Active Shooters in the ED: What to Do When There’s a Threat

You never want to face it, but knowing what to do in an active shooter situation saves lives. Learn your best course of action and how to prepare your emergency department now.

Active Shooters In The ED: What To Do When There’s A Threat

As part of an ED team, you know what it takes to save lives, but do you know what to do in an active shooter situation?

While no one wants to think about potential violence in their emergency department, at their facility, learning what to do in an active shooter situation and creating a plan to keep your staff safe will save lives.

What To Do In An Active Shooter Situation In Your Emergency Department

The U.S. Department of Homeland Security defines an active shooter as someone “engaged in killing or attempting to kill people in a confined and populated area[*].”

According to the Active Shooter training booklet issued by the DHS, there are three steps to keeping you, your staff, and your patients safe[*]:

#1. Escape And Find A Way Out

If there’s an active shooter in your emergency department, your first priority should be getting out ASAP. So become familiar with all your ED’s exits and pick the quickest route to get outside from where you are.

Do not grab your belonging like your purse or even your phone if it means potentially encountering the shooter.

Don’t use the elevators, take the stairs. You can also use windows to escape if you’re on a lower floor.

Run in a zigzag pattern, or from one cover to the next, if you’re in the shooter’s line of sight. This will make you more difficult as a target.

When you’re safely outside the ED you can call 911, explain the situation, and wait for help. Take this time to do a headcount of your missing coworkers to let police know how many people may still be inside with the shooter.

If you can’t make it out one of the escape routes, your next best bet is to hide and cover.

#2. Hide And Find Cover From Gunfire

Remove yourself from the line of fire and find a hiding place not easily accessible to the shooter. Then:

Lock and barricade the door. Find a room you can barricade yourself inside, like an exam room, closet, or office, and lock the door from the inside. Move heavy furniture in front of the door to prevent or make it difficult for the shooter to enter.

Park Dietz, founder and president of Threat Assessment Group, told The New York Times that people should choose a room near an elevator because it’s likely to have reinforced construction whereas office walls may be thin drywall with little protection[*].

Stay crouched low but not flat on the ground. Active shooters are most likely to fire at your torso or head-level, but you don’t want to put yourself at a disadvantaged position lying on the floor in case you need to flee quickly.

Active Shooters In The ED: What To Do When There’s A Threat

Turn off the lights and stay quiet. Lights and sounds like whispering or crying will alert an active shooter to your whereabouts.

Put your phone on silent and call 911 when safe. Briefly explain the situation and where you are to the 911 operator in a low voice and then stop speaking. Leave the line open so the dispatcher can hear what’s going on without you needing to explain more.

Here’s what you should tell the 911 operator:

  • Your ED’s address and the location of the active shooter in your department specifically
  • Number of shooters (if there’s more than one)
  • Physical description of the shooter
  • Number/type of weapons the shooter has
  • How many staff and potential victims there may be

If the shooter enters the room you’re hiding in before law enforcement gets there, experts say you can fight back but only as a final option.

#3. Take Action As A Last Resort

You should only interact with the shooter if your life is in imminent danger.

Diego Redondo, former FBI special agent and director of public safety and risk management at John Jay College of Criminal Justice, tells CNBC that you should never go out searching for the shooter — especially if you’re alone[*].

If you’re hiding with a group of people, Redondo says everyone should attack the shooter at once and attempt to disarm him together by overwhelming him.

Opportunities to take the shooter down may happen if he stops to reload, but that may only last a few seconds.

Throw anything you can find — rolling carts, scissors, scalpels, charts, fire extinguishers, etc. — to disarm, injure, or simply confuse the gunman.

As the DHS active shooter guidebook advises, commit 100% to your actions and make them as aggressive as possible.

To prevent a substantial loss of life, you should also create a plan for everyone in your ED group to follow in this situation.

How To Prepare Your Staff To Deal With An Active Shooter Situation Safely

An active shooter situation creates chaos. But this is usually over within 10 to 15 minutes, or until law enforcement arrives.

Rather than panicking and freezing, your staff will know exactly what to do if you:

Create An Emergency Action Plan (EAP)

Establish protocols you want your staff to follow in the event of an active shooter at your ED, also known as an Emergency Action Plan.

Your EAP should contain at least two evacuation routes, including schematics and floor plans for safe areas with exits. It should also have protocols for what to do if someone is shot.

Post evacuation routes in visible areas throughout your emergency department.

Equally important is discussing what your staff should not do in an active shooter situation, such as:

Don’t pull the fire alarm. This not only creates confusion for people as to what’s really going on, it may also cause people to pool in hallways where they will be easy targets.

Also, many fire alarms automatically unlock doors in facilities, which is not what you want when you’re hiding from an active shooter.

Don’t play dead. While some victims remain motionless and are spared, gunmen have been known to fire into wounded people on the ground too.

Staff and patients will follow the lead, of someone well-trained on the topic, which makes practicing for an active shooter drill crucial.

Practice Active Shooter Drills As Often As Fire Drills

Practice makes perfect and every second you save in this short time boosts your survival rate.

So consider partnering with local police to design training exercises and conduct mock active shooter drills.

Your team will learn tips like:

  • Exactly where/how to evacuate
  • Recognizing the sound of gunshots
  • What to do if they’ve been shot or see someone else get injured
  • The best places to hide
  • How to protect themselves and others
  • Actions to take when law enforcement arrives

Though no one wants to prepare for the worst, practicing what to do in an active shooter situation may lead to the best outcomes for your physicians and patients. 

Read the full Active Shooter training booklet from the Department of Homeland Security with your independent ED group here.

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