‘Secure, Preserve, Fight’ has been proposed as an alternative way to respond to active shooters in healthcare settings when ‘Run, Hide, Fight’ is not possible. Here are the specific details of this approach. By Dr. Charles Denham II, Dr. Gregory Botz, Charles Denham III and William Adcox

ACTIVE SHOOTER INCIDENTS have been on the rise throughout the United States. The most recent FBI data has identified 250 active shooter inci- dents between 2000 and 2017, in which 799 people were killed and an add- itional 1,418 were wounded. In the first half of that period, there was an average of 6.7 incidents per year. That number has tripled to over 20 incidents per year in the second half of that period. Four percent (10) were in healthcare organ- izations.

Additionally, the Annals of Emergen- cy Medicine published a 2012 study that examined all U.S. hospital shootings be- tween 2000 and 2011 in which there was at least one injured victim. It identified 154 incidents in 40 states
causing death or injury to a staggering 235 people.
Active shooter events at healthcare facilities are different from schools, shopping malls and commercial bus- inesses for several important reasons:

1. The active shooter’s motives usually are much more personal, targeted and focused.
2. Necessary security measures are often harder to undertake.
3. Healthcare providers feel compelled to stay with their patients.
4. Certain patients will die without continued life support in ICUs and operating rooms.
5. Certain areas of hospitals are not easy to harden or evacuate.
6. Most hospitals are organized vertically and rely heavily on elevators.
7. Emergency departments may lock down or shut down during an event.
8. The violence could end in less than 10 minutes, but the healthcare deliv- ery disruption could be prolonged.
9. Many healthcare shootings occur at entrances or just outside buildings.
10. Healthcare facilities cannot easily shut down for training.

In last summer’s excellent article by K. Inaba et.al in the New England Journal of Medicine (NEJM) titled “Active-Shooter Response at a Health Care Facility,” the authors framed a number of key issues that are summarized and updated below. They say the “run, hide, fight” response to an active shooter may work in many venues and for certain areas of hospitals, but healthcare facilities should consid- er a different approach for areas where “run, hide, fight” is not possible. Certain caregivers who are caring for vulnerable patient populations such as children, the elderly and those relying on life support systems need an alternative approach. K. Inaba et. al’s proposed alternative is for