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Hospital Shootings Rare, But Preparedness Still Warranted

 |  By John Commins  
   September 24, 2012

Your chances of being struck by lightning are greater than your chances of being shot in a hospital.

That doesn't means you should dance in a cornfield in the middle of a thunderstorm. Nor does it mean your hospital's patients, visitors, or staff should take cover and comfort behind long odds and the laws of probability.

The report from four researchers from Johns Hopkins University School of Medicine, published this month in the Annals of Emergency Medicine online, examined 11-years of data on 154 hospital shootings that resulted in 235 dead or injured.

The data showed that 30% of the shootings at acute-care hospitals occurred in the emergency department, and 50% involved the firearm of a police or security officer which was either used by security to fire at a suspect or stolen from the officers to shoot victims. The study notes that no hospital is immune from shootings. Zero risk is not attainable.

Gabe Kelen, MD, the report's lead author and the director of the Johns Hopkins Department of Emergency Medicine, said in the study that it would have been difficult to prevent many of the shootings they reviewed because the crimes involved a "determined shooter with a specific target."

Common motives for shootings included grudges or revenge, suicide, and euthanizing an ill relative. The report examined the years 2000–2011 and included a Sept. 16, 2010 shooting at the Baltimore-based health system in which a distraught gunman shot a physician, and then killed his ailing mother and himself.

Rather than spending money on metal detectors and other security checkpoints, the report suggests that the best deterrents include specialized training for hospital law enforcement and security teams, with an emphasis on the proper securing of firearms.

Metal detectors create a false sense of security, the report said, and do nothing to address the more than 40% of shootings that occur on hospital properties outside of buildings. Plus, hospitals have unique demands for 24-hour public access that require multiple entrances and exits to accommodate large numbers of people.

Bryan Warren, president of the International Association for Healthcare Security & Safety, tells HealthLeaders Media that every hospital should undergo an annual or biannual security assessment by a qualified expert. "The first thing is have someone come in and look at what you've got and do a gap analysis versus best practices and regulatory standards," says Warren. "What are the must-haves, should-haves and like-to-haves?"

Warren, who is also senior manager for corporate security at Charlotte, NC-based Carolinas HealthCare System, says the report correctly notes that no hospital is too small to ignore the security of patients, visitors, and employees.

"You need to have a professional well-trained knowledgeable security staff on board," he says. "If you have a 25-bed critical access hospital out in the middle of somewhere can you afford to have the same level of security as a 1,500-bed urban hospital? No. I'm not saying that. But you do need to have a dedicated professional to at least help assist in setting up your program and you need to follow some of the best practices."

After years of mistakenly thinking that hospitals are sanctuaries from violence, many federal and state officials are coming to realize that hospital security has not been given the attention it deserves. Warren says attitudes changed when the Department of Homeland Security included hospitals on its critical infrastructures list.

"People now realize that regardless of what the incident is in the community, if it results in injuries or potential injuries they are all going to end up at the hospital," he says. "So the hospital is very different from the industrial or manufacturing or retail environment because we get people no matter what. If it's a train wreck, a car wreck, a terrorist event, a shooting they are all going to end up at a hospital. Security at hospitals is a more complex issue."

Warren says the federal Occupational Safety and Health Administration also has shown a renewed interest in workplace safety at hospitals and other healthcare facilities. "OSHA is taking what once would have been a workplace violence issue and placing it under their general safety clause, which says that regardless of your industries you have to provide a safe working environment for employees," he says.

"We are seeing that more and more in a number of hospitals. I would like to say that hospitals are changing because they saw the light but it's more because they are feeling the heat, quite frankly."

All of this is occurring as reports of workplace violence in hospitals appear to be on the rise.

"I couch it because there hasn't been a clear determination. Are there more incidents or are reporting mechanisms being observed more closely? I think it is a combination," Warren says.

"We are seeing the ripple effect of the weak economy. There are a lot of people who maybe they are behavioral health patients who can't afford their medications any longer. You've got longer waits in emergency department. All those things are contributing factors."

But it's also a generational thing. Years ago it was thought to be part of the job. ‘If I am going to work in the ED I expect I am going to be spit on and cursed at.' You are seeing a generation gap where people are saying that is not part of the job and it's unacceptable," Warren says. "You are seeing a rise in the number and acuity of incidences but at the same time I think that a proportionate number of that increase is due to the simple fact that people are reporting it more often, as they should have all along."

Everything is complicated and laced with qualifiers in the hospital setting, even the definition of workplace violence. "Does it mean physical contact? Does it include psychological intimidation? Does it include physical violence without intent? If you have a patient coming out of anesthesia and they flail their arms and strike someone is that workplace violence? These are the questions that are difficult to answer and haven't been addressed when you look at these studies," Warren says.

Because of the complex nature of hospital violence, Warren says individual hospitals should be allowed organizational discretion to set parameters and use discretion. "It has to be looked on at a case-by-case basis," he says. "But each facility should have some hard and fast bright lines about what the criteria should be. They should have some process policies and procedures in writing so they have an idea of when they are going to prosecute and when they are not."

For healthcare clinicians and executives contemplating security issues at their hospitals, Warren offered several links to free services and guidelines.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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