently
announced the release of a new Blast Injury mobile application to
assist in the response and clinical management of injuries
resulting from terrorist bombings and other mass casualty
explosive events. The application provides clear, concise,
up-to-date medical and healthcare systems information to assist
healthcare providers and public health professionals in the
preparation, response, and management of injuries resulting from
terrorist bombing events.
CHA commends the hospitals that received and treated patients
from the active shooter tragedy that occurred in San Bernardino
County this week, and is proud of the hospitals and health
systems that have planned and trained with law enforcement
agencies, local emergency medical services and fire agencies in
preparing for and responding to such incidents. Additionally, CHA
encourages all hospitals to utilize the multitude of resources
that are available on the CHA emergency preparedness website. In
addition to the existing CHA planning and training for active
shooter resources and links, UCSF Medical Center has recently
shared its training video and template table top exercise to
assist other hospitals.
In the wake of the Newtown, Connecticut shooting, the CHA
Hospital Preparedness Program (CHA-HPP) released its most
recently developed tool “Hospital Code Silver Activation – Active
Shooter Planning Checklist”. The checklist is provided to support
hospital efforts in reviewing and developing active shooter
This resource was initially developed to support the CHA-HPP
course “Planning and Training for Active Shooter Events”.
The tool was developed with key advisements from agencies such as
FEMA, Department of Homeland Security and the International
Association for Healthcare Security and Safety.
The California Hospital Association’s Hospital Preparedness
Program has developed a course for the active shooter incident. A
course by and for hospitals which helps participants review
organizational aspects of planning and training to increase
survivability of patients, visitors and staff in an active
The City of Houston, Texas, has produced a six-minute, graphic
video on what to do when encountering an active shooter. The
video is entitled “Run-Hide-Fight: Surviving an Active Shooter
Event” and was produced with a $200,000 grant from the U.S.
Department of Homeland Security.
This 90-minute webinar can help private and public sector
personnel understand the importance of developing an emergency
response plan and the need to train employees on how to respond
if confronted with an active shooter.
The presentation describes the three types of active
shooters–workplace/school, criminal, and ideological–and how
their planning cycles and behaviors differ.
All employees can help prevent and prepare for potential active
shooter situations. This course provides guidance to individuals,
including managers and employees, so that they can prepare to
respond to an active shooter situation.
This course was written for non-law enforcement personnel. The
material may provide law enforcement officers information on
recommended actions for non-law enforcement employees to take
should they be confronted with an active shooter
situation. Upon completing this course, the participant will
be able to:
Describe actions to take when confronted with an active
shooter and responding law enforcement officials.
This report was published by the Annals of Emergency Medicine
(Volume 60, Issue 6, December 2012, Pages 790–798.e1) and
was presented, in part, at the Society for Academic Emergency
Medicine annual meeting, May 2012, Chicago, IL.
July 2012 – For emergency managers, events such as these
are mass casualty events. There will be a regional response
from all first responders, police and emergency medical
technicians. Hospitals will need to gear up to receive
victims, the dispatching of patients to multiple hospitals will
need to be orchestrated by a Hospital Control entity. In
this case the event happened late at night. Command staff
are not present and it is important that those on duty have the
training and knowledge to respond to a larger event and initiate
proper command and control procedures.