Planning for Active Shooters in Your Hospital

This member-only article appears in the July issue of Patient Safety Monitor Journal.

This March, nursing supervisor Nancy Swift was shot to death in her office at UAB Highlands Hospital in Birmingham, Alabama. Swift had been reprimanding a central sterile supply worker, Trevis Coleman, when he pulled out a gun and fired on her. Afterwards, Coleman killed himself, but not before injuring an instrument management supervisor who was on campus.

When people think of workplace violence in healthcare, they tend to think of loud verbal threats or fighting between patients and providers. However, no discussion on this topic is complete without taking into account gun violence.

The threat of an active shooter roaming the hallways is one of the biggest fears among safety professionals and C-suite executives in the healthcare industry. Providers have been forced to endure any number of scenarios, such as disgruntled employees, drive-by shootings and gang violence, abusive exes seeking vengeance, and hostage situations.

Preparedness for active shooter situations is also on the minds of accrediting organizations and agencies such as the NFPA, which in May unveiled a new standard, NFPA 3000, to help first responders, healthcare providers, facility managers, and others prepare for an active shooter incident. CMS, The Joint Commission, and OSHA have also called for better protection of healthcare workers from workplace violence of all kinds, including active shooters, or are currently considering new standards.

Steve Wilder, BA, CHSP, STS, has spent more than three decades in healthcare safety, security, and risk management, including stints as a hospital risk manager and corporate director of safety and security for a health system. He has consulted with hundreds of clients, including hospitals, clinics, and physician practices, and has trained thousands of workers in workplace safety and security.

In addition to his regular contributions to healthcare magazines, Wilder co-authored the book The Essentials of Aggression Management in Healthcare: From Talkdown to Takedown.

During a December 2017 webinar organized by HCPro, Wilder explained how to comply with the revised CMS rule for emergency preparedness and prepare your staff for any situation. He also helped attendees understand the key parts of an active shooter plan, went over how staff can improve decision-making skills, and provided tips on controlling staff anxiety and stress during emergency situations.

As part of this 90-minute webinar—which can be viewed on demand through—he shared his five key components for an active shooter plan. The following is a summary of that portion of Wilder’s presentation.

Step 1: Conduct a vulnerability assessment
Wilder believes the first key component of an active shooter plan is determining threats. Who might pose internal or external threats to your building or campus? How can you assess vulnerabilities that “are the chinks in the armor that allow an opportunity for a bad guy to strike”? Then you should consider the potential outcomes if an active shooter were to barge into your healthcare facility.

As a consultant, Wilder routinely does vulnerability assessments for healthcare organizations.

“We come in from the outside and see the things you see every day to the point where you stop seeing them,” he said. “I tell my clients, ‘We’re good guys that get paid to look like bad guys.’ ”

Wilder said that for an active shooter event to occur, three critical factors must be present.

“First of all, there has to be a bad guy. The bad guy is always going to be a part of our society. There’s nothing we can do to get rid of him. We can put one in jail and there will be 10 more stepping up to take his place,” said Wilder. “Secondly, the bad guy has to have a motive. I can’t do anything about the motive. That comes from inside his heart or inside his head.”

He continued: “And thirdly, he has to have an opportunity. … The only thing we can do is take away his opportunity to strike at our place, whether it’s a burglar or an active shooter or an arsonist, a predator, whatever the case may be. The only thing we can do is take away his opportunity, and that’s what the security vulnerability assessment is designed to do.”

After identifying all the opportunities “for the bad guys to strike,” steps can then be taken to put programs in place “to minimize the vulnerabilities,” which, said Wilder, is “a great step.”

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