Hospital-based shootings in the United States, 2000-2019
DOI:
https://doi.org/10.5055/ajdm.0503Keywords:
workplace violence, healthcare worker, firearms, shootingsAbstract
Introduction: Violence in healthcare settings, particularly directed toward healthcare workers, has received increasing attention in the United States (US). However, there is limited evidence on trends in hospital-based gun violence. We aimed to better understand the characteristics of US hospital-based shootings over two decades.
Methods: A search of Nexis Uni was conducted for newspaper articles, newswires, web news articles, or magazines mentioning hospital-based shootings during the period from 2000 to 2019. Articles were screened for relevance, and data were subsequently extracted and categorized by two independent reviewers.
Results: From 2000 to 2019, we identified 148 hospital-based shootings with 241 victims. Mean number of shootings increased from 3.4/year during 2000-2004 to 8.4/year during 2005-2009 (rate ratio [RR]: 2.5, 95 percent confidence interval [CI]: 1.4, 4.3), to 11.2/year during 2010-2014 (RR: 1.3, 95 percent CI: 0.9, 2.0) but decreased to 6.6/year during 2015-2019 (RR: 0.6, 95 percent CI: 0.4, 0.9). An overwhelming majority (91 percent) of shooters were male with a median age of 46. The most frequent motive was the spillover of social violence (22 percent). The majority (59 percent) of events involved a single victim, although 14 percent had three or more victims.
Discussion: Hospital-based shootings remain a persistent threat, with the 2010-2014 period representing increased risk. While motives were varied, spillover of social violence was the most frequent. These findings can potentially inform prevention and mitigation strategies for hospital-based gun violence.
References
Bellizzi S, Napodano CMP, Lorettu L, et al.: Healthcare as a target for violence: From conflicts to pandemics. Health Secur. 2021; 19(5): 570-571. DOI: 10.1089/hs.2021.0112.
Dadfar M, Lester D: Workplace violence (WPV) in healthcare systems. Nurs Open. 2021; 8(2): 527-528. DOI: 10.1002/nop2.713.
Healthcare Workplace Violence: Occupational health and safety administration. Available at https://www.osha.gov/healthcare/workplace-violence/. Accessed December 15, 2024.
Lombardi B, Jensen T, Galloway E, et al.: Trends in workplace violence for health care occupations and facilities over the last 10 years. Health Aff Sch. 2024; 2: Qxae134. DOI: 10.1093/haschl/qxae134.
Preventing Workplace Violence in Healthcare: Occupational health and safety administration. Available at https://www.osha.gov/hospitals/workplace-violence/. Accessed November 30, 2024.
Vento S, Cainelli F, Vallone A: Violence against healthcare workers: A worldwide phenomenon with serious consequences. Front Public Health. 2020; 8: 570459. DOI: 10.3389/fpubh.2020.570459.
Liu J, Gan Y, Jiang H, et al.: Prevalence of workplace violence against healthcare workers: A systematic review and meta-analysis. Occup Environ Med. 2019; 76(12): 927-937. DOI: 10.1136/oemed-2019-105849.
Rossi MF, Beccia F, Cittadini F, et al.: Workplace violence against healthcare workers: An umbrella review of systematic reviews and meta-analyses. Public Health. 2023; 221: 50-59. DOI: 10.1016/j.puhe.2023.05.021.
James A, Madeley R, Dove A: Violence and aggression in the emergency department. Emerg Med J. 2006; 23(6): 431-434. DOI: 10.1136/emj.2005.028621.
Yusoff HM, Ahmad H, Ismail H, et al.: Contemporary evidence of workplace violence against the primary healthcare workforce worldwide: A systematic review. Hum Resour Health. 2023; 21(1): 82. DOI: 10.1186/s12960-023-00868-8.
O’Brien CJ, van Zundert AAJ, Barach PR: The growing burden of workplace violence against healthcare workers: Trends in prevalence, risk factors, consequences, and prevention—A narrative review. EClinicalMedicine. 2024; 72: 102641. DOI: 10.1016/j.eclinm.2024.102641.
Pompeii L, Dement J, Schoenfisch A, et al.: Perpetrator, worker and workplace characteristics associated with patient and visitor perpetrated violence (type II) on hospital workers: A review of the literature and existing occupational injury data. J Saf Res. 2013; 44: 57-64. DOI: 10.1016/j.jsr.2012.09.004.
Caruso R, Toffanin T, Folesani F, et al.: Violence against physicians in the workplace: Trends, causes, consequences, and strategies for intervention. Curr Psychiatry Rep. 2022; 24(12): 911-924. DOI: 10.1007/s11920-022-01398-1.
Adashi EY, O’Mahony DP, Cohen IG: Congress’ failure to address violence against health care workers. Health Aff Forefr. DOI: 10.1377/forefront.20240130.552221.
Grossman DC, Choucair B: Violence and the US health care sector: Burden and response. Health Aff (Millwood). 2019; 38(10): 1638-1645. DOI: 10.1377/hlthaff.2019.00642.
Kumari A, Sarkar S, Ranjan P, et al.: Interventions for workplace violence against health-care professionals: A systematic review. Work. 2022; 73(2): 415-427. DOI: 10.3233/WOR-210046.
