Emergency department active shooter training: A survey of current practices in 2020





disaster planning, emergency medicine, gun violence, workplace violence


Background: Shooting events in hospitals are increasing in frequency, with the emergency department (ED) being the most common site of such events. EDs must be prepared for shooting events, but current practices surrounding active shooter preparation are unknown.

Objective: To determine what active shooter training emergency medicine physicians are receiving.

Methods: A survey was developed to assess current practices around active shooter preparation in EDs. The survey was distributed to members of the American College of Emergency Physicians’ Emergency Medicine Practice Research Network. All members of the Emergency Medicine Practice Research Network are currently practicing emergency medicine physicians.

Results: There were 194 respondents. The most common form of training received was online (76/194), followed by lecture (50/194). Only 39 respondents had participated in an active shooter drill. Sixty-five respondents (33 percent) reported having never received any formal active shooter training.

Conclusion: There is a wide array of active shooter training that emergency medicine physicians are receiving, with nearly one-third receiving no training at all.

Author Biographies

Gregory Jasani, MD

Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland

James MacNeal, DO, MPH

Mercyhealth Prehospital and Emergency Services Center’s Tactical Training Center, Janesville, Wisconsin

Jon Mark Hirshon, MD, PhD

Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland


US Department of Health and Human Services (HHS), US Department of Homeland Security, US Department of Justice, Federal Bureau of Investigation, Federal Emergency Management Agency: Incorporating Active Shooter Incident Planning into Healthcare Facility Emergency Operations Plans. Washington, DC: HHS, 2014. Available at https://www.phe.gov/Preparedness/planning/Documents/active-shooter-planning-eop2014.pdf. Accessed September 16, 2020.

Healthcare and Public Health Sector Coordinating Council (HPH SCC): Active Shooter Planning and Response: Learn How to Survive a Shooting Event in the Healthcare Setting. Washington, DC: HPH SCC, 2017. Available at https://www.fbi.gov/file-repository/active_shooter_planning_and_response_in_a_healthcare_setting.pdf/view. Accessed September 16, 2020.

Joint Commission: Preparing for Active Shooter Situations. Oakbrook Terrace, IL: Joint Commission, 2014. Available at https://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_Four_July_2014_Final.pdf. Accessed September 16, 2020.

Brinsfield KH, Mitchell E: The department of homeland security’s role in enhancing and implementing the response to active shooter and intentional mass casualty events. Bull Am Coll Surg. 2015; 100(Suppl. 1): 24-26.

Schwerin DL, Ruggiero C, Thurman J, et al.: Active shooter response. In StatPearls. Treasure Island, FL: StatPearls, 2020. Available at https://www.ncbi.nlm.nih.gov/books/NBK519067/. Accessed May 19, 2020.

Kelen GD, Catlett CL, Kubit JG, et al.: Hospital-based shootings in the United States: 2000 to 2011. Ann Emerg Med. 2012; 60(6): 790-798. DOI: 10.1016/j.annemergmed.2012.08.012.

Wax JR, Cartin A, Craig WY, et al.: US acute care hospital shootings, 2012-2016: A content analysis study. WOR. 2019; 64(1): 77-83.

National Census of Fatal Occupational Injuries in 2015: News release. US Dept of Labor Bureau of Labor Statistics; December 16, 2016. Available at: bls.gov/news.release/archives/cfoi_12162016.pdf. Accessed September 16, 2020.

Emergency Nurses Association (ENA): ENA Topic Brief: Active Shooter Preparedness in the Emergency Department. Schaumburg, IL: ENA, 2016. Available at https://www.ena.org/shop/catalog/education/practice-resources/active-shooter-preparedness-in-the-emergency-department/c-23/c-104/p-306. Accessed June 18, 2020.

Sanchez L, Young VB, Baker M: Active shooter training in the emergency department: A safety initiative. J Emerg Nurs. 2018; 44(6): 598-604. DOI: 10.1016/j.jen.2018.07.002.

US Department of Homeland Security (DHS): Active Shooter: How to Respond. Washington, DC: DHS, 2008. Available at https://www.dhs.gov/xlibrary/assets/active_shooter_booklet.pdf. Accessed September 16, 2020.

US Department of Homeland Security (DHS): Stress and Decision Making. Washington, DC: DHS, 2011. Available at https://www.fletc.gov/sites/default/files/imported_files/reference/researchpapers/Stress-and-Decision-Making-04-06-12–Approved–-Pulic-Release–508-Accessible.pdf. Accessed September 16, 2020.

Wexler B, Flamm A: Lessons learned from an active shooter full-scale functional exercise in a newly constructed emergency department. Disaster Med Public Health Prep. 2017; 11(5): 522-525. DOI: 10.1017/dmp.2016.181.

The Joint Commission: Quick Safety 4: Preparing for Active Shooter Situations (Updated June 2021). Oakbrook Terrace, IL: Joint Commission, 2021.



How to Cite

Jasani, MD, G., J. MacNeal, DO, MPH, and J. M. Hirshon, MD, PhD. “Emergency Department Active Shooter Training: A Survey of Current Practices in 2020”. American Journal of Disaster Medicine, vol. 16, no. 4, Dec. 2021, pp. 263-9, doi:10.5055/ajdm.2021.0410.




Most read articles by the same author(s)