What's your plan for an active shooter in your ED?

[The White Coat Investor]

Okay, you're sitting at the desk typing away into the EMR, some dude comes in from triage and starts shooting. What do you do? Does your plan change if you discharged the guy a half hour ago after telling him 5 times that you're not giving him Percocet? Does your plan change if your hospital is a "gun-free zone" like mine? What is your duty to your patients? To your family? Do you try to talk? Do you run and hide? Do you attack? Do you have a "panic button"? Does it work? Are your security guards armed? What is the police response time to your ED?

Police: Hospital gunman fired many shots, killed himself

Police: Armed man shot, critically injured at Cache Valley Hospital

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[link2swim06]

Well I have a city police officer in my ED. So hopefully the shooting wouldn't last long.

But if I wasn't armed I try to run or hide. Its going to be a losing battle to go against someone who has a gun (if you are unarmed). After the threat is cleared by PD, then you can try to help victims.

 

[TheComebacKid]

You can save the most lives if you are alive. Grab as many turkey sandwiches as possible and go wait in the dirty utility room where all the bedside commodes are. No one will find you there. Once you get the all clear, go back to saving lives.

 

[southerndoc]

Luckily we have a police officer in our ER at all times along with 4-5 armed security guards (guns and tasers). The hospital still hasn't installed a metal detector despite our numerous requests.

Unless you have a way to defend yourself, it's best to take cover and not confront the person. You'll only end up dead and then you won't be able to help victims.

More than likely, an active shooter in a hospital is going to be shooting at the healthcare workers and not the patients. Most attacks at hospitals have been targeted.

 

[Janders]

No police in my ED.
Guards, when around, are completely un-armed.

The police station is next door; they do come running quickly but it will be at least 2-3 minutes.

There is a panic-phone that is directly connected to the police station, and its along the best route out of the department if you are fleeing...

There is a different panic button to alert the security booth out by the lobby near the Unit Coordinator's seat, but frankly that won't be super useful with a gunman.

So i do have an exit strategy (i.e. route) and a couple of other options if it is blocked, and a couple spots that have solid lockable doors without windows that would make OK hiding spots if I am stuck in those corners of the ED. Yes, I have purposefully walked this through, and I would encourage everyone else to do so in their ED.

Odds are I'm high-tailing it out of here, and at best am alerting the cops on the way out the door. And I'm telling everyone else to run as well.

But its a pretty small ED, and the quarters are tight, so it would be very feasible that a confrontation would rapidly unroll in a manner that doesn't allow for a rapid running escape. As such it might become a charge-the-gunman-from-4-directions-at-once event. Suboptimal.

 

[Raryn]

Get the hell out of dodge, hopefully through a door that takes a badge to open.

 

[deleted480308]

It’s a shame so many places don’t allow staff to carry

 

[miacomet]

Don't you guys have mandatory drills? We have them, and I would follow their advice.

This is what makes Australia and NZ appealing.

 

[Rendar5]

Even if I were armed, the answer is the same, GTFO. There are 3 exits in the ed all opposite each other. We have armed police officers in my ED to respond who are trained to deal with a gunman.

 

[RustedFox]

No cops at my shop.
Security is unarmed, and is either a 60-something with exertional dyspnea s/p CABG, or a millennial with mommy-issues.
I'm hosed. Good thing the doc workstation is in the back with three exits really close and bathrooms that lock from the inside.

 

[Angry Birds]

Cry and soil myself. Then run and hide.

 

[theseeker4]

Are there any hospitals that would allow anyone other than police/security to carry a gun? I can't imagine any hospital actually allowing that (even though they should).

At my residency hospital there are numerous armed security guards, who are full police officers, who carry guns and tasers. Any active shooter would be quickly confronted and shot, probably before I even had time to try to retreat/react. If someone confronted me with a gun, I would do my best to talk them down and/or stall them to allow security to respond. If they were actively shooting right in front of me, I would either attack them with whatever I could if I had the opportunity, or GTFO if I didn't think I had a prayer of closing the distance before they noticed me coming. Obviously my actual reaction would possibly differ if actually facing this situation instead of sitting behind a computer typing about it, but there you go.

 

[Cinclus]

We have a plan for what to do if there is an active shooter in the hospital (not necessarily in the EC). It essentially involves locking and barricading all of the doors into and within the EC and then taking cover yourself in another locked room. We actually had to do this not long ago for a real hospital active shooter situation. But if they were in the EC, I would just RUN. I know where all my exits are and how to get outside as fast as possible

 

[WilcoWorld]

Run.

If you can't run, hide.

