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Active Shooter- Ethics for Healthcare Professionals

February 3, 2020

Written by Clay Smith

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There is debate as to whether healthcare professionals should “Run, Hide, Fight” in an active shooter incident (ASI) or “Secure, Preserve, Fight” to protect our patients first. What do you think?

Why does this matter?
ASIs have occurred in healthcare settings – over 150 from 2001-2011. The FBI and FEMA recommend a “run, hide, fight” approach. But how does this square with our responsibility to protect our patients? If you have not listened to Rob Orman’s interview about this, you need to.

May we never need to make this decision…
This is a reflection on an article in 2018 NEJM by beloved trauma surgeon Kenji Inaba et al, in which they advise a “Secure, Preserve, Fight” approach instead of “Run, Hide, Fight.” In the NEJM piece, they note that it is hard to run away when hospitals are arranged vertically, with movement largely by elevator. Where are we supposed to run? They also note that ICUs filled with incapacitated patients are usually open floor plans. Where are we supposed to hide? Finally, Inaba and colleagues note that we have a moral responsibility to benefit and protect our patients, which precludes running away. But there is debate on this. Some argue that remaining with patients increases the number of targets, casualties, and potential obstacles once law enforcement officers arrive and need to fire weapons.

These authors argue that healthcare professionals have an obligation to accept significant but not absolute risk of personal harm to care for our patients. For example, if we are called on to care for an ebola victim, we expect our healthcare facility to provide us with significant resources to protect ourselves when caring for such a patient. In the same way, the authors argue that if we are expected to stay and care for our patients in an ASI, our healthcare facilities should reciprocate and provide us with the resources we need to keep us safe.

The authors recommend:

  • Security screening and metal detectors at entrances

  • ASI response planning and staff training

  • Internally activated lockdown capability to secure areas with vulnerable patients

  • ASI alert and notification systems

In short, healthcare facilities and administrators have a responsibility to keep workers as safe as possible. This allows healthcare professional to better carry out their responsibility to not only protect their own lives but also those of their patients.

What would you do in an ASI – “run, hide, fight” or “secure, preserve, fight?” and why? Comment on the blog or on social media.

“Run, Hide, Fight,” or “Secure, Preserve, Fight”: How Should Health Care Professionals and Facilities Respond to Active Shooter Incidents? Acad Emerg Med 2019 Dec 28[Online ahead of print]

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2 thoughts on “Active Shooter- Ethics for Healthcare Professionals

  • secure preserve fight is cuckoo for cuckoo puffs. I’m a doc and can help you with your medical need. Sorry friend, I’d love to help you in case of volcano eruption as well, but that’s outside my scope. My obligation to you in a situation like that is that of one human to another, but not a physician to a patient. So if I would stop and help someone on the street, then great, you can expect the same in the ED for a non-medical situation. But if I’d be running in terror on main st, then I’m running in terror in the ED.

What are your thoughts?