High caliber health care

BY E. DWIGHT OSTEEN II, BS,RPSGT, Sleep Services Director, Apollo Hospital, Director, Active Shooter Preparedness Program

When we are ill, we all want the highest caliber of care possible, and as a physician, you are constantly striving to provide that care. Yet in today’s society it is becoming obvious that the caliber we may encounter is that from a firearm. Let us spend some time looking at what can be done: to survive this type of scenario; what we can do to prevent this type of scenario; and what actions should be avoided and why.


You are at a hospital visiting a family member or calling on a patient, and you hear what you think may be gun shots. What do you do next? A very quick assessment needs to be performed. The protocol encouraged by the federal government is “Run, Hide, Fight”. Do you know where the exit is relative to the gunfire? If so running is a probably a good idea as long as the exit is away from the sound of the gunfire. If the noise is between you and the exit, closing the room door and barricading it with anything available would be the appropriate response. Lastly, if the source of the gunfire is so close that you have no choice but to fight, pick up whatever you can and start throwing it at the assailant. Even the act of pretending to throw something will typically elicit a dodging response from the person. Do this repeatedly until you can close the distance between yourself and the shooter and attempt to disable the shooter’s ability to be a threat. Bear in mind, that this is ONLY as a last resort and every option is better than this option. Reasoning with someone like this is not advised. If they are unstable enough to grab a gun, go into a hospital, and start shooting, they are not stable enough to be reasoned with. There is also a chance that their mental state is such that they are not fully aware of what they are doing or the consequences of their actions.


The vast majority of hospital-based active shooter scenarios are targeted type events. The shooter is looking for someone specific and is uninterested in harming anyone other than the intended target unless necessary. Preventing these scenarios is possible in some cases, but preparedness is the best strategy. There are a few key things that can be done to help in prevention, and they are not things that are commonly thought of. The first is just simply being kind. Make sure that you look at people in the eye and ask them how they are doing. If they are normal, they will appreciate the courtesy, and if they are a threat, you will likely sense the threat and can alert security. The next thing that can be done is to look at clothing that is being worn and bags that are being carried. Clothing can be very concealing, and while it is possible for someone to wear a trench coat in Houston in July, it would certainly raise suspicions. Bags are another clue. Many bags today bear logos and if the person is there on business will likely carry a business type bag of some sort. Large duffel type bags are not bags that are likely to be found in the professional work environment of a hospital unless they contain linens. The last thing that can be done to aid in prevention is to make sure your facility has a program that regularly tests and educates the staff. Well trained staff are far more likely to be able to prevent a tragedy of this nature or to reduce its effect.

Actions to avoid

In Texas, it is no secret that many people carry firearms. Most medical facilities prohibit the carrying of these weapons on their campus, and it becomes trespassing to carry your firearm on campus. That being said, many individuals still keep a firearm secured in their vehicle. During preparedness training, the most common incorrect response ends with the trainee going to their car, retrieving their firearm, and claiming to be able to end the active shooter event on their own. This is really a fantasy, though. The reality is that police are now trained to not wait for backup when responding to an active shooter situation and instead are to enter the scene and attempt to limit the casualties, even to the point where they will pass by the wounded to stop the shooter. If that is you walking around with your handgun looking for the shooter, you now look like the shooter and things can only go downhill from here. The best scenario ends with you walking out in handcuffs, and the worst scenario ends with you dead at the hands of either the police or the real shooter.

The next mistake that is common is the thought that you can talk someone that is an active shooter into stopping. There is no reasoning with crazy and/or the criminally insane. Just like in nature, your best hope of survival lies in you looking like a bigger threat than is worth handling. If you are confronted by an active shooter run the other way and if you have no choice, do everything in your power to disable the shooter.

The last major mistake that people can make is failing to act at all. Fear can be paralyzing, and, in this case, that makes you a sitting duck. As you evacuate in these scenarios do everything in your power to take as many people with you as possible, however, do not let someone else’s fear get you killed. If they are adamant about not leaving, you are forced to leave them behind.

Whether it is someone coming to do harm to staff or euthanize a patient, being prepared for the scenario is the most important thing we can do to save lives, including our own. Your facility may not have addressed this very real threat. Take the time to develop a plan and learn about how to handle this type of a threat environment. There are resources available and people willing to help.