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Active Shooters in Healthcare SettingsJulie MitchellMcKendree UniversityActive Shooters in Healthcare SettingsOver the last two decades there have been an increasing number of incidences of active shooters in the United States, healthcare workers need to have a heightened sense of awareness of this potential risk. “An active shooter is defined as an individual actively engaged in killing or attempting to kill people in a confined or populated area” (Palestis, 2016, p. 74). While the incidence of active shooters remains less common in a hospital setting, they are becoming a more common occurrence in hospitals within the United States (Palestis, 2016). Many Emergency Departments across the county have 24-hour access with easy entry, for this reason they are one area at increased risk. The importance of ongoing training and drills should be discussed in all departments, with the nurses and staff in the Emergency Department being a primary focus. Problem StatementBecause active shooter events in the United States has become much more common place, it has become necessary for hospitals and healthcare facilities to have emergency plans in place to minimize damage, injuries and deaths. “From January 2000 – December 2011, there were 154 hospital related shootings in 148 different hospitals, resulting in 235 victims…Most occurred within the emergency department (34%) or patients’ rooms (32%)” (Hodge & Nelson, 2014, p. 268). On going training and improved response time to active shooter events in the hospital setting remains imperative for the safety of both staff and patients. Goldstein, 2018). For this reason, hospital staff and healthcare workers need to have an increased awareness and preparedness in the event of an active shooter. Over the last decade there has been a dramatic increase in active shooter events, with 51% occurring in hospitals having less than 40 beds, leading to the conclusion that smaller hospitals may be easier to maneuver and have less security (Bhimji & Goldstein, 2018). Rural hospitals tend to fall into this category. Most of the hospitals in rural communities are critical access facilities with minimal staff on duty especially at night. Many do not have armed security. Healthcare staff examining and understand what can trigger the problem and who commits these crimes remains important (Palestis, 2016). Impact of Problem Hospitals face a challenge when it comes to an active shooter event. The uniqueness of a hospital setting with multiple points of entrance make it difficult to predict where an event might take place. As with many facilities the Emergency Department is often in the initial line of danger because it is a high flow traffic area and has ease of access. Effective training and awareness of who and what to look for is incredibly important. Understanding the types of violence taking place also maintain importance. According to Bhimji & Goldstein (2018), law enforcement classifies active shooting events into five categories:Type 1, or criminal intent, in which the shooter holds no connection with the workplace. This type of shooter usually has a chief motive of left. This type remains unheard of in healthcare.Type 2, or customer/patient, commonly experienced with psychiatrist and social workers due to a disagreement between the patient, employee or customer.Type 3, or worker-to-worker, accounting for about 7% of all workplace homicide, as a result of workplace conflicts.Type 4, or domestic violence, where the shooter is an acquaintance or spouse, and can occur in the workplace, usually during the process of a separation or restraining order. Type 5, or ideological, in which the perpetrator develops ideas and intends to produce mass violence, usually on innocent people (p.2-3). In an active shooter event, the Federal Bureau of Investigations (FBI) instructs anyone facing a shooter to do one of three things: run, hide, or fight (Palestis, 2016). The first option includes running or moving quickly away from the shooter. However, this can cause an ethical dilemma for healthcare workers when faced with the problem of saving themselves or saving patients. The second option, hiding, may not be possible depending on the area of the event. Most medication rooms are locked and offer protection, but space is limited. The last option is to fight the shooter but only as a last resort. The Emergency Nursing Association recommends that Emergency Departments participate in active shooter training exercises. On recommendation from participant in active shooter trainings drills should include:Mandatory attendance for staffWell-trained actorsFlexibility in location within the healthcare settingAvailability of trained staff to participate in a debriefing after drillsOngoing opportunities for active shooter training for new staff (Sanchez, Young, & Baker 2018). Preparedness for an active shooter event remains necessary. Healthcare facilities must be prepared before an event occurs. The importance of identifying triggers, understanding who commits these acts, and assessment and intervention of potential triggers needs to be understood by healthcare staff. Quality education is key to providing safety for patients, staff, and visitors alike in a healthcare setting. The purpose of this paper explores research-based evidence of the best practices for staff, patient safety, and cost incurred from this very real and traumatic issue. Nurses, being an important aspect in patient and staff safety in an active shooter event, need to be prepared and ready to respond, as most of these traumatic events are over before law enforcement arrives (Sanchez et al, 2018).