An active shooter in physician offices: Planning for the unthinkable

active shooter, workplace violence, gun violence, shooting, gun, physicians

An active shooter or an armed intruder at a medical practice office is unthinkable, but it has happened. Every healthcare provider has to accept the reality and realize it can happen anywhere, including at your practice.

It doesn’t matter how well you think you know your patients, their families, your staff, or anyone else. There are hundreds of documented cases where the victims shared a common thought afterward: “I’d have never dreamed he/she would do something like that.”

Therefore, it is imperative that medical practices everywhere, of all specialties and sizes, prepare for the possibility. You need to plan for an active shooter the same way you prepare for any other potential emergency, whether it be fire, utility failure, or natural disaster. That said, few medical practices have the knowledge or the qualified staff to develop an active shooter plan.

It is not easy, but it doesn’t have to be complicated. There are basically five steps to active shooter preparedness:

Assess your vulnerabilities

A security vulnerability assessment (SVA) is a systematic process that helps you identify three critical factors by asking yourself the following questions:

  • What are the concerns and possibilities we face that could lead to an event? In other words, what are the threats?
  • What are the chinks in the armor of our office security management program that could create an opportunity for the shooter to strike here? In other words, what are the vulnerabilities?
  • What are the potential outcomes if it does happen? In other words, what are the risks?

Trying to develop a plan without having an SVA performed by a qualified healthcare security professional is akin to going to the doctor and expecting treatment without first having an exam. It simply doesn’t work.

Draft an active shooter plan

I want to be careful here. There are a lot of packaged plans on the market that can tempt the unqualified customer. I’ve looked at some, and I wasn’t impressed. Remember, these plans are written, packaged, and sold for the sole purpose of making someone money.

Your office plan needs to be tailored specifically to your office environment, culture, and surroundings. Unfortunately, this isn’t an instance where one size fits all. Every practice is different, and every practice has unique considerations. The plan must be written for your practice if it can be used by your practice.

Test your plan

Your plan looks good. You’ve brought in someone qualified to help identify vulnerabilities and plan for an active shooter. You’ve sat at your desk and you’ve developed a foolproof plan. Now, it’s time to test the plan.

The best method I’ve found is to conduct a tabletop exercise with a limited number of your staff. Make a pot of coffee, create and print out an imaginary scenario, and sit your selected staff members around the table. As a team, go through the scenario using your plan as a guide.

You will no doubt find areas where you thought your plan would work, but it needs to be modified. Actually, that’s great. You have learned how to safely improve your plan without any casualties. Once you identify where the tweaks need to be made, revise your plan, then create a new scenario, and test the plan again. Repeat this process until your plan really is foolproof.

Create a training program

Now that you know your plan works, the next step is to develop a training program. Again, there are a lot of packaged training programs on the market, but none are created to match your plan.

Your training program must be consistent with the written plan you have perfected. Otherwise, you may have a plan that says to do one thing and a training program that says to do something different. This disconnect will cost lives in the event of an active shooter.

Develop your training based on the final revision of your plan, and then train all your staff. All employees must be trained—this cannot be considered optional training—and the training must be periodically reinforced. The subject matter is too sensitive, and these days, too realistic.

Plan for recovery

I wish I could help you develop a plan that would assure an active shooting event will never happen to you. You’d have one less thing to worry about, and I could retire a relatively young man. Alas, I cannot.

The best you can do is try to minimize the opportunities through the SVA and prepare your staff. The sad reality is if an active shooter event occurs, there will be injuries and there will likely be casualties. Most of the time, you don’t even know something’s happening until you hear the gunshots, and by then there is usually at least one victim.

If the unthinkable happens, remember there will be a tomorrow. How you face all of the tomorrows after the event will depend on how well prepared you were for the most often forgotten or neglected part of the planning: recovery.

The goal of a recovery plan is to help your practice return to some form of normal. It’s important to realize yesterday’s normal will not be your tomorrow’s normal. Normal will have to be redefined after the event.

Here are some of the challenges you will face after an active shooter event:

Challengeresource needed
Media presencePublic relations specialist
Plaintiff’s attorneysYour attorney / insurance representative
Looters / gapers / thrill seekersArmed or unarmed security
Survivors (staff, patients, and family)Crisis counseling services
Biohazard cleanup and restorationCleanup and restoration services
Evacuation and relocationTransportation service

Recovery planning is often overlooked. We tend to focus on response and mitigation of the actual event but never think about the aftermath. You and your staff will be in shock. You will not be thinking rationally, and you won’t know where to begin. Having these resources prearranged is one way of ensuring someone will be there to help you through what will likely be the most trying moments of your life.

Moving ahead after the event will be a challenge. You can’t do it alone. You will need resources, and your relationship with those resources needs to be developed in advance with the hopes they will never be used.

I understand you don’t ever want to imagine an active shooter event happening to you. But it has happened in medical practices, hospitals, and offices across the nation. Ignoring a problem doesn’t mean it won’t happen. It only means you will have a higher than necessary casualty count. Accept that an active shooter situation can happen at your practice and follow these five steps to create a better state of preparedness and readiness.