Assessment of active shooter preparedness in US hospital systems




active shooter preparation, hospital preparedness, emergency preparedness, run-hide-fight, secure-preserve-defend, hemorrhage control techniques


Background: Active shooter events are horrific, unfortunate realities in American hospitals. Protecting patients and staff in an active shooter event is made more difficult in the cases of critically ill and otherwise immobile patients. Previous work has proposed theoretical mitigation strategies for active shooter events. This study assesses American hospitals’ current, active preparedness plans.

Methods: This is a survey-based study with questionnaires distributed to leaders in American healthcare. The survey assessed current active shooter protocols with a particular emphasis on managing critically ill patients. Data were summarized with frequency and percentage.

Results: The survey was distributed to 294 hospital systems across the United States, and representatives from 60 hospital systems responded. Ninety-eight percent of these hospital systems have an active shooter protocol; 24 percent report a plan to provide care for critically ill patients. Among those hospital systems with a plan for caring for immobile patients, substantial heterogeneity exists in the philosophy and implementation of these protocols. Additionally, 52 percent of hospital systems routinely practice response drills to active shooter events. Notably, hospital systems that had experienced an active shooter event in the past were more likely to practice implementing active shooter protocols.

Conclusions: While most hospital systems have an active shooter protocol in place, these plans are infrequently practiced and generally do not include contingency arrangements for the sickest, immobile patients. The results from this study highlight a significant opportunity for improvement in American hospital safety procedures.

Author Biographies

Dylan Kahler, MD

Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania

Susan Chishimba, MSN, RN

Vizient, Inc., Irving, Texas

Jodi L. Eisenberg, MHA, CPHQ

Vizient, Inc., Irving, Texas

Amy J. Goldberg, MD, FACS

Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania

Tony Reed, MD, PhD, MBA

Senior Vice President, Chief Quality, Safety, & Experience Officer, Inspira Health, Vineland, New Jersey


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How to Cite

Kahler, D., S. Chishimba, J. L. Eisenberg, A. J. Goldberg, and T. Reed. “Assessment of Active Shooter Preparedness in US Hospital Systems”. American Journal of Disaster Medicine, vol. 18, no. 1, Nov. 2023, pp. 37-45, doi:10.5055/ajdm.0458.