Public expects physicians, nurses to protect patients in emergency hospital situations

In the event of a hospital shooting situation, over 50% of the public expects physicians and nurses to protect patients from harm, and over 50% of health care professionals believe they have a special duty to protect patients, according to a recent study published in the Journal of the American College of Surgeons.

Despite this agreement, however, the two groups view the safety of hospitals in a different light. Most of the public believes hospitals to be safe havens, while health care professionals are more likely to see them as a potentially risky setting for an active shooter event.

The findings are the result of a national survey by the Hartford Consensus, conducted in March 2017.

An active shooter event is defined by the FBI as one in which one or more persons actively engage in killing or attempting to kill people in a populated area.¹ In the United States, active shooter events have been occurring more frequently. From 2000 to 2006, an average of 6.4 active shooter events occurred in the US per year, according to a study done by researchers at Texas State University and the FBI.² From 2007 through 2013, this average rose to 16.4 events per year.

Further, 2.5% of the shooting events occurred in a health care setting.

In assessing shooting events from 2000 to 2011, including those that did not meet the definition of an active shooting event from the FBI, researchers found 154 shooting incidents occurred on hospital premises with at least one injured person in each incident.³

“A hospital is even more precarious than other public places because patients are so vulnerable. Some are unable to flee, or may be impaired by medical conditions or treatments that render them unable to understand commands that can lead them to safety,” said lead author Lenworth M. Jacobs, Jr., MD, FACS, Chairman of the Hartford Consensus, and professor of surgery and vice president of academic affairs, Hartford (Conn.) Hospital, Hartford, CT.

Dr. Jacobs and his co-author, Karyl J Burns, RN, PhD, department of surgery, Hartford Hospital, conducted an online survey of health care professionals who were mostly physicians and members of the Eastern Association for the Surgery of Trauma, ACS Board of Governors and Board of Regents, and members of the Hartford Consensus. They also conducted a national telephone survey of 1,017 adults to determine the public’s perceptions of active shooter events in hospitals.

They received responses from 684 health care professionals, of whom 92% were physicians, 95% worked in a hospital, and 94% provided direct patient care.

A full 33% of health care professionals believed the risk of an active shooter event to be “high” or “very high” in a hospital, compared to only 18% of the general public. More members of the public believed that hospitals are “somewhat” or “very prepared” for an active shooter event compared with health care professionals (72% vs 55%, respectively).

The general public and health care professionals were in agreement regarding physician/nurse obligations to patients during active shooter events (61% vs 62%, respectively), responding that professionals have a special duty to protect patients, similarly to the way firefighters protect the general public.

Yet only 39% of the public and 27% of health care professionals believed that doctors/nurses should accept a “high” or “very high” degree of personal risk to help patients in danger. But in setting such as the operating room or ICU, where patients are more vulnerable, more professionals believe they should assume a “high” or “very high” level of risk to get their patients out of danger, compared to 36% in less vulnerable patient locations, like floors with ambulatory patients (45% and 36% vs 22%, respectively).

“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,” said Dr. Jacobs. “But we’ve also learned that health care professionals are realistically more aware of the potential danger.”

Hospitals should take the necessary steps to ensure that the entire staff is “hard-wired” to deal with an active shooter event, recommended Dr. Jacobs.

“Ten years ago, an active shooter event was a non-concept for hospitals, but clearly things have changed.  Hospitals need to build resilience against such attacks as called for by former President Barack Obama’s Presidential Policy Directive 8, promoting a fully integrated preparedness system to strengthen the nation’s resilience to deal with natural and manmade disasters.  That directive means hospitals need to think about their vulnerability for an active shooter event, then develop a response plan, and practice it,” he concluded.  

References

1. Federal Bureau of Investigation. Active shooter resources. Available at: https://www.fbi.gov/about/partnerships/office-of-partner-engagement/active-shooter-resources.  Accessed August 10, 2017. 
2. Blair JP, Schweit KW. A study of active shooter incidents, 2000-2013.Texas State University and Federal Bureau of Investigation, U.S. Department of Justice, Washington DC, 2014. Available  at: https://www.fbi.gov/file-repository/active-shooter-study-2000-2013-1.pdf.  Accessed August 11, 2017.
3. Kelen GD, Catlett CL, Kubit JG, Hsieh YH. Hospital-based shootings in the United States: 2000 to 2011. Ann Emerg Med 2012;60(6):790-798.