Active Shooter at Work: How to Prepare

About this course

Gun violence is ever present, and as a result, active shooting incidents are on the rise. The Federal Bureau of Investigation (FBI) defines an active shooting event as one where an armed individual is killing or attempting to kill people in a building or specific area with any firearm, such as an assault rifle. This course will discuss the various factors that influence active shooter events in healthcare settings, the profile of an active shooter, and how facilities and individuals can prepare and develop a plan of action to minimize the danger.

Learning objectives

• Define an active shooting event as described by the Federal Bureau of Investigations.
• Discuss factors that influence active shooter events
• Identify behaviors of a potential active shooter
• Review how healthcare staff can prepare for an active shooter event
• Understand steps to improve survival in an active shooting

Course outline

16 sections · finish in any order across devices

1. 1

   Introduction

   In the US, gun violence is ever present, and as a result, active shooting incidents are on the rise.1 The Federal Bureau of Investigation (FBI) defines an active shooting event as one where an armed individual is killing or attempting to kill people in a building or specific area with any firearm, s

   4 min

2. 2

   Active Shooters in Healthcare Settings

   Given the comparatively lower number of active shooter incidents, identifying meaningful patterns about active shooters in healthcare settings is difficult. However, widening the scope and analyzing all healthcare-based shootings provides valuable insight into vulnerable areas, targeted individuals,

   4 min

3. 3

   Intentions for Shooting

   Law enforcement agencies cite several types of intent for workplace active shootings: 12

   4 min

4. 4

   Preparation for an Active Shooting

   Preparing for an active shooter is critical in a healthcare setting, not only to prevent deaths and injuries but also to keep the facility operational, especially if patients are admitted, or surgeries are underway. If an active shooter is intent on causing chaos, areas such as emergency departments

   4 min

5. 5

   Active Shooter Behaviors

   Currently, there is no clear profile of an active shooter.1 However, researchers have studied the behaviors and patterns of previous offenders to identify certain traits, observable behaviors, and signs that are prevalent among active shooters. With an understanding of these behaviors, healthcare pe

   4 min

6. 6

   Signs of Aggression and Potential Workplace Violence

   Along with the warning behaviors described in the section above, there are other subtle signs of aggression every person should look out for in their healthcare workplace, in co-workers, patients, and visitors.11 Among patients and visitors, be wary of erratic and irrational behavior, especially aft

   4 min

7. 7

   Preparation Through Active Training Exercises

   There is a great deal of uncertainty in an active shooter situation, with conditions changing minute by minute. There are always loud noises from gunfire, screams, explosions, and alarms which combine to create a highly stressful environment. It is natural for anyone in this situation to feel fear,

   4 min

8. 8

   What to Do If a Shooting Occurs in a Healthcare Setting

   The FBI and Department of Homeland Security (DHS) have developed a three-point plan that every workplace must adhere to in the event of an active shooting. Known as “Run, Hide, Fight,” this protocol lists the order of actions individuals should follow considering their circumstances. 1,2

   4 min

9. 9

   Run

   Following the survivalist mindset, the first line of action should be to evacuate the healthcare facility as quickly as possible if there is an accessible exit path available. To do this safely, it is critical to know all the exits nearby and have a clear escape route in mind. All personal belonging

   4 min

10. 10

    Hide

    If it is impossible to evacuate the facility, the next course of action is to hide in a place where an active shooter is least likely to discover. Ideally, it should still provide an opportunity to escape if the chance becomes available.