If you can't hide, fight.

 

[miacomet]

Run hide fight. Don't your places have drills?

 

[TooMuchResearch]

Run, hide, fight.
No police in any of my current EDs.
Large amount of unarmed (they have tasers) security in the big ED. One security guard on site in the smaller ones except maybe the smallest one.
You don't stay with the patients unless your goal is to create more casualties.
Yes, we have panic buttons and they do work.

 

[MechEDoc]

Why aren't EDs built like inner city 7-11s? Bullet proof glass and the like. It would save me from being interrupted when pondering an EKG by a annoying family member asking for where the bathroom is.

I did work in an ED where security had K9s. They used them to chase an Alzheimer's patient back into their room. I felt sick to my stomach. Glad that didn't make YouTube.

 

[Angry Birds]

Why aren't EDs built like inner city 7-11s? Bullet proof glass and the like. It would save me from being interrupted when pondering an EKG by a annoying family member asking for where the bathroom is.

I did work in an ED where security had K9s. They used them to chase an Alzheimer's patient back into their room. I felt sick to my stomach. Glad that didn't make YouTube.

Militarizing the ER like that would increase hostility levels all around. There are studies on this phenomenon.

The truth is that shootings are uncommon, and the harms from militarization of the ER are probably higher than the benefits.

 

[gro2001]

I did work in an ED where security had K9s. They used them to chase an Alzheimer's patient back into their room. I felt sick to my stomach. Glad that didn't make YouTube.

Wow. That is... wow.

 

[alpinism]

Are there any hospitals that would allow anyone other than police/security to carry a gun? I can't imagine any hospital actually allowing that (even though they should).

At my residency hospital there are numerous armed security guards, who are full police officers, who carry guns and tasers. Any active shooter would be quickly confronted and shot, probably before I even had time to try to retreat/react. If someone confronted me with a gun, I would do my best to talk them down and/or stall them to allow security to respond. If they were actively shooting right in front of me, I would either attack them with whatever I could if I had the opportunity, or GTFO if I didn't think I had a prayer of closing the distance before they noticed me coming. Obviously my actual reaction would possibly differ if actually facing this situation instead of sitting behind a computer typing about it, but there you go.

Multiple night docs at DRH carry guns.

Not exactly sanctioned by admin but its common knowledge.

 

[medic4lyfe]

.

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[The Knife & Gun Club]

When I was a medical assistant at a big inner city hospital in Atlanta, we had active shooters maybe once a year. They were usually gang related though - not an unhinged person just mowing down everyone. Luckily no one every actually made it into the ED, closest was the ambulance bay (and they didn’t actually discharge the weapon, just drew it).

Everyone just did the usual run, fight, hide thing, while hospital police took care of the situation.

 

[OnlyOneZlatan]

Nobody walks into our shop or the nearby ones without walking through an airport metal detector or getting wanded by a police officer or security guard as they go looking through your things. You could probably assume what city I am from, the true club

 

[MechEDoc]

Perhaps I'm dense, but the sign to the entrance where I work says not weapons. So far that's solved the problem in every ED I've worked in. People aren't shooting them up because they're not allowed to bring in guns!!! You need more laws making ignoring the sign illegal!

 

[Mighty Mouse]

One addendum to the above (from an ACEP lecture I heard in 2015)

1) Run
2) If can't run, then hide
3) If can't hide, then fight

but if you choose to stay with your patient, you will die with your patient.

 

[Redrox]

In residency each doc desk had a panic button (that I kept hitting with my knee accidentally) which would cause police officers to swarm pretty dang quick, felt very comforting.

 

[Apollyon]

In residency each doc desk had a panic button (that I kept hitting with my knee accidentally) which would cause police officers to swarm pretty dang quick, felt very comforting.

It happened more than once? In my town, for example, for the first false alarm/accidental trip of a burglar alarm, for which police respond, it's a freebie. However, for the second and thereafter, it's a $50 fine.

If you triggered the active shooter panic button more than once, when there wasn't one, I am surprised that security/police didn't have a chat with you.

Just wondering.

 

[shoal007]

It happened more than once? In my town, for example, for the first false alarm/accidental trip of a burglar alarm, for which police respond, it's a freebie. However, for the second and thereafter, it's a $50 fine.

If you triggered the active shooter panic button more than once, when there wasn't one, I am surprised that security/police didn't have a chat with you.

Just wondering.

They understand. The unwritten rule for police, don't piss off doctors or nurses as they might not take care of you when needed. Obviously false, but it's why we can get out of traffic tickets.

