Why it's so difficult for hospitals to address active shooter threats

The apparent murder suicide at Valhalla, N.Y.-based Westchester Medical Center Aug. 8 illustrates the complexity of protecting hospitals filled with the most sick and vulnerable individuals in the nation, according to Iohud.

Here are four things to know:

1. Unlike mass shootings at movie theaters, schools and concerts, hospital shootings are often more personal in nature.

"Hospital shootings tend to be more targeted shooters ... where the motive was grudge, or suicide, or euthanizing an ill relative," Christina Catlett, MD, associate professor of emergency medicine at Baltimore-based John Hopkins Medicine and associate director of the Johns Hopkins Office of Critical Event Preparedness and Response, told Iohud. "It's much harder to target your security measures to that particular set of motives."

2. Another challenge hospitals face when an active shooter is at large is the presence of elderly or immobile patients, which persuades staff to stay with their patients.

"There is the common active-shooting training of run, hide or fight, but it's unique in a healthcare facility because providers are going to feel very compelled to stay with their patients," Christopher Smith, director of emergency preparedness for the Healthcare Association of New York State in Rensselaer County, told Iohud.

3. A study conducted by Johns Hopkins researchers found many hospital shootings take place outside the building or near the entrance, suggesting metal detectors are unable to prevent such events. There were 154 hospital-based shootings across the U.S. between 2000-11, causing 235 deaths and injuries. About 30 percent of the 154 shootings happened in emergency departments, according to the study. Of these ED incidents, about 50 percent involved a police or security officer's firearm.

4. Many hospitals nationwide are upgrading staff training, technology and focused security measures to prepare for a potential shooting, Dr. Catlett told Iohud. Some of the upgrades include increasing security at entrance ways and including more expansive ID checks for people wishing to enter the building. Many hospitals also install badge-access checkpoints and metal detectors to selective units. Annual emergency-preparedness reviews also help hospital staff practice safety measures.

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