    4 min

11. 11

    Fight

    Fighting the active shooter is a last resort and should only be done when life is in imminent danger. The consequences of a failed attempt are life-threatening, so you should commit fully to actions. Be aggressive, forceful, and vocal to distract and confuse the active shooter. Yell and improvise we

    4 min

12. 12

    Know the Codes at Your Workplace

    Every healthcare facility uses color codes to define emergencies.27 These are communicated through an intercom system, thus allowing personnel to respond quickly to various events without creating panic among patients and visitors. It is critical for every person working in a healthcare setting to k

    4 min

13. 13

    Description

    Blue

    4 min

14. 14

    Get Involved in Your Organization

    Healthcare providers and staff participating actively in their workplace’s active shooter plans and responses assist in raising the overall level of preparation. Important steps include actively participating in training activities, by asking questions to improve communication, and practicing drills

    4 min

15. 15

    Nursing Considerations

    In the event of an active shooter, several nursing considerations must be considered. Nurses may find themselves in a situation where self-survival involves leaving their patients.11 This can be particularly difficult to do if those patients are in critical states, such as those in NICUs, dialysis u

    4 min

16. 16

    Conclusion

    In recent years, active shooter incidents have become more common in workplaces, and as a result, healthcare facilities must be prepared.1 In most cases of active shooters in healthcare, the shooter has a personal grudge against a doctor or employee and is often emotionally unstable. Preparation is

