Healthcare News & Insights

6 steps for creating an active shooter plan

From 2000-2011, there were 164 hospital related shootings. While that number means you’re more likely to be struck by lightning than to be shot in a hospital, shootings in and around healthcare grounds do happen and it’s up to hospital administrators to make sure a plan is in place. In this guest post, Scott Cormier, VP of emergency management, environment of care and safety at a facility management company, details six steps that’ll help hospital administrators develop an effective response plan to an active shooter situation. 


Active shooter – No matter where you are, that two-word phrase inspires fear and panic in almost everyone, and it should. An active shooter is an individual or individuals actively engaged in killing or attempting to kill people in a confined and populated area.

Now, imagine that active shooter is within the walls of your hospital.

An active shooter event in the environment of a healthcare facility presents new and unique challenges:

  • healthcare professionals may be faced with decisions about leaving patients
  • visitors will likely be present, and
  • patients and hospital staff may be unable to evacuate due to age, injury, illnesses or a medical procedure in process.

Because of the unpredictable and quickly evolving nature of an active shooter situation, individuals must be prepared to manage it before law enforcement personnel arrive on the scene. These six steps will help hospital staff in creating a plan to effectively respond to an active shooter situation in a healthcare facility.

1. Establish reporting method for active shooter incidents to staff & guests

Research shows that warnings don’t induce panic. People need accurate information and clear instructions. The quick delivery and notification of an incident can keep people out of harm’s way. And that means saving lives. In creating the notification plan, hospital staff need to consider multiple factors to make sure the notification plan is as clear as possible.

Protocols should be available and clearly understood by those responsible for issuing the alert. Make sure communication barriers, such as multi-lingual, hearing impaired and learning disabled messaging, are all considered in the reporting method. Electronic communications, such as text messages or email, are effective provided the language uses familiar terms and considers the issues mentioned above. Other methods include the use of sounds or lights as notification.

When choosing notifications, stakeholders should also consider hospital workers in locations outside of main buildings or in more remote areas of the hospital grounds. Another critical aspect is the ability to alert other local hospitals and emergency responders – as well as letting patients, visitors and staff know when the hospital grounds are safe once again.

2. Create emergency escape procedures & route assignments for healthcare staff

The golden rule is less people in the hot zone means less victims. In fact, according to the Healthcare and Public Health Sector Coordinating Council, an evacuation policy and procedure, as well as emergency escape procedures and route assignments, are among the items that must be included in an effective plan.

Because of that, active shooter plans should identify safe areas and provide floor plans of the entire healthcare network. It also should include secondary and, if possible, tertiary routes for when the primary evacuation routes are unusable.

3. Establish lockdown procedures for individual units, locations & other buildings

Hospital grounds normally include multiple buildings and wings. In fact, in research conducted by John Hopkins University of Medicine in Baltimore, 40% of all the hospital-based shootings occurred outside of hospital buildings.

In creating an active shooter plan, teams should consider how to effectively lockdown patients, visitors and staff to keep them safe, making sure to take into account access to functional safety needs when advising on shelter sites.

In terms of shelter sites, effective shelter-in-place locations should be carefully selected. Optimal location characteristics include thick walls, solid doors with locks, minimal interior window, first-aid emergency kits, communication devices, and telephones or duress alarms.

4. Integrate plan with facility Emergency Operations Plan & Incident Command System 

An active shooter plan should be integrated with both the hospital’s Emergency Operation Plan (EOP) and Incident Command System (ICS). Hospitals are required to have an EOP which describes how a facility will respond to and recover from all hazards. It’s inclusive of the following six critical elements within the Joint Commission’s Emergency Management Standards:

  • communications
  • resources and assets
  • safety and security
  • staff responsibilities
  • utilities and clinical
  • support activities

An ICS is a management system designed to enable effective and efficient domestic incident management by integrating a combination of facilities, equipment, personnel, procedures and communications operating within a common organizational structure.

5. Establish pertinent info for emergency response agencies & hospitals

Pertinent information for other local hospitals and emergency response agencies may include items such as telephone numbers, names and distance from the active shooter location. Having this information collected and easily accessible during an emergency has the potential to help teams act quickly when time is at a premium.

6. Maintain plan with ongoing training

Ongoing training is an important part of ensuring everyone involved shares the most up-to-date resources. Training shouldn’t be limited to one approach, consider using methods such as annual competencies, monthly newsletter, orientation and training videos.

Patient safety demands safe facilities. Part of that includes the creation and implementation of a smart, effective active shooter plan. While there may never be a need to enact it, planning for the unexpected will keep hospital staff, patients and visitors safe.

Hospitals and healthcare facilities save lives every day. Why should this be any different?

Scott Cormier is VP of emergency management, environment of care (EOC) and safety at Medxcel Facilities Management, specializing in facilities management, safety, environment of care and emergency management.



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