Active Shooter: Know the Facts

By Kim Maryniak, PhDc, MSN, RNC-NIC, Contributor

According to the National Consortium for the Study of Terrorism and Responses to Terrorism (START), between 1995 and 2014, there were a recorded 510 terrorist attacks in the United States, resulting in 3,264 deaths (START, 2015). A 2013 study by the Federal Bureau of Investigation (FBI) examined active shooter incidents occurring between 2000 and 2013. This study identified 160 active shooter occurrences within 13 years, averaging 6.4 incidents per year between 2000 and 2007, and an average of 16.7 incidents per year between 2008 and 2013 (FBI, 2013).

Although there have been differing statistics of active shooter incidents in the media due to a variation in definitions, the FBI study demonstrates valid data. There are now current, accurate statistics for 2014 and 2015 which include the recent active shooter incidents in the media involving mass shootings at Fort Hood, Texas (2014), Isla Vista, California (2014), Charleston, South Carolina (2015), Chattanooga, Tennessee (2015), Roseburg, Oregon (2015), Colorado Springs, Colorado (2015), and San Bernardino, California (2015) (Los Angeles Times, 2015).

In one study investigating shootings which occurred in hospital settings from 2000 through 2011, it was discovered that there were 154 shootings, with a total of 235 victims, either injured or killed. Of these 154 events, 59% occurred within the hospital itself, which included 29% in the emergency department and 19% in patient rooms; 41% of the events were on the hospital grounds, including 23% in the parking lot. Of the shootings that took place in an emergency department, 23% of them involved the perpetrator using a security officer’s gun. Shootings were also more common in larger hospitals (greater than 400 beds) (Kelen, Catlett, Kubit, & Hsieh, 2012).

Although there are no clear characteristics of a potential active shooter, the FBI has identified potential qualities, such as a personal grievance, recent acquisitions of multiple weapons, recent interest in previous shootings, increased weapons training, and experience of a perceived or real personal loss (FBI, 2013; Healthcare and Public Health Sector Coordinating Council, 2015). An active shooter in the workplace may be a current or former employee, and someone who reacts spontaneously. During an active shooting event, victims are selected at random. Active shooters generally carry out events alone, and hand guns are the weapon most frequently used. Although pre-planning is usually involved, the event itself is unpredictable and evolves quickly (U.S. Department of Homeland Security, 2015). Hospital shooters are usually male, can be any age, frequently know their victim(s), and are less likely to commit suicide (Lehman-Huskamp, 2015).

Training is important to enable personnel to react appropriately if confronted with an active shooter situation. As these situations evolve quickly, fast decisions could mean the difference between life and death. If you are in harm’s way, you will need to decide rapidly on the safest course of action, based on the scenario that is unfolding. In an active shooter situation, those involved should rapidly determine the best way to protect their own lives. The recommended actions are 1) Run- if there is an accessible escape path, attempt to evacuate; 2) Hide- if evacuation is not possible, find a place to hide where the active shooter is less likely to find you; and 3) Fight- as a last resort and if your life is in imminent danger, attempt to incapacitate the active shooter (Federal Emergency Management Agency [FEMA], 2015).

Healthcare professionals have a duty to care for the patients for which they are responsible. Since incidents such as an active shooter scenario are highly dynamic, some ethical decisions may need to be made to ensure the least loss of life possible. Every reasonable attempt to continue caring for patients must be made, but in the event this becomes impossible without putting others at risk for loss of life, certain decisions must be made. Considerations include to allocate resources fairly with special considerations to those most vulnerable, limit harm to the best extent possible, prepare to discontinue care to those who may not be able to be brought to safety in consideration of those who can, and consider the greater good as well as your own interests. Although difficult, it is important to understand that with limited resources, healthcare professionals may not be able to meet the needs of all involved. During an active shooter incident, it is another consideration that some people will choose to remain in a dangerous area (Healthcare and Public Health Sector Coordinating Council, 2015).

No one wants to think that he or she may be involved in an active shooter incident. However, it is important to be proactive and make potential plans. How would you react? Where would you go? What would you do? How would you help those around you? How would you deal with potential ethical conflicts? These are considerations that you may need to face.

References:
Federal Bureau of Investigation. (2013). A study of active shooter incidents in the United States between the years of 2000 and 2013. Retrieved from https://www.fbi.gov/about-us/office-of-partner-engagement/active-shooter-incidents/a-study-of-active-shooter-incidents-in-the-u.s.-2000-2013

Federal Emergency Management Agency. (2015). Active shooter: What you can do. Retrieved from http://training.fema.gov/is/courseoverview.aspx?code=IS-907

Healthcare and Public Health Sector Coordinating Council. (2015). Active shooter planning and response in a healthcare setting. Retrieved from https://www.fbi.gov/about-us/office-of-partner-engagement/active-shooter-incidents/active-shooter-planning-and-response-in-a-healthcare-setting

Kelen, G.D., Catlett, C.L., Kubit, J.G., & Hsieh, Y.H. (2012). Hospital-based shootings in the United States: 2000 to 2011. Annals of Emergency Medicine, 60(6), 790-798.

Lehman-Huskamp, K. (2015). Active shooter in the hospital setting: Are you prepared? Retrieved from http://www.cardinalglennon.com/Documents/continuing-education/2015-pediatric-trauma-conference-active-shooter-in-the-hospital-setting.pdf

Los Angeles Times. (2015). Deadliest U.S. mass shootings, 1984-2015. Retrieved from http://timelines.latimes.com/deadliest-shooting-rampages/

National Consortium for the Study of Terrorism and Responses to Terrorism (START). (2015). American deaths from terrorism attacks. Retrieved from http://www.start.umd.edu/pubs/START_AmericanTerrorismDeaths_FactSheet_Oct2015.pdf

U.S. Department of Homeland Security. (2015). Active shooter preparedness. Retrieved from http://www.dhs.gov/active-shooter-preparedness


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Biography:
Kim Maryniak has over 26 years nursing experience in medical/surgical, psychiatry, pediatrics and neonatal intensive care nursing. She has been a staff nurse, charge nurse, educator, instructor, manager and nursing director. Kim is certified in Neonatal Intensive Care Nursing and has been active in both the National Association of Neonatal Nurses and American Nurses Association. Kim’s current and previous roles have included professional development and practice, research utilization, nursing peer review and advancement, education, infection control, nursing operations, quality and process improvement.