Are Physicians, Nurses Obligated To Protect Patients During An Active Shooter Event?

Patients and hospital staff have different perceptions about the risk of active shooter events in hospitals, according to a recent survey conducted by the Hartford Consensus, which is part of an American College of Surgeons-led committee formed to improve survivability from mass casualty events.

The survey polled more than 1,000 adults and more than 680 healthcare professionals on their perception of potential active shooter events at hospitals. These events — defined by the FBI as an event where a person attempts to kill people in a populated, public place — are on the rise across the country, and hospitals are not exempt. One FBI study showed active shooter events grew from an average of 6.4 events per year from 2000 to 2006 up to an average of 16.4 events per year from 2007 to 2013. While just four of the events occurred in healthcare facilities, a study with a broader definition of shooter events identified 154 shooting incidents from 2000 to 2011 that occurred on hospital grounds and injured at least one person.

"Ten years ago, an active shooter event was a non-concept for hospitals, but clearly things have changed," Lenworth Jacobs Jr., MD, lead author of the survey, chairman of the Hartford Consensus, professor of surgery and vice-president of academic affairs at Hartford (Conn.) Hospital, said in a statement.

The Hartford Consensus survey showed the general public felt safer than healthcare professionals in hospitals. The public was less likely to feel the risk of an active shooter event in a hospital was high or very high (18 percent) than healthcare professionals (33 percent). The public was also more likely to believe hospitals are prepared for an active shooter event (72 percent) than healthcare staff (55 percent).

"Our findings also show that the public tends to view the hospital as a safe haven, certainly safer than other public places like shopping malls or airports," Dr. Jacobs said in a statement. "But we've also learned that healthcare professionals are realistically more aware of the potential danger."

The hospital is a uniquely vulnerable setting for active shooter events because patients may not be mobile or lucid enough to flee the area. This presents a potential conundrum for hospital staff, who in an active shooter event may be torn between the instinct to flee and the duty to protect patients. Nearly two-thirds of both the public (61 percent) and healthcare professionals (62 percent) felt physicians and nurses had an obligation to protect patients during a shooter event, although only 39 percent of the public and 27 percent of healthcare professionals felt this obligation should hold if physicians or nurses had to take on a high or very high degree of personal risk.

The survey authors suggest hospitals prepare staff, especially those working in settings with patients who are immobile, like the emergency department, operating room or intensive care unit, to discuss the risks, consequences and strategies for decision-making in the event of an active shooter.

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