Schwerin DL, Thurman J, Goldstein S: Active shooter response. In StatPearls. Florida: StatPearls, 2024. Available at http://www.ncbi.nlm.nih.gov/books/NBK519067/. Accessed November 29, 2024.
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.e1. 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. Work. 2019; 64(1): 77-83. DOI: 10.3233/WOR-192970.
Lozovatsky M, Saha S: The impact of firearm violence on the healthcare system of the United States. Ethics Biol Eng Med. 2014; 5(1): 1-12. DOI: 10.1615/EthicsBiologyEngMed.2014012035.
Ahmed SH, Waseem S, Shaikh TG, et al.: Baffling dilemma of workplace violence in healthcare: Will there be an end? Med Confl Surviv. 2022; 38(4): 289-294. DOI: 10.1080/13623699.2022.2073648.
Zhang S, Zhao Z, Zhang H, et al.: Workplace violence against healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Environ Sci Pollut Res. 2023; 30(30): 74838-74852. DOI: 10.1007/s11356-023-27317-2.
Doucette ML, Crifasi CK, Frattaroli S: Right-to-carry laws and firearm workplace homicides: A longitudinal analysis (1992–2017). Am J Public Health. 2019; 109(12): 1747-1753. DOI: 10.2105/AJPH.2019.305307.
Ayasreh IR, Hayajneh FA: Workplace violence against emergency nurses: A literature review. Crit Care Nurs Q. 2021; 44(2): 187-202. DOI: 10.1097/CNQ.0000000000000353.
Spelten E, Thomas B, O’Meara P, et al.: Violence against emergency department nurses; can we identify the perpetrators? PLoS One. 2020; 15(4): e0230793. DOI: 10.1371/journal.pone.0230793.
Aljohani B, Burkholder J, Tran QK, et al.: Workplace violence in the emergency department: A systematic review and meta-analysis. Public Health. 2021; 196: 186-197. DOI: 10.1016/j.puhe.2021.02.009.
Rosenthal LJ, Byerly A, Taylor AD, et al.: Impact and prevalence of physical and verbal violence toward healthcare workers. Psychosomatics. 2018; 59(6): 584-590. DOI: 10.1016/j.psym.2018.04.007.
Phillips JP: Measuring healthcare workplace violence in real time: Measuring healthcare workplace violence. Jt Comm J Qual Patient Saf. 2024; 50(3): 164-165. DOI: 10.1016/j.jcjq.2024.01.005.
Sari H, Yildiz İ, Çağla Baloğlu S, et al.: The frequency of workplace violence against healthcare workers and affecting factors. PLoS One. 2023; 18(7): e0289363. DOI: 10.1371/journal.pone.0289363.
Carey I, Hendricks K: Workplace violence against healthcare workers using nationally representative estimates of emergency department data, 2015-2017. Am J Ind Med. 2023; 66(4): 333-338. DOI: 10.1002/ajim.23463.
Hooton A, Bloom BM, Backus B: Violence against healthcare workers at the emergency department. Eur J Emerg Med. 2022; 29(2): 89-90. DOI: 10.1097/MEJ.0000000000000905.
D’Ettorre G, Pellicani V, Mazzotta M, et al.: Preventing and managing workplace violence against healthcare workers in emergency departments. Acta Biomed. 2018; 89(4-S): 28-36. DOI: 10.23750/abm.v89i4-S.7113.
Vilke GM, Billberry E, Bongbong DN, et al.: Impact of implementation of a new weapons screening at an urban emergency department. J Emerg Med. 2023; 65(6): e594-e599. DOI: 10.1016/j.jemermed.2023.08.010.
Smalley CM, O’Neil M, Engineer RS, et al.: Dangerous weapons confiscated after implementation of routine screening across a healthcare system. Am J Emerg Med. 2018; 36(8): 1505-1507. DOI: 10.1016/j.ajem.2017.12.043.
Stowell KR, Hughes NP, Rozel JS: Violence in the emergency department. Psychiatr Clin North Am. 2016; 39(4): 557-566. DOI: 10.1016/j.psc.2016.07.003.
Drone E, Wallen M, Ganti L: Assessment of emergency department staff awareness of policy and expert opinion protocol regarding active shooter event. Ann Emerg Med. 2020; 76(4): S100-S101. DOI: 10.1016/j.annemergmed.2020.09.275.
Brigo F, Zaboli A, Rella E, et al.: The impact of COVID-19 pandemic on temporal trends of workplace violence against healthcare workers in the emergency department. Health Policy Amst Neth. 2022; 126(11): 1110-1116. DOI: 10.1016/j.healthpol.2022.09.010.
Jasani G, MacNeal J, Hirshon JM: Emergency department active shooter training: A survey of current practices in 2020. Am J Disaster Med. 2021; 16(4): 263-269. DOI: 10.5055/ajdm.2021.0410.
Warren B: Workplace violence in hospitals: Safe havens no more. J Healthc Prot Manage. 2011; 27(2): 9-17.
Published
How to Cite
Issue
Section
License
Copyright 2007-2025, Weston Medical Publishing, LLC and American Journal of Disaster Medicine. All Rights Reserved.
