Hostage Survival Strategies for Healthcare Active Assailant Events

Active assailant incidents in healthcare facilities present one of the most extreme challenges for staff, patients, and security professionals. While the primary goal in any such event is always to escape from danger if possible, circumstances may arise where escape is not an option. In these rare but high-risk situations, individuals must rely on a contingency plan that includes barricading, communicating, or, in the worst-case scenario, surviving as a hostage.

This article provides guidance for healthcare professionals, behavioral health staff, and security officers on strategies for maximizing survival during a hostage situation within an active assailant attack.

Why Preparedness Matters

Hostage incidents, though rare, have occurred in healthcare settings.

• On March 9, 2018, at the Veterans Home of California in Yountville, a gunman entered during a staff event, taking three female employees hostage. After a long standoff, all three were tragically killed (Los Angeles Times, 2018 ).
  
  
• In October 2016, at Nepean Hospital in New South Wales, Australia, a former nurse held a doctor hostage at knifepoint, leading to a confrontation in which a police officer and security guard were shot (Sydney Morning Herald, 2016).

These incidents highlight the vulnerability of healthcare environments, where open access, high patient volumes, and emotionally charged situations increase the risk. The Joint Commission emphasizes that active assailant preparedness must include training, drills, and post-event recovery strategies.

Understanding the Hostage-Taker’s Objectives

Hostage-takers often seek control, leverage, or attention. Recognizing these motivations can help healthcare staff understand behaviors and make safer choices. Compliance in the early stages, remaining calm, centered, and non-threatening, reduces the chance of escalating aggression..

Steps for Hostage Survival

1. Stay Focused and Centered

Fear and anxiety are natural, but survival depends on maintaining composure. Controlled breathing helps slow the heart rate, reduce fear, and project calmness. Appearing cooperative presents you as neither a threat nor a problem.

Example (Nurse in ER): When taken into a supply room by an assailant, a nurse focuses on slow, steady breaths to keep  a clear mind and avoid panic  nods at the assailant to acknowledge commands without defiance.

2. Observe and Gather Information

Every detail may aid authorities during rescue. Note the number of assailants, their behavior, possible weapons, and any exits. Listen for accents, names, or phrases that could later assist responders.

Example (Security Officer): While restrained in a waiting room, the officer quietly tracks that there are two assailants, one giving orders, one hesitant. This information could shape tactical responses if shared later.

3. Control Your Breathing and Positioning

Regulate your breathing to stay calm. If ordered to sit, choose a position away from doors or windows but near cover, such as a wall or furniture. Strategic placement minimizes exposure during potential rescue operations.

Example (Behavioral Health Tech): Directed to sit on the floor, the tech slides closer to a wall, protecting their back and staying clear of direct sightlines.

4. Avoid Direct Eye Contact and Sudden Movements

Direct stares or abrupt gestures can be misinterpreted as challenges. Keep your movements slow, comply with directions, and maintain a cooperative demeanor.

Example (Physician): When told to move chairs, the physician moves deliberately and avoids sudden turns, ensuring the assailant does not perceive resistance.

Building Rapport with the Hostage-Taker

Small, respectful interactions may humanize you and lower tension. Keep responses brief, deferential, and non-threatening. Expressing vulnerability, such as nervous breathing or a cough, may even elicit empathy.
If directed to walk, subtle actions such as stumbling can provide insights into the assailant’s behavior, whether they show concern or react harshly. These cues reveal mindset and possible openings for negotiation or escape.

If an Opportunity to Escape Arises

Escape attempts are dangerous and should only occur if the chance of success is high.

• Leverage Distractions: Wait for a moment of divided attention before moving.

• Identify Concealed Exits: Know your hospital’s layout, supply rooms, service corridors, or stairwells may provide unexpected escape paths【CISA Guide to Active Shooter Preparedness†https://www.cisa.gov/active-shooter-preparedness】.

Example: During a brief distraction when the assailant answers a phone, a nurse quietly slips into an adjacent linen room, securing the door behind her.

If a Rescue Team Arrives

• Stay Low and Comply: Immediately lie down or remain close to cover. Keep hands visible.

• Follow Commands Exactly: Law enforcement will respond quickly and may not know who is a hostage and who is the assailant or part of a team of captures. Identify yourself calmly and avoid sudden movements.

Example: When tactical officers enter, a staff member raises empty hands while lying prone, stating, “I am hospital staff, I am not armed.”

Conclusion

Hostage survival during an active assailant attack in healthcare settings requires a blend of patience, observation, and readiness. Remaining calm, compliant, and observant increases the chance of survival until escape or rescue becomes possible.

While hostage events are rare, the devastating examples in California and Australia prove their reality. Healthcare facilities must take preparedness seriously, implementing training, regular drills, and communication protocols is vital【OSHA Workplace Violence in Healthcare, 2016†https://www.osha.gov/workplace-violence】.

By practicing contingency plans, escape, barricade, and defend as a last resort, staff can respond effectively, even under extreme duress. Preparation saves lives.