Active shooter preparedness resources

Healthcare active shooter preparedness requires balancing patient safety and care in the complex healthcare setting. A proactive plan incorporating security, compassionate care, and crisis management is needed to reduce patient harm and medical operations.

Vizient Medical Executive Network leaders polled healthcare institutions regarding active shooter response. Several organizational tactics were found to be lacking or inconsistent. The Vizient Medical Executive Network issued a call to action to address these vulnerabilities. Forty people from twenty-seven Vizient member organizations developed Recommendations and Rationales to help hospitals mitigate common risks, identify national guidelines, and prepare for such situations.

Learn more: Vizient Report - Assessing Active Shooter Preparedness in U.S. Hospital Systems

Printable Active Shooter Resources Overview


In the US, from 2018 – 2023, there has been a consistent rise in active shooter events (injuries and casualties) to over 300 in 2023.

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Recommendations and Rationales

During an active shooter event, effective communication is the cornerstone between chaos and potential safety

The urgency and uncertainty of active shooter events demand clear, swift, and strategic communication channels. Timely dissemination of accurate information not only aids in the swift response of law enforcement but also empowers individuals to make informed decisions, seek safety, and assist others. In these high-stress moments, the value of communication cannot be overstated—it serves as a lifeline, guiding actions and potentially saving lives amidst the harrowing circumstances of an active shooter situation. Recommendations included covering the type of language to use when broadcasting an event, internal and external communication, and the important connection to emergency first responders and law enforcement.

The healthcare organization should consider whether plain language or code language is to be used during the initiation of an active shooter situation. Evidence supports using plain language.

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The healthcare organization should consider several rapid communication platforms such as overhead pages, text messages and emails. Consideration should be given to content and frequency of messaging with clear and concise instructions. While there is no specific evidence that supports one type of rapid communication over the other, experience shows that direct, quick communication has the potential to mitigate the situation.

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The healthcare organization should have a crisis communication plan in place to manage initial communication decisions before a crisis happens. When available, the healthcare organization should partner with Law Enforcement Public Information Officers. In rural communities, when law enforcement resources are scarce or not immediately available, the healthcare organization should have bullet point communication prepared in advance for concise information to be shared.

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Consideration should be given to partnering with emergency services and law enforcement agencies in advance of any emergency to ensure a well-coordinated, efficient, and safe response to a potential or real Active Shooter threat.

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In an active shooter situation, physical security measures serve as the first line of defense and a crucial component in safeguarding lives

Establishing robust physical security protocols and systems within a healthcare organization can significantly mitigate the impact of such a crisis. These measures encompass access control, fortified barriers, and designated safe zones, all designed to delay or deter an attacker's progress and provide valuable time for response and evacuation. The importance of physical security during an active shooter event cannot be overstated—it acts as a vital shield, offering a critical layer of protection to individuals and enabling a more structured and coordinated response to mitigate the threat. Recommendations include focusing on building design, such as limited access, metal detectors, access management, and mitigation efforts, such as designated safe rooms.

Utilize an evidence-based approach to designing or renovating healthcare organization facilities to increase safety and prevent vulnerabilities that may be further exposed during a crisis. Conduct security vulnerability assessments yearly to identify gaps and areas of improvement.

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Implement an access control plan that provides protection against an external threat, establishes reasonable security controls and mitigates risks as identified in the healthcare organizations security management risk assessment.

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The use of physical security safeguards plays a critical role in active shooter mitigation strategies. Have the integration of multiple physical facility options and technologies creates expanded and enhanced opportunities for early detection of threats, expedited response times and more robust forensic evidence.

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In active shooter situations, every second is critical. Safe rooms enable occupants to seek immediate protection rather than evacuating the premises, which may expose them to danger. It is recommended, staff should be trained and have the ability during a crisis event to identify a safe room or area to hide, barricade and lockdown.

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In the face of an active shooter event, having a comprehensive and well-rehearsed plan of action, coupled with a swift and coordinated response, stands as the key to minimizing casualties and ensuring the safety of individuals

A meticulously crafted plan tailored to the specific environment and regular drills and training equip individuals with the necessary knowledge and instincts to act decisively in an emergency. The ability to swiftly execute predetermined protocols, including evacuation procedures, sheltering strategies, and communication protocols, can significantly reduce confusion and aid containment efforts. The importance of a meticulous plan and a practiced response during an active shooter event cannot be overstated; they form the bedrock upon which lives can be safeguarded and potential devastation mitigated. Having a response plan and knowing how and when to activate it is crucial. Recommendations included cover the construct and activation. Additionally, specific to active shooter events, preparedness for hemorrhage control should also be a critical element of a healthcare organization's response plan.