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[Redrox]

Cops were in house (rough town) and never minded, found my confusion and embarrassment entertaining.

Oh crap what's going on, did some one call you guys ??!

You, dude. You again.

Lunch on me again ?

Let's do pizza this time.

 

[Birdstrike]

First, get armed guards in your hospital, if able. In regards to this below quote:

One addendum to the above (from an ACEP lecture I heard in 2015)

1) Run
2) If can't run, then hide
3) If can't hide, then fight

but if you choose to stay with your patient, you will die with your patient.

I'd like to propose a #4, which is, "If you can't do 1, 2 or 3, then play dead."

Not joking. There are so many examples of this actually working, that it probably needs to be moved up to #3 on the list.

Texas Church Attack Victim Survived by Playing Dead as Gunman Looked for 'More People to Shoot'

5-Year-Old Girl Survived Charleston Shooting By Playing Dead, Family Member Says | HuffPost

https://nypost.com/2017/01/02/i-stayed-alive-by-playing-dead-during-nightclub-shooting/

6-Year-Old Survived Newtown School Shooting By Playing Dead

Or you can get some bullet proof armor, like the one's I just ordered from a cop-friend of mine, which are in my kids' backpacks, right now (total parental paranoia and unnecessary, I know, but whatever, I can afford it, and you just never know.) Therefore, my kids version of rule #1 is, "1) Put on your 'magic backpack' and Run."

I suppose you could also get your CWP (which I have) and conceal-carry at work (which I do not do) but most hospitals and states do not allow concealed carry in hospitals, even by MDs. And this makes no sense to me, for the government to bar MDs from otherwise legal and licensed concealed carry at their workplace. What are they afraid of? Doctors might have to make life and death decisions?

 

[BAM!]

I'm using grandma SNF'er as a body shield as I bee-line for the exit!

 

[Dr.Jekyll75]

B52 dipped needles as i shoot them through my straw shooter. Rural ER cant afford the glock =/

 

[precisiongraphic]

I'd like to propose a #4, which is, "If you can't do 1, 2 or 3, then play dead."

Not joking. There are so many examples of this actually working, that it probably needs to be moved up to #3 on the list.

Texas Church Attack Victim Survived by Playing Dead as Gunman Looked for 'More People to Shoot'

5-Year-Old Girl Survived Charleston Shooting By Playing Dead, Family Member Says | HuffPost

https://nypost.com/2017/01/02/i-stayed-alive-by-playing-dead-during-nightclub-shooting/

6-Year-Old Survived Newtown School Shooting By Playing Dead

Yes, I also noticed this. Almost all of the last shootings (Those listed above plus Parkland, Umpqua Comm College, Battaclan, Turkish Nightclub New Year) had survivors that survived by playing dead. Drawbacks are you have to wait until others or you are shot first, there's blood around and other random things like being in the right place at the right time.

 

[coffeebythelake]

Cry and soil myself. Then run and hide.

i would argue that you could do all these things at the same time. doesn't have to be one after another...

 

[DocRPP]

I had to take mandatory training before starting one of my ED rotations, on what to do when there is an active shooter in the hospital. The take-home message of the training for me was basically run, hide or fight as others have mentioned.
1. If there is an active shooter but he/she is far away, evacuate the patients and run. Once safe, call 911.
2. If it is not possible to run because there are no safe ways to run or if the shooter is too close, take shelter in an area that can be closed down. Switch off all the lights, put phones in silent mode, arm yourself with whatever is available in that room, stay away from doors, block the doors with heavy objects and call 911.
3. If you are directly in confrontation with a shooter 100% take action. Throw stuff at him, such as keys staplers, etc to distract, disorient or incapacitate the person. Discharging a fire extinguisher is also supposed to be very effective. Once the shooter is down, call 911.
I do not know how practical/effective these measures are I never had to face a shooter situation.

 

[bravotwozero]

I did work in an ED where security had K9s. They used them to chase an Alzheimer's patient back into their room.

While I agree that's terrible, I laughed so hard when I read that. Haven't done so in ages. Thanks for that.

 

[engineeredout]

If its good enough to protect you against a nuclear missile, it should work for an active shooter right?

 

[WilcoWorld]

If its good enough to protect you against a nuclear missile, it should work for an active shooter right?

Dude, Bert looks wasted.

 

[Birdstrike]

While I agree that's terrible, I laughed so hard when I read that. Haven't done so in ages. Thanks for that.

Apparently Alzheimer's disease doesn't totally destroy the portion of the amygdala that tells us a drooling, barking, tooth-gnashing German Shepherd needs to be respected.