Active shooter in the emergency department: A scenario-based training approach for healthcare workers


  • Joseph G. Kotora, DO
  • Terry Clancy, PhD, NREMT-P
  • Lauren Manzon, BA
  • Varun Malik, BS
  • Robert J. Louden, PhD
  • Mark A. Merlin, DO, EMT-P, FACEP



education, training, internal disaster management, violence, healthcare policy


Background: An active shooter in the emergency department (ED) presents a significant danger to employees, patients, and visitors. Very little education on this topic exists for healthcare workers. Using didactic and scenario-based training methods, the authors constructed a comprehensive training experience to better prepare healthcare workers for an active shooter.
Methods: Thirty-two residents, nurses, and medical students participated in a disaster drill onboard a US military base. All were blinded to the scenarios.The study was approved by the institutional review board, and written consent was obtained from all participants. Each participant completed a 10-item pretest developed from the Department of Homeland Security’s IS:907 Active Shooter course. Participants were exposed to a single active shooter scenario followed by a didactic lecture on hostage recovery and crisis negotiation. Participants were then exposed to a scenario involving multiple shooters. Many of the participants were held hostage for several hours. The training concluded with a post-test and debrief. Paired Student’s t-test determined statistical significance between the pretest and post-test questionnaire scores.
Results: Paired Student’s t-tests confirmed a statistically significant difference between the pretest and posttest scores for the subjects, as a whole (p < 0.002 [−0.177, −0.041]).There was no difference in scores for nurses (p = 1 [−1.779, 1.779]).The scores for resident physicians (p < 0.01 [−0.192, −0.032]) and medical students (p < 0.01 [−0.334, −0.044]) were found to be significant.
Conclusions: Didactic lectures, combined with case-based scenarios, are an effective method to teach healthcare workers how to best manage an active shooter incident.

Author Biographies

Joseph G. Kotora, DO

Fellowship, EMS and Disaster Medicine, Newark Beth Israel Medical Center, Newark, New Jersey.

Terry Clancy, PhD, NREMT-P

Chief, Education, Certification, & Technology, New Jersey Department of Health, Office of Emergency Medical Services, Trenton, New Jersey.

Lauren Manzon, BA

Research Assistant, Newark Beth Israel Medical Center, Newark, New Jersey.

Varun Malik, BS

Research Assistant, Newark Beth Israel Medical Center, Newark, New Jersey.

Robert J. Louden, PhD

Professor, Program Director, Criminal Justice & Homeland Security, Georgian Court University, Lakewood, New Jersey.

Mark A. Merlin, DO, EMT-P, FACEP

Program Director, Fellowship, EMS and Disaster Medicine, Newark Beth Israel Medical Center, Newark, New Jersey; Adjunct Associate Professor, Rutgers University School of Public Health, Piscataway, New Jersey.


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How to Cite

Kotora, DO, J. G., T. Clancy, PhD, NREMT-P, L. Manzon, BA, V. Malik, BS, R. J. Louden, PhD, and M. A. Merlin, DO, EMT-P, FACEP. “Active Shooter in the Emergency Department: A Scenario-Based Training Approach for Healthcare Workers”. American Journal of Disaster Medicine, vol. 9, no. 1, Jan. 2014, pp. 39-51, doi:10.5055/ajdm.2014.0140.




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