Correspondence
An active shooter in our hospital
Published Online February 2, 2015 http://dx.doi.org/10.1016/ S0140-6736(14)62411-9
1728
On Jan 20, 2015, at about 11 am, a gunman deliberately shot and killed a gifted young cardiac surgeon in our hospital. Michael Davidson, aged 44, director of endovascular cardiac surgery at Brigham and Women’s Hospital (Boston, MA, USA), was shot twice by the assailant, who then turned his weapon on himself, with similarly fatal consequences. In the immediacy of the moment, several staff members, without knowing whether the shooter was still at large, tended to their stricken colleague and transported him rapidly to the emergency department, while others systematically secured themselves and patients in various rooms—doors closed and locked, furniture moved to barricade. It is impossible to know whether lives were saved by the responses of our staff in the area, but the tenet of our active shooter preparation was singular— we cannot ever fully prevent such occurrences, but we can, and must, prepare for them. Mass shootings in Aurora, CO, Newtown, CT, Washington DC Navy Yard, Los Angeles International Airport, and more recently the Charlie Hedbo shootings in Paris, have shown the potential of a so-called active shooter to inflict devastating loss of life. 1 The United States Department of Homeland Security (DHS) defines an active shooter as “an individual actively engaged in killing or attempting to kill people in a confined and populated area.”2 Active shooter is a specific term used by law enforcement to describe a shooting in progress where law enforcement personnel and bystanders have the potential to affect the outcome of the event. The random, violent and short-lived nature of these events makes management by public safety responders a challenge. Hospital shootings are rare, but health-care personnel are more at risk of violent acts than most of
them suspect. From 2000 to 2011, there were 154 hospital-related shootings in the USA, 60% of which were inside the hospital and the remainder on hospital grounds. Shootings happened in 40 US states, with 235 people injured or killed.3 Active shooter events are even rarer; only four such events occurred at health-care facilities between 2000 and 2013. Of those four events, two shooters committed suicide at the scene, paralleling our event.4 At Brigham and Women’s Hospital, our focus has shifted to recovery, supporting the grieving, and aiding the healing process that allows those affected by the events to begin to navigate the path to a new normal. A hospital is a place of healing, sanctuary, and comfort, both for those who seek care and those who provide it. A place of healing must welcome its community openly with warmth, but must also promise safety and security. Our after-action review of the shooting, designed to examine individual and collective responses and identify opportunities for improvement, is well underway. But, in preparing for the future, we will leave no stone unturned. We have commissioned a nationally regarded security firm to help us to design the best solution to the irreconcilable conflict between ensuring accessibility for our community and preventing a person or object capable of inflicting violence from entering. We cannot, with certainty, prevent, but we can certainly anticipate and prepare. We declare no competing interests.
*Eric Goralnick, Ron Walls [email protected] Brigham and Women’s Hospital and Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA 1
2
Jansheski JW. Mass shootings in the United States: common characteristics and predictive behaviors. Fort Levenworth: US Army Command and General Staff College, 2013. Department of Homeland Security. Active shooter preparedness. http://www.dhs.gov/ active-shooter-preparedness (accessed March 10, 2015).
3
4
Kelen GD, Catlett CL, Kubit JG, Hsieh YH. Hospital-based shootings in the United States: 2000 to 2011. Ann Emerg Med 2012; 60: 790–98. Blair JP, Schweit KW. A study of active shooter incidents in the United States between 2000 and 2013. Washington: Texas State University and Federal Bureau of Investigation, US Department of Justice, 2014.
