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Important steps to prepare for a potential active shooter in your facility

Tragic events, including a 2017 shooting at an Ohio nursing home that killed three people and recent deadly mass shootings, bring well-needed attention to the importance of healthcare facilities taking the necessary steps to prepare for a potential active shooter/armed intruder scenario.

An active shooter event can and does happen in in all types of healthcare facilities, and in all sizes of communities and towns. Healthcare safety and security expert Steven Wilder offers important guidance on how to prepare your facility and train all staff members on the proper course of action when an incident does occur to ensure the best possible outcome.

How you and your organization can better prepare for a potential event

Planning and training are a critical part of surviving an active shooter/armed intruder attack, according to Wilder. He recommends healthcare facilities address four critical planning and training steps to prepare for a potential event.

1. Perform a Security Vulnerability Assessment, which looks at some key things within your organization:

  • What are the threats? From what and from whom should we be protecting ourselves?
  • What are our vulnerabilities? Vulnerabilities are possible weaknesses in your operation that could allow an armed intruder/active shooter event to happen.
  • What are the potential risks? What are the likely consequences if a vulnerability is recognized and compromised?
  • What can you do to minimize the vulnerabilities?

2. Develop an Active Shooter Emergency Response Plan that is focused on healthcare. Healthcare facilities have unique challenges in developing a plan that not only addresses employees’ survival but also the survival of patients or residents as well. Develop a plan with a survival mindset, Wilder says, to include:

  • Locations of exits
  • Potential hiding places
  • Barriers that can used to put between people and the shooter
  • Identification of “weapons of opportunity” that can be used to defend against or attack the intruder if necessary
  • Protocols and training on when and how to contact area emergency responders, including police, fire, and EMS personnel

Call 911 as soon as safely able to do so

Do not assume others have already called
Continue to try if there’s a busy signal
Give pertinent information (if known):
Name of shooter  |  Description  |  Location  |  Number and type of weapons

3. Develop a Training Program consistent with your plan and tailored to your specific environment of care. Trained and untrained people usually respond in completely different ways, according to Wilder. Both will be afraid, that is a normal human response. But a trained person will recall what they’ve learned through their training and so will be much better prepared. Survival is a result of training, Wilder says.

Training should be both classroom and hands on and should include every employee from the newest through the administrator to the CEO. Provide a range of options and choices for occupants to make safe decisions in the shortest time possible.

Active Shooter Response Plan

For facilities that have residents to worry about, Wilder recommends the use of a Safety Action Plan commonly called the “Four Outs,” which is becoming a national model in the long-term care industry:

  • Get out (run)
    The goal is to get as many patients, residents, visitors and staff members out of the building. Use the closest exit that is away from the suspect. The more distance you put between yourself and the shooter, the less chance you have of becoming a casualty.
  • Hide out
    Find a place to hide out if you can’t get out of the building or if you can’t get to a point of safety. Turn off the lights. Make the room look unoccupied as much as possible. Close the blinds; silence cell phones.
  • Keep out
    Many rooms in healthcare facilities do not have a lock on the door – patient rooms, skilled nursing resident rooms, memory care rooms, therapy rooms. Have an alternate plan to move things in front of the door to act as a barricade to keep the intruder out. Examples include resident or patient beds, bedside tables, or chairs.
  • Take out (fight)
    This is where the only chance of survival is to fight back. Plan your attack using any available “weapons of opportunity” that you can use to fight back. Examples include chairs, a heavy lamp, a letter opener, a hot cup of coffee, phone cords or belt buckles.

4. Plan for Recovery, which is a very critical, but often the most overlooked part, of a crisis event, says Wilder. Recovery may take days, weeks or months to happen. Resources to help facilitate recovery for employees, residents/patients, and your physical facility can include:

  • Mental health services for victims
  • Recovery firm specialists to perform biohazard clean up and restoration to put your facility back into usable condition
  • New or additional security measures
  • A consultant to deal with potential media stories
  • Legal representation and insurance personnel to handle potential lawsuits

Watch this webinar to learn how to address risks associated with an armed intruder or active shooter in or near a healthcare facility, and how to develop a culture of preparedness with procedures, training and exercises.


About our expert: Steven Wilder is President & CEO of Sorensen, Wilder & Associates, which has worked with more than 150 hospitals and long-term care facilities throughout the U.S. Mr. Wilder has spent more than 30 years in safety, security and risk management. Before founding his own firm, he served as the corporate director of safety and security for a major healthcare system with nine hospitals and 15 long-term care facilities.