Dr. Ankit Raj

Intern

Kasturba Medical College

Manipal

 

On 11th September, at the anniversary of 9/11, Charleston Area Medical Center, West Virginia’s largest hospital was put on a brief lock-down following a shooting near its parking lot.[1] The incidence was neither the first nor an isolated one in the United States, now infamous for its rampant gun violence and its failure to control it. Gun violence and mass shootings have become so common in the United States, that it is not uncommon for news agencies to ignore multiple sporadic episodes of gun violence unless it involves a large group or a popular location. Relaxed gun laws in the US has resulted in higher gun ownership which in turn has given rise to a higher level of homicides and suicides resulting from firearms.[2] Initially occurring in violent neighborhoods, nightclubs or at private places, this problem has rapidly leapfrogged into places meant to treat victims of gun violence: the hospitals.

Hospitals and other healthcare settings are especially vulnerable to intentional and non-intentional shootings. There are patients who cannot run, hide or defend themselves owing to their medical conditions and ongoing therapy. Healthcare providers are not trained to defend themselves either and are often caught off-guard. Due to the prevalence of sense of vulnerability in hospitals, a lack of preparedness and inefficient mitigation response, hospitals provide a target-rich setting for shooters. While gun violence in hospitals attracts intense media coverage and public attention, little has been done to understand or to treat this horrible American nightmare.

While relatively little literature is present on hospital-related gun violence in and outside the United States, a study done by John Hopkins University puts these sporadic and isolated events together and gives a bird’s eye view of the hospital related gun violence in the United States. [3]The study identified that while seeming common, hospital-related shootings were a relatively rare occurrence compared to other workplace-related violence. Although shootings happened both inside the hospital as well as outside on the hospital grounds, the most common site was Emergency Department, followed by the parking lot and patient rooms. It could be owed to the fact that the Emergency Department is the most visible part of any hospital to the public eye and also the most easily accessible. A substantial majority of the perpetrators were men and represented almost all brackets of age-groups while the majority of victims were perpetrators themselves, followed by hospital employees; physicians; and nurses. Most of the events involved a determined shooter with a strong motive such as grudge or revenge, suicide, “euthanizing” an ill relative, and prisoner escape.

Although it is now identified that hospital-related shootings are relatively rare compared to other forms of workplace violence, such events are especially unpredictable and pose a risk to vulnerable inhabitants of hospitals.[3] A significant change to hospital security protocols and mitigation policy is urgently needed for risk reduction. To bring a change to the current gun-violence, we need to create evidence-based active shooter policies and involve all stakeholders in the discussion as well as in implementation. Hospital staff, most significantly doctors and nurses, need to be provided training on identifying rapidly escalating and potentially dangerous situations. In case of an active shooting, immediate communication, activation of Code White or Code Silver and enforcement of an evasion plan should be the first priority.[4]Strategic videos like “Run, Hide, Fight,” produced by Homeland Security, acting as an excellent tutorial on surviving an active shooter event.[5] A strategic preparation to deal with active shooting might reduce the fatality and casualty, but it will never completely solve the issue. A risk reduction approach with a focus on creating awareness of gun violence, tighter scrutiny of gun-owners and higher security at hospitals will serve a long way in reducing the effects of gun violence.

Hospital-shootings represent the culture of violence currently prevailing in western and developed countries, especially the United States. It is the responsibility of government, hospital administrations and policymakers to introduce stringent policies on gun ownership and violence and provide a sense of security to vulnerable caregivers and patients. It is understandable that with the relaxed gun laws of the United States, it is difficult to implement a “No Weapons” policy. But there is no harm in implementing the “No Weapons” policy at certain places like hospitals and healthcare facilities. Evidently, it is the motive of United States policymakers and tenacity of the taxpayers that will determine whether hospitals are safe places to provide healthcare or another soft spot for perpetrators.

 

REFERENCES:

  1. “UPDATE: Lock down Lifted At Charleston Hospital, Police Looking For Two Shooters”. 2018. Thenewscenter.Tv. https://www.thenewscenter.tv/content/news/Shooting-prompts-Charleston-hospital-to-be-placed-on-lockdown—492925041.html.
  2. “America’s Unique Gun Violence Problem, Explained In 17 Maps And Charts”. 2018. Vox. https://www.vox.com/policy-and-politics/2017/10/2/16399418/us-gun-violence-statistics-maps-charts.
  3. Kelen, Gabor D., et al. “Hospital-Based Shootings In The United States: 2000 To 2011.” Ann Emerg Med. 2012 Dec;60(6):790-798.e1. doi: 10.1016/j.annemergmed.2012.08.012
  4. “Hospital Shootings: Rare, With “Directed” Motives”. Today’s Hospitalist. 2013. ://www.todayshospitalist.com/hospital-shootings-rare-with-directed-motives/.
  5. “RUN. HIDE. FIGHT.® Surviving An Active Shooter Event – English”. 2018. YouTube. https://www.youtube.com/watch?v=5VcSwejU2D0.

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