Department of Error Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet 2015; 385: 1729–37—In the Role of the funding source section, “No other monies were received by any of the authors” should have read “RJW and AMS received travel expenses from MUGAS for investigator meetings in London”. This correction has been made to the online version as of Feb 2, 2015 and the printed version is correct. Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet 2015; 385: 1729–37—The references in the appendix of this Article were incorrectly numbered. The appendix has been corrected as of May 1, 2015. Santolaya ME, O’Ryan ML, Valenzuela MT, et al, for the V72P10 Meningococcal B Adolescent Vaccine Study group. Immunogenicity and tolerability of a multicomponent meningococcal serogroup B (4CMenB) vaccine in healthy adolescents in Chile: a phase 2b/3 randomised, observer-blind, placebo-controlled study. Lancet 2012; 379: 617–24—In this Article, the second sentence of the penultimate paragraph of the results section should have read: “Fever (≥38°C) was reported after 123 (4%) of 3329 4CMenB doses compared with 44 (2%) of 2738 after placebo injections (p
An active shooter in our hospital
Published Online February 2, 2015 http://dx.doi.org/10.1016/ S0140-6736(14)62411-9
1728
On Jan 20, 2015, at about 11 am, a gunman deliberately shot and killed a gifted young cardiac surgeon in our hospital. Michael Davidson, aged 44, director of endovascular cardiac surgery at Brigham and Women’s Hospital (Boston, MA, USA), was shot twice by the assailant, who then turned his weapon on himself, with similarly fatal consequences. In the immediacy of the moment, several staff members, without knowing whether the shooter was still at large, tended to their stricken colleague and transported him rapidly to the emergency department, while others systematically secured themselves and patients in various rooms—doors closed and locked, furniture moved to barricade. It is impossible to know whether lives were saved by the responses of our staff in the area, but the tenet of our active shooter preparation was singular— we cannot ever fully prevent such occurrences, but we can, and must, prepare for them. Mass shootings in Aurora, CO, Newtown, CT, Washington DC Navy Yard, Los Angeles International Airport, and more recently the Charlie Hedbo shootings in Paris, have shown the potential of a so-called active shooter to inflict devastating loss of life. 1 The United States Department of Homeland Security (DHS) defines an active shooter as “an individual actively engaged in killing or attempting to kill people in a confined and populated area.”2 Active shooter is a specific term used by law enforcement to describe a shooting in progress where law enforcement personnel and bystanders have the potential to affect the outcome of the event. The random, violent and short-lived nature of these events makes management by public safety responders a challenge. Hospital shootings are rare, but health-care personnel are more at risk of violent acts than most of
them suspect. From 2000 to 2011, there were 154 hospital-related shootings in the USA, 60% of which were inside the hospital and the remainder on hospital grounds. Shootings happened in 40 US states, with 235 people injured or killed.3 Active shooter events are even rarer; only four such events occurred at health-care facilities between 2000 and 2013. Of those four events, two shooters committed suicide at the scene, paralleling our event.4 At Brigham and Women’s Hospital, our focus has shifted to recovery, supporting the grieving, and aiding the healing process that allows those affected by the events to begin to navigate the path to a new normal. A hospital is a place of healing, sanctuary, and comfort, both for those who seek care and those who provide it. A place of healing must welcome its community openly with warmth, but must also promise safety and security. Our after-action review of the shooting, designed to examine individual and collective responses and identify opportunities for improvement, is well underway. But, in preparing for the future, we will leave no stone unturned. We have commissioned a nationally regarded security firm to help us to design the best solution to the irreconcilable conflict between ensuring accessibility for our community and preventing a person or object capable of inflicting violence from entering. We cannot, with certainty, prevent, but we can certainly anticipate and prepare. We declare no competing interests.
*Eric Goralnick, Ron Walls [email protected] Brigham and Women’s Hospital and Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA 1
2
Jansheski JW. Mass shootings in the United States: common characteristics and predictive behaviors. Fort Levenworth: US Army Command and General Staff College, 2013. Department of Homeland Security. Active shooter preparedness. http://www.dhs.gov/ active-shooter-preparedness (accessed March 10, 2015).
3
4
Kelen GD, Catlett CL, Kubit JG, Hsieh YH. Hospital-based shootings in the United States: 2000 to 2011. Ann Emerg Med 2012; 60: 790–98. Blair JP, Schweit KW. A study of active shooter incidents in the United States between 2000 and 2013. Washington: Texas State University and Federal Bureau of Investigation, US Department of Justice, 2014.
Department of Error Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet 2015; 385: 1729–37—In the Role of the funding source section, “No other monies were received by any of the authors” should have read “RJW and AMS received travel expenses from MUGAS for investigator meetings in London”. This correction has been made to the online version as of Feb 2, 2015 and the printed version is correct. Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet 2015; 385: 1729–37—The references in the appendix of this Article were incorrectly numbered. The appendix has been corrected as of May 1, 2015. Santolaya ME, O’Ryan ML, Valenzuela MT, et al, for the V72P10 Meningococcal B Adolescent Vaccine Study group. Immunogenicity and tolerability of a multicomponent meningococcal serogroup B (4CMenB) vaccine in healthy adolescents in Chile: a phase 2b/3 randomised, observer-blind, placebo-controlled study. Lancet 2012; 379: 617–24—In this Article, the second sentence of the penultimate paragraph of the results section should have read: “Fever (≥38°C) was reported after 123 (4%) of 3329 4CMenB doses compared with 44 (2%) of 2738 after placebo injections (p
