Healthcare in America is under assault.
According to the Bureau of Labor Statistics (BLS), healthcare workers are five times more likely to experience workplace violence than other workers.
Over the past twenty years, shootings of physicians in hospital settings have more than tripled. Understanding these events is essential to reducing violence of all sorts in healthcare and ensuring hospital safety.
In their 2022 crime survey, the International Association of Healthcare Security & Safety (IAHSS) found that violent crimes in US hospitals jumped 47% from 2021 to 2022. The BLS’s most recent report, which covers roughly the same period, found that healthcare workers—who represent just 12% of the US workforce—experienced 72.8% of all cases of workplace violence serious enough to require days away from work, medical treatment, or job reassignment.
While deadly attacks are a small subset of the high number of total assaults that occur in healthcare, nearly all deadly attacks committed in healthcare facilities involve a firearm.
(Related: See how to protect your hospital with physical security solutions for healthcare)
Last year, Dr. Daniel L. Schwerin, Dr. Jeff Thurman, and Dr. Scott Goldstein released an update to their guide to healthcare/hospital active shooter preparation and response.
This is an insightful planning resource, highlighting the security challenges unique to healthcare settings, and clearly laying out your active shooter response options in medical settings.
Differentiating Between Types of Hospital Active Shooter Events
Schwerin, Thurman, and Goldstein identify five categories of active shooter events in hospitals and healthcare. These are similar to the four categories of workplace violence recognized by NIOSH (the National Institute for Occupational Safety and Health), in that they differentiate the major motives driving violence in hospitals.
Understanding these five types of active shooter events helps healthcare organizations make better decisions to address the possibility of violence in their facilities.
Type 1: Criminal Intent
In these situations, the shooter has no formal or legitimate connection with the healthcare facility, and the motive is usually theft. In most cases, the attacker uses a deadly weapon, and there is a high risk of injury for the worker. Criminal intent shootings include everything from a spontaneous attempt at shoplifting that turns violent to a pre-planned robbery. In healthcare settings, especially pharmacies, a common motive is to steal prescription pain medication.
When you consider workplace violence overall, criminal intent assaults account for most attacks and the majority of fatalities. That is not the case in healthcare.
Type 2: Customer/Patient
In these situations, the shooter is a patient, former patient, or family member/partner/close associate of a patient. This category encompasses a wide range of situations, from someone in the midst of a mental health crisis lashing out at an EMT to a former patient with a long-simmering grudge targeting a specific doctor. According to research by the International Healthcare Security and Safety Foundation (IHSSF), as much as 93% of healthcare workplace violence falls into this category.
Type 3: Worker-to-Worker
In these situations, both the assailant and victim are current or former employees of the healthcare organization. As in other workplaces, these cases often arise from bullying and other interpersonal conflicts, or follow disciplinary action or termination of employment.
While worker-to-worker violence is a small portion of workplace violence overall (Schwerin, Thurman, and Goldstein estimate it to be around 7%), it’s believed to be a major driver of violence in many industries, including healthcare. NIOSH found more than half of all nurses have experienced recurrent threats or verbal abuse from a coworker.
Type 4: Intimate Partner Violence or Domestic Violence
In these situations, the victim may be an employee or a patient. The attack usually occurs after the victimized partner has taken measures to end an already violent situation. The abusive partner or former partner arrives at the healthcare facility targeting the victims. This category accounts for around a quarter of all workplace violence. It is a smaller portion of the total violence in healthcare settings, but still an important potential motive to consider when planning how to best protect healthcare staff, clients, and visitors.
Type 5: Ideological Violence
In these situations, an attacker arrives at a healthcare facility with intent to directly harm people or property, usually on a large scale. They are motivated by an extreme ideology, and the attack is usually the result of lengthy planning. They may act alone, or conspire with other like-minded individuals or extremist groups.
While NIOSH does not include ideological violence among their categories of workplace violence, it is a growing concern in healthcare, with recent attacks targeting family planning and fertility clinics and the 2024 assassination of UnitedHealthcare CEO Brian Thompson.
Preparing for Hospital Active Shooter Events
At Total Security Solutions, we’ve noted recent increases in calls from healthcare providers who want to enhance their physical security. Recent inquiries have included:
- Large hospital systems looking to improve security in their emergency departments, behavioral health units, and administrative offices
- Pharmacies worried about theft
- Plastic surgeons who need to secure a small reception area
- Therapists and psychiatrists responding to patterns of threatening behavior
In our experience, healthcare facilities must balance several factors. They need ballistic protection with enhanced forced-entry resistance without impacting the patient experience or interfering with a welcoming, healing atmosphere.
The right solution that protects people in an emergency and deters violence from the start will take very different forms in different healthcare settings, even within a single facility.
For example, both therapists’ offices and large behavioral health units in hospitals tend to focus on access control. They are well served by a secure vestibule system that allows employees to safely vet everyone before they are buzzed through.
Such systems also send a clear message: If you act like a threat, these doors will not open. Transaction windows and secured teller lines at pharmacies send a similar message: Our employees can safely choose not to deal with anyone who becomes threatening.
Other medical settings need to take a very different approach to keep people safe. For example, an emergency department can’t restrict access, so many hospitals choose to secure the nurses’ station. This protects both the employees whose public interaction exposes them to risk and creates an area where they can shelter in emergencies.
Developing a Response Plan and Protective Strategy
No single product or initiative can effectively deter violence or minimize the impact on its own.
To effectively respond to hospital-based shootings, healthcare facilities must adopt a systems approach. This includes:
1. Building an Active Shooter Response Plan
Every organization should have a formal, documented active shooter response plan aligned with Department of Homeland Security (DHS) and Federal Emergency Management Agency (FEMA) guidance. The plan should include detailed protocols for communication, evacuation, lockdown, and coordination with law enforcement.
2. Training Healthcare Professionals
Healthcare workers, including administrative staff and volunteers, should receive training on recognizing warning signs of violence, implementing lockdown procedures, and assisting patients during an active shooter incident. Training should be frequent, scenario-based, and address department-specific responsibilities.
3. Physical Security Measures
Facilities should integrate ballistic glass, bullet-resistant fiberglass, and forced-entry resistant framing systems in high-risk zones like emergency medicine departments and pharmacy counters. These materials help preserve valuable time for hospital employees and patients to escape or seek cover.
4. Secure Communication Systems
Having a fast, reliable system for mass notifications across the hospital is crucial. Whether it’s overhead announcements, secure mobile alerts, or panic buttons, clear communication can help direct potential victims to safety.
5. Coordination with Homeland Security and Local Task Forces
Hospitals should establish partnerships with local law enforcement, DHS representatives, and emergency response task forces. These relationships support coordinated response efforts, realistic training drills, and shared intelligence on emerging threats.
6. Behavioral Threat Assessment and Mental Health Support
Any violence prevention plan should include behavioral threat assessment teams and mental health resources for both patients and staff. As research suggests, mental health challenges often play a role in such incidents. Supporting mental health can mitigate risks before they escalate into violence.
Security Solutions for Healthcare Providers
Protecting your healthcare facility from violence requires a thoughtful, layered approach. Look for solutions that deter attacks and delay an attacker from entering further to do more damage. At TSS, we have decades of experience delivering physical security solutions that balance safety and aesthetics to meet your goals. With more than 30,000 installations completed, no one else comes close to our breadth of experience in custom design, fabrication, and installation. That isn’t just because we have skilled designers and experienced tradespeople. It’s because we take the time to understand your goals, challenges, and concerns, and then use what we learn to find the best solution for you.
If you have questions are are ready to start planning your project, please contact us. We look forward to working with you to save lives.
