If you’ve worked in a hospital emergency department, you know it’s a pressure cooker. Crowded
rooms. High-stakes decisions. Emotions running high. It’s no surprise that violence is a growing
threat in these environments—and yet, most hospital staff still feel unprepared for an active
shooter event.
That has to change.
Why the ER Is a Target
Emergency departments are open by design. That openness saves lives—but it also creates
risk. With the rise of workplace violence in healthcare, we can’t afford to ignore the possibility of
a violent intruder. Whether it’s an angry family member, a mentally unstable patient, or a
targeted attack, the reality is clear: hospitals are vulnerable.
Security teams do their best, but they can’t be everywhere at once. And most clinical staff aren't
trained to respond to threats like active shooters. In fact, many don’t even know what steps they
can take to stay safe.
The Limits of "Run, Hide, Fight"
"Run. Hide. Fight." You’ve probably heard that phrase a dozen times. It’s the default advice for active shooter situations—but it was never designed for healthcare.
Running may not be an option when you’re with an immobile patient. Hiding might be impossible in an open trauma bay. Fighting? Not realistic for someone unarmed and untrained.
Healthcare settings require a different approach—one built around the roles, responsibilities, and realities of the people who work there.
What Preparedness Really Looks Like
Emergency preparedness in a hospital isn’t about turning staff into tactical experts. It’s about giving them the
mindset and tools to react effectively under pressure.
Here’s what that includes:
- Situational awareness. Learning how to notice early warning signs of aggression or violence.
- Simple decision-making frameworks. Under stress, complex plans fall apart. Staff need clear, adaptable steps.
- Communication skills. Knowing how to coordinate with coworkers, de-escalate, or call for help fast.
- Physical positioning. Understanding where to stand or move for maximum safety.
- Protecting others. Thinking through how to shelter patients or lead them to safety, even when evacuation isn’t an option.
This isn’t about heroics—it’s about making better choices when seconds matter.
Why Most Training Falls Short
Too often, safety training is a one-time slideshow or an annual online module. It doesn’t stick. Real learning comes from hands-on, scenario-based practice. Staff need to see it, do it, and feel it so they can access those lessons in the heat of the moment.
Another common mistake? Training that focuses only on policies or that treats all employees the same. A security officer, an ER nurse, and a hospital receptionist all face different realities. Effective preparation accounts for those differences.
Mindset Is Everything
Preparedness starts with mindset. If people believe they’re helpless, they won’t take action when it counts. But when they know what to look for and how to respond, confidence grows—and that can be the difference between chaos and control.
It’s not about removing fear. It’s about replacing it with readiness.
P.S. Want to go deeper on this topic? I’m hosting a free webinar on May 21st where we’ll walk through realistic, practical strategies for healthcare workers to stay safe and protect others in an active shooter situation.