Develop and implement comprehensive an active shooter incident response plan and procedures within healthcare organizations to mitigate risks, minimize harm and ensure critical business operations and patient care can be maintained.

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Include and train staff on options and criteria for active shooter incident responses in the Active Shooter Response Plan.

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Develop and implement a plan which includes training and applicable supplies for providing hemorrhage control capabilities during an active shooter event. Deploy hemorrhage control kits to points of entry and other areas within the healthcare organization. Hemorrhage control kits contain essential supplies to control severe bleeding and are vital for immediate first aid response.

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Practicing drills and simulations for an active shooter event isn't just about going through the motions — it's a vital rehearsal that can make a life-saving difference in a crisis

Drills and simulations immerse individuals in realistic scenarios, allowing them to familiarize themselves with emergency procedures, responses, and decision-making under pressure. By experiencing these simulated situations, participants gain invaluable insights into the dynamics of an active shooter event, honing their instincts, improving coordination, and fostering a heightened sense of preparedness. Regular drills and simulations serve as an essential bridge between theory and real-life execution, empowering individuals and healthcare organizations to respond effectively, minimize panic, and maximize safety in the face of a potential threat. Recommendations related to drills and simulation include a review of planning and preparation, suggestions for executing the drills and simulations in a healthcare setting, and finally, how to close the loop and do a full review after a drill.

Development of an active shooter response plan, with a robust drills and simulation process is an imperative step in safeguarding the well-being of the patients, families, staff and visitors present in your healthcare organization’s facilities.

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Simulating an active shooter drill or simulation in a secure environment in conjunction with law enforcement is the best practice. As close to a real-life scenario or series of scenarios without creating security risks or staff/community trauma is the goal. Leaders and staff must be trained in their respective roles and responsibilities but also in the roles and responsibilities of others, such as how and when law enforcement will respond. The desired outcome is to create perspective on how all roles impact each other to contribute to the success of the overall response is by drilling.

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After an active shooter exercise/drill has been concluded, consideration should be made to (1) conduct a debrief of the drill, (2) offer support resources to staff as needed, (3) conduct a survey for the drill and (4) develop an after-action report.

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The aftermath of an active shooter event demands a comprehensive approach to post-event recovery that extends beyond physical healing

The significance of post-event recovery lies in the physical rehabilitation of those affected and in addressing the emotional, psychological, and communal impact left in its wake. It encompasses a multifaceted support system that offers trauma-informed care, counseling, and resources to individuals, families, and communities grappling with the profound aftermath. Recovery efforts aim to restore a sense of safety, rebuild shattered confidence, and foster resilience while acknowledging the long-term effects such incidents can have on mental health and the collective psyche. The importance of post-event recovery in an active shooter situation is pivotal, guiding the healing process and aiding in the restoration of shattered lives and communities. There are many areas to review after an event. Some of those that stood out as areas with potential vulnerability include addressing post-traumatic stress and employee wellbeing. Culture also plays a crucial role in preparing for an active shooter event as it shapes individuals' mindsets, behaviors, and responses. Ultimately, a culture that prioritizes preparedness and collective responsibility becomes a powerful foundation upon which effective responses to any type of event can be built.
Consider integrating a culture that aims to balance accountability and fairness in handling errors, incidents, and near-misses within an organization or specific context promoting a culture that values learning and improvement while also holding individuals accountable and balanced manner. View the full recommendation
Implementing an employee well-being program is a way to enhance the overall health, happiness and productivity of the workforce. A successful employee well-being program is an ongoing initiative that requires continuous evaluation, adaptation and improvement based on the evolving needs and feedback of the workforce. Tailoring the program to the unique cultural needs of the organization is the key to success. View the full recommendation
Consider implementing a peer support program as part of a post-event emergency response to provide a network of support that goes beyond the typical structure of professional or hierarchical assistance. View the full recommendation
Post Event Critical incident stress management is crucial to the emotional well-being of healthcare workers. There are a variety of evidence-based models recommended in current literature. Organizations should identify which evidence-based program (or portions of that program) best align with the clinical expertise of their staff and the values and beliefs of the patient populations they serve. View the full recommendation
The use of animal assistance crisis response (AACR) interventions before, during, and after critical events has been shown to be beneficial in promoting emotional well-being of healthcare professionals while mitigating the risk of post-traumatic stress disorders such as post-traumatic stress disorder (PTSD), stress illness, burn out, moral distress/moral injury. View the full recommendation
Include in Active Shooter Response Plan invention procedures to address communication, screening, triage services to the appropriate level of care, support, and practical recovery assistance to all involved in the threat or event, including on patients, families, and visitors. View the full recommendation
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