The recent horrific events surrounding San Bernardino and Paris underscore the conceit that active shooter incidents must be included into the new reality of day-to-day existence in virtually every part of the world. In the United States, the incidence of active shooter events has more than doubled, comparing the period 2000-2006 with 2007-2013. The literature indicates that many countries share this concern. With a recent report indicating global terror groups are planning more attacks upon the western industrialized countries, there should be no expectation that this increase in active shooter events is an aberration. Among the soft targets that remain a cause of concern for federal and state agencies is the healthcare system. In fact, active shooter incidents have increased in hospitals from nine per year in 2000-2005 to 16.7 per year in 2006-2011. Granted, most of the incidents target specific individuals, but it does underscore the vulnerability of healthcare facilities, their staff and clients.
Due to certain mass shooting events in the United States, there has been a paradigm shift as to the way innocent civilians should respond to an active shooter. The current adage articulated by governmental organizations is, “Run, Hide, and Fight.” However, within the healthcare system, this is rather simplistic and does not fully and completely acknowledge the roles and responsibilities of the healthcare professional, in particular, the nurse. The duty of the nurse to the patient and, by extension, the family of the patient, may run counter to the standard, well-accepted active shooter response guidelines as promulgated by federal and various law enforcement agencies. The survival instincts of the nurse to an active shooter announcement may be completely opposite to what the nurse may desire to do in order to protect the patient. This inherent conflict between the nurse’s survival instincts and one’s duty to one’s patient oftentimes is not fully explored in most of the training programs associated with an active shooter response.
The purpose of this paper is to facilitate an exploration of the issues associated between nurse and patient when both are confronted with an active shooter situation by providing a road map and a template to assist the facilitator with developing an active shooter tabletop exercise. Emphasis will be placed upon the Emergency Department and its nurses since that is the locus of great accessibility to the public and often the site of violence.