Healthcare facilities are places meant to heal, not places meant to harm. But as gun violence skyrockets across the country, medical facilities are far from immune. Violence has seeped into ERs and soiled waiting rooms, and an active shooter in hospital-based settings is news that has been plastered across the headlines far too often. The unique risk profile of medical centers reinforces the importance of addressing hospital shootings by stopping them before they start.
Read on to learn about the practical and thorough approaches to preparedness, the importance of active-shooter-at-hospital preparedness plans, and the innovative technology that could revolutionize safety for staff, patients, and visitors.
Hospital Security Risks and Vulnerabilities
A variety of places are noted for their vulnerabilities when it comes to shootings. These places, such as schools, hospitals, malls, supermarkets, courthouses, churches, and office buildings, tend to share a handful of commonalities, including open floor plans, high-traffic areas, and public access.
Healthcare facilities, however, are among the facilities that stand out for various reasons. These include the following:
- Most hospitals leave doors unlocked during the day and possibly during the night, allowing for easy access
- Less than a third of healthcare facilities have metal detectors (even when they do have detectors, these are frequently limited to emergency rooms, leaving other entrances unguarded)
- Hospitals are filled with defenseless people, including those who are non-ambulatory, recovering from surgery, newly born, elderly, or tethered to machines and IV stands, making it harder or impossible for them to escape, protect themselves, hide, or fight back
- Hospitals help those experiencing high emotions, including grief, anger, and trauma, acting as a boiling point for populations who may already be on edge
- Many hospitals have onsite mental health departments and emergency rooms, making them places frequently visited by those in crisis or under the influence of substances
- Hospitals run on routine, giving a shooter insight into who’s on the clock during specific shifts and what times of day are likely busiest
- Hospitals have their locations and floor plans on their websites, giving a shooter information on the building’s layout, entrances and exits, and stairwells, as well as the hospital’s proximity to police stations
- Hospitals have waiting rooms packed with people, which creates a high-target area for both mass shootings and hostage situations
- Hospitals contain all sorts of floors, closets, and empty rooms, providing ample places to hide and fostering confusion during crises
- Hospital policies typically ban staff from carrying concealed weapons, compromising their ability to defend themselves and their patients
Where do Most Hospital Shootings Occur?
Shootings have happened in nearly all areas of hospitals and medical facilities, including exam rooms and surgical suites. Nonetheless, the most common places for these types of shootings include the following:
- Emergency rooms, which account for as many as 29% of hospital shootings
- Parking lots, garages, and outside hospital grounds, which account for up to 23% of incidents
- Patient rooms and corridors, which account for up to 19% of incidents
- Operating rooms and ICUs account for the fewest number of incidents, but they do occur
Emergency departments are most vulnerable because they’re accessible 24 hours a day, tend to be the most tension-filled area, and allow for interaction between the shooter and the victims; emergency departments are also the most likely location for drug-related and alcohol-related shootings. Outside areas are nearly just as vulnerable because they’re so accessible, with effectively nothing standing in the way of a shooter and a hospital parking lot.
Patient room shootings happen as well, especially when the shooter has an intended target in mind (this type of shooting is common in domestic violence situations, for example). Operating rooms and ICUs are the least exposed areas because they’re typically restricted, requiring a badge or ID. Even so, a shooter may access these areas when they hold a grudge against a particular surgeon or other medical professional. Surgical suites are especially prone to hostage situations, as they’re full of typically unconscious patients and the doctors and nurses who’ve vowed to protect them.
Recent and Previous Examples of Shootings at Hospitals
Hospital active shooter incidents are not rare; between 2000 and 2019, 146 such shootings occurred, with an increase noted over time.
In the past 10 years, several high-profile incidents have taken place, including the following:
Florida Incident in 2016
In 2016, a gunman named David Owens entered Parrish Medical Center in the middle of the night through the emergency room doors. He then went up to the third floor, where he shot and killed an 88-year-old patient and a 36-year-old employee. It’s believed that he didn’t know either victim; he simply chose them at random.
New York City Incident in 2017
In 2017, a disgruntled doctor went to his former workplace armed with an AR-15 rifle. He killed a fellow physician and wounded six others before turning the gun on himself. Henry Bello, the identified shooter, had previously worked at Bronx-Lebanon Hospital Center before he quit amid sexual harