'A pandemic of gun violence': Hospital workers call for safety while healing others

When front-line hospital workers report to their jobs each day, it is impossible to know every situation they might encounter with patients, visitors and colleagues. But one situation appears more in the realm of possibility of late: the potential for a shooting or other violent incident. 

Shootings at hospitals are still rare, but they have become more common in recent years. A shooting on a hospital campus June 1 in Tulsa, Okla., marked the 233rd mass shooting in the U.S. this year, a number that rose to 267 by June 14. Also on June 1, a security guard died after being shot by a jail inmate being treated at Miami Valley Hospital in Dayton, Ohio. The inmate then fatally shot himself in the hospital's parking lot. In October 2021, a certified nursing assistant was shot and killed at Thomas Jefferson University Hospital in Philadelphia.

A tweet from June 1 shone a light on the issue's prevalence: "Today's shooting at my med school hospital in Dayton, OH didn't even make national news because it was overshadowed by another shooting at another hospital in Tulsa, OK."

And shootings are not the only incidents of violence. There have been other violent events in recent months at healthcare facilities, including when two staff nurses and an emergency department physician were stabbed June 3 at Encino (Calif.) Hospital Medical Center.

Overall, 9 in 10 healthcare workers have seen or experienced violence in the workplace, according to a survey released in May. 

Scary situation for workers

In the wake of recent incidents of violence, many clinicians are facing increased anxiety at work, they told Becker's.

Edward Barksdale, MD, is surgeon-in-chief at UH Rainbow Babies & Children’s Hospital in Cleveland, which reported more gunshot wound injuries so far this year than all last year. 

"We are clearly in what I would call a pandemic of gun violence," said Dr. Barksdale, who is also a professor of surgery at Case Western Reserve University School of Medicine. "Whenever you're in the presence of a pandemic or an epidemic, you worry that the spread of the violence virus may not just impact you as a voyeur but also as a victim. Many of my colleagues on the front lines are quietly or not so quietly anxious about the spread of this violence not only in the community but also in the hospital as we saw [in Tulsa]."

Violence in healthcare settings is not new. However, Louis Hondros, DO, an emergency care physician and director of emergency management and preparedness at Rush Medical Center in Chicago, said the issue is more concerning for workers right now.

Dr. Hondros said healthcare workers at his organization are asking: Could this happen to us? What are we capable of doing in this event? What do I need to know? What is the safest thing that I can do in these scenarios?  

The Tulsa shooting is especially personal for Dr. Barksdale because he knew Preston Phillips, MD, who was killed in the tragedy. Dr. Barksdale graduated from Boston-based Harvard Medical School in 1984, the same year Dr. Phillips started.

"When you look at the news and you see these events, it's really easy to be dispassionate about them, to turn both your eyes and your heart away from them — until you know the person," Dr. Barksdale said. "Then it becomes extremely personal and heart wrenching. We're feeling some angst. I'm feeling intense angst and wondering who's next." 

Dr. Barksdale was the first African American to serve as chief of the west surgery service at Boston-based Massachusetts General Hospital, and he served as a mentor to Dr. Phillips, who is also African American.

Dr. Barksdale said he remembers Dr. Phillips as "a calm, serious and spiritual guy."

"When someone looks up to you and you advise them about a career and about opportunity and about how to survive in an academic environment that is focused on excellence and you watch him develop, it's almost the same pride you have within a family of seeing a sibling do well," Dr. Barksdale said.

Still, no matter the training or career trajectory, he noted that all physicians are vulnerable to violence.

"We as physicians are incredibly vulnerable because I say that we do the most intimate things that people do outside of being a priest or what might occur in a romantic relationship," Dr. Barksdale said. "People bear their all to us. People allow us to be incredibly invasive. We lean into that vulnerability. We are healers. What I'm anxious about with these situations is that many more of us are going to be more guarded with patients. And it is our humanity that allows us to be healers. I hope this doesn't have an impact on nurses, surgeons or other healthcare providers who then become more cautious about their patients and will lose the effectiveness of their ability to be healers." 

What are the solutions? 

There are options when it comes to solutions to address concerns for healthcare workers. For example, increased hospital security has been a topic of discussion at health systems. Healthcare executives are also calling for gun safety and changes to address gun violence.

No matter the approach, Dr. Barksdale and Dr. Hondros agree more needs to be done and that moving forward should involve a multifaceted effort.  

Dr. Barksdale, as co-founder of the Antifragility Initiative — a holistic, hospital-based violence intervention program for teens at UH Rainbow Babies & Children's Hospital — said his perspective comes from the standpoint of victims. 

"We know that the biggest cause of gun violence in children is a previous episode of being a victim. About 30 percent of our patients who come in shot between the ages of 6 and 15 will return within two years with another gunshot wound injury," he said. "So my perspective is from a public health standpoint. I look at the risk factors. I define the problem, which is guns and gun violence. But the risk factors are poverty and despair and hopelessness that we see within our communities, in particular our communities of color. Once you are a victim, you are much more likely to be a victim again or to be a victimizer. So it's important for us to think holistically about how we break the cycle."

He added that he believes it is important to ensure there is reasonable gun safety legislation, but he is more focused on how to limit people being victims concurrently with reasonable gun legislation. 

Dr. Barksdale, who is also the immediate past president of the American Pediatric Surgery Association, has worked in his roles to advocate for gun safety legislation, and on the local level he has been involved in providing education in schools about conflict resolution and avoiding use of guns.

Additionally, he said his hospital is focused on trauma informed care. 

"What we recognize is violence is the end result often of trauma people have experienced in their life that percolates within them and then is emitted," Dr. Barksdale said. "Not only does someone pick up a gun, but sometimes we in the hospital — due to our lack of empathy and inability to lean into our patients who are victims — don't provide them with the emotional support. So we may revictimize them. So [patients] leave the hospital with this mentality and they're still hurt and not healed."

To address that, he said the hospital, through its Antifragility Initiative, is training providers to listen to these patients and focus on being healers. 

"Healed people heal people," Dr. Barksdale said. "We're focusing on using the event of presenting to the hospital as a victim or gun violence or other violence as a means of promoting the recovery and the post-traumatic growth of people."

Regarding other efforts in hospital workplaces, Dr. Barksdale said it is increasingly apparent that many institutions will need metal detectors, and there should be a public education campaign that alerts people about the serious nature of gun violence.

Still, he acknowledged: "There's not going to be one solution that manages all of this. It's going to be a bevy of solutions and [hospitals, communities and politicians] working together to do the things to make this improve."

Dr. Hondros, at Rush, agreed a varied approach is necessary. He said this includes gun reform as well as looking at mental health resources. 

Within his hospital, particularly in the emergency department, workers have been doing more active shooter drills.

"We just had an active shooter drill on May 19 and try to make it as realistic as possible," Dr. Hondros said. "If something happened at a particular day and time, [we assessed] what our capabilities are, what we would be able to do, and what protocols could we put in place."

He acknowledged that planning is difficult because scenarios are unique. He said the focus is always learning about opportunities in the facility that would enable workers to feel safer or more prepared in the event of a shooting.

"We did learn that we have structures in each area of our emergency department where our employees could run into, where there are secure areas," Dr. Hondros said. "One of the biggest challenges is we're emergency healthcare providers. I was a critical care paramedic for six years before med school. We are staff that run into the fire, not away from the fire. We're trained to run into the fire. This is counterintuitive. If something goes down, we're looking around seeing how we can help, and you can't do that in this scenario because you're trying to avoid more casualties. That's a hard thing to teach our people, that safety comes first at the cost of potential lives of your colleagues."

In addition to drills, the Rush emergency department has also set up disaster carts where workers could start pulling out medical equipment to triage and treat colleagues quickly in the event of a shooting, Dr. Hondros said.

He said his organization is also considering metal detectors. 

"The things that was once talked about but didn't think it was feasible unfortunately has come to light now that we seriously have to take into consideration," Dr. Hondros said. 

Rush has also recently developed a Code Silver internal code, which alerts front-line workers, hospital security and other hospital officials that a volatile situation is occurring because a person has a weapon.

"Our employees come in every day thinking could this happen, but more importantly is that they're concerned about what are we able to do to make sure this is as safe of an environment as possible," Dr. Hondros said. "… They want to know what we are doing, what are we implementing, how are we able to secure their safety and what can we do. That's what the focus is. You have to be realistic, and it's difficult because we don't have a one-size-fits-all plan. They're unique. We run these unique scenarios and we keep learning from them." 

Meanwhile, he said one thing is agreed upon by healthcare leaders and workers across the industry: The issue of violence in healthcare settings needs to be addressed, and they will continue striving to create safe environments for employees.


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