RISKAlert Report # 1060  Updated:  Aug. 17, 2018                                                 Houston, Texas

PHYSICIANS WANT TO CHANGE HOW HOSPITALS AND CARE FACILITIES RESPOND
TO AN ACTIVE SHOOTER – MASS CASUALTY EVENT  

The New England Journal of Medicine  included an editorial by a group of physicians, including senior author, Kenneth Mattox, MD affiliated with Baylor College of Medicine and Houston-based Ben Taub Hospital, said he hopes the modified strategy will become a national campaign, led by the American College of Surgeons and the Department of Homeland Security.

The physicians want the Department of Homeland Security slogan, Run-Hide-Fight, replaced by a new
strategy for hospitals, which they called, “secure, preserve, fight.”  

According to the group of physicians, “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,” according to the editorial.

The physicians who wrote the editorial studied past active shooter events, and were concerned that many patients in a hospital are not able to evacuate due to their medical issues.  They did say that physicians, staff, patients and visitors should follow the “run, hide, fight” strategy if they can, the authors argue, the strategy does not work for incapacitated patients who may die if abandoned by caregivers who have an ethical duty not to abandon their patients.

One of the challenges they discussed include the actual hospital facility designs, which they said can also present a problem, with reliance on elevators and narrow stairwells, “target-rich chokepoints for a shooter” and large common areas with little furniture, intersecting walls or equipment to hide behind.

The authors recommended a “secure, preserve, fight” strategy that focuses on preparation, with designated areas having devices that can lock and secure doors and entry points. Lifesaving kits to treat excessive bleeding should also be placed throughout the facility.

LESSONS LEARNED:

1.  Hospitals should discuss the care of these immobile patients in an active shooter incident
      and evaluate adding the secure, preserve, fight strategy.

2.  Every hospital should realize that violent is now endemic in healthcare, and should position
lifesaving supplies throughout the healthcare facility, nursing home, or nursing facility.

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