Armed Assailant in a Health Care Setting: Are We Prepared?

Summary: While armed assailant attacks in a healthcare setting are rare, they pose a potential risk to healthcare staff, patients, visitors, and the infrastructure. They can disrupt health care services and deprive people of life-saving treatment. Many hospitals have well-developed disaster plans to respond to a mass casualty incident (MCI) occurring outside the hospital. Hospital staff receive emergency preparedness training to respond to MCI as part of their job scope, either through online modules or participation in disaster drills. A lack of an armed assailant incident response plan can significantly reduce the hospital’s ability to appropriately respond to such an incident. The random, short-lasting but violent nature of an armed assailant incident makes healthcare response extremely challenging. Along with the response to the incident, the other challenges also include the management of the assailant as well as the safety and management of the patients, public, and healthcare staff during the incident. The primary objectives of the response plan should be: • threat assessment and pre-incident planning • initiating immediate response during an incident to minimize the assailant’s access to potential victims • damage and post-incident recovery and support plans During the attack, based on the best available evidence, adopting the model of “Run, Hide, Fight” or “Secure, Preserve, Tell” are recommended. Care provision to the injured during this event should be remembered by the acronym THREAT. • T- Threat Suppression • H- Hemorrhage Control • RE - Rapid Extrication to safety • A - Assessment by medical providers • T- Transport to definitive care Once the attack has ended, there must be an assessment of the department/hospital’s ability to continue routine operations. Various stakeholders of the health care facility should work together to develop an armed assailant incident response plan that best suits their needs and capacity. This will be of immense benefit for keeping healthcare facilities safe.