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• Active shooter planning and response in a healthcare setting. (2017, January 24). Federal Bureau of Investigation. https://www.fbi.gov/file-repository/active_shooter_planning_and_response_in_a_healthcare_setting.pdf/view
• US Department of Homeland Security. (2009). Active Shooter - How to Respond. https://www.dhs.gov/xlibrary/assets/active_shooter_booklet.pdf
• Hospitals & Healthcare Facilities Security Awareness for Soft Targets and Crowded Places ACTION GUIDE. (n.d.). https://www.cisa.gov/sites/default/files/publications/19_0515_cisa_action-guide-hospitals-and-healthcare.pdf
• Kelen, G. D., Catlett, C. L., Kubit, J. G., & Hsieh, Y.-H. (2012). Hospital-Based Shootings in the United States: 2000 to 2011. Annals of Emergency Medicine, 60(6), 790-798.e1. https://doi.org/10.1016/j.annemergmed.2012.08.012
• Wax, J. R., Cartin, A., Craig, W. Y., & Pinette, M. G. (2019). US acute care hospital shootings, 2012-2016: A content analysis study. Work (Reading, Mass.), 64(1), 77–83. https://doi.org/10.3233/WOR-192970
• Active Shooter Incidents in the United States in 2018 | Federal Bureau of Investigation. (2018). Federal Bureau of Investigation. https://www.fbi.gov/file-repository/active-shooter-incidents-in-the-us-2018-041019.pdf/view
• Active Shooter Incidents in the United States in 2019. (n.d.). Federal Bureau of Investigation. https://www.fbi.gov/file-repository/active-shooter-incidents-in-the-us-2019-042820.pdf/view
• Active Shooter Incidents in the United States in 2020. (n.d.). Federal Bureau of Investigation. https://www.fbi.gov/file-repository/active-shooter-incidents-in-the-us-2020-070121.pdf/view
• FBI. (2022). Active Shooter Incidents in the United States in 2021. Federal Bureau of Investigation. https://www.fbi.gov/file-repository/active-shooter-incidents-in-the-us-2021-052422.pdf/view
• Active Shooter Incidents in the United States in 2022. (n.d.). Federal Bureau of Investigation. https://www.fbi.gov/file-repository/active-shooter-incidents-in-the-us-2022-042623.pdf/view
• Schwerin, D. L., & Goldstein, S. (2020). Active Shooter Response. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519067/
• Types of Workplace Violence | WPVHC | NIOSH. (2020, February 7). Wwwn.cdc.gov. https://wwwn.cdc.gov/WPVHC/Nurses/Course/Slide/Unit1_5
• 1 dead, 4 injured in shooting at Minnesota health clinic. (2021, April 20). AP NEWS. https://apnews.com/article/multiple-people-shot-clinic-minnesota-1385ed48500db468259680cf20469c04
• Landry, G., Zimbro, K. S., Morgan, M. K., Maduro, R. S., Snyder, T., & Sweeney, N. L. (2018). The effect of an active shooter response intervention on hospital employees’ response knowledge, perceived program usefulness, and perceived organizational preparedness. Journal of Healthcare Risk Management, 38(1), 9–14. https://doi.org/10.1002/jhrm.21313
• ‌4 killed in shooting at Tulsa medical building, shooter dead. (2022, June 1). AP NEWS. https://apnews.com/article/tulsa-oklahoma-c29a239d1c2ac7f7f0bfdc161b72f6f2
• Active Shooter Incidents in the United States in 2016 and 2017 | Federal Bureau of Investigation. (2016). Federal Bureau of Investigation. https://www.fbi.gov/file-repository/active-shooter-incidents-us-2016-2017.pdf/view
• Chicago hospital shooting claims 3 lives; gunman also dead. (2021, April 21). AP NEWS. https://apnews.com/article/shootings-us-news-il-state-wire-rahm-emanuel-ap-top-news-dc38f7411db644fba3a6419f21abf69e
• Active Shooter Incidents in the United States in 2014 and 2015. (n.d.). Federal Bureau of Investigation. https://www.fbi.gov/file-repository/activeshooterincidentsus_2014-2015.pdf/view
• Planned Parenthood shooting suspect insists he’s competent. (2021, April 20). AP NEWS. https://apnews.com/article/ap-top-news-shootings-us-news-state-courts-denver-517b4cd2b04c910b449a6a32527f822d
• The cost of surviving gun violence: Who pays? (n.d.). AAMC. https://www.aamc.org/news/cost-surviving-gun-violence-who-pays
• Security Violation. (n.d.). Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/news/media/releases/firearm_related_injuries_account_for_28_billion_on_emergency_room_and_inpatient_charges_each_year
• Landry, G., Zimbro, K. S., Morgan, M. K., Maduro, R. S., Snyder, T., & Sweeney, N. L. (2018). The effect of an active shooter response intervention on hospital employees’ response knowledge, perceived program usefulness, and perceived organizational preparedness. Journal of Healthcare Risk Management, 38(1), 9–14. https://doi.org/10.1002/jhrm.21313
• Simons, A., & Meloy, J. R. (2017). Foundations of Threat Assessment and Management. Handbook of Behavioral Criminology, 627–644. https://doi.org/10.1007/978-3-319-61625-4_36
• Reid Meloy, J., Hoffmann, J., Guldimann, A., & James, D. (2011). The Role of Warning Behaviors in Threat Assessment: An Exploration and Suggested Typology. Behavioral Sciences & the Law, 30(3), 256–279. https://doi.org/10.1002/bsl.999
• Akiyama, C. (2020). Surviving an Active Shooter Incident in the Intensive Care Unit. Critical Care Nursing Quarterly, 43(1), 3–8. https://doi.org/10.1097/cnq.0000000000000286
• Scott‐Herring, M. (2022). Active Shooter Preparedness: Is Your OR Ready? AORN Journal, 115(6), 546–551. https://doi.org/10.1002/aorn.13691
• Mapp, A., Goldsack, J., Carandang, L., Buehler, J. W., & Sonnad, S. S. (2015). Emergency codes: a study of hospital attitudes and practices. Journal of Healthcare Protection Management: Publication of the International Association for Hospital Security, 31(2), 36–47. https://pubmed.ncbi.nlm.nih.gov/26411048/
• Giwa, A., Milsten, A., Vieira, D., Ogedegbe, C., Kelly, K., & Schwab, A. (2020). Should I Stay or Should I Go? A Bioethical Analysis of Healthcare Professionals’ and Healthcare Institutions’ Moral Obligations During Active Shooter Incidents in Hospitals — A Narrative Review of the Literature. The Journal of Law, Medicine & Ethics, 48(2), 340–351. https://doi.org/10.1177/1073110520935348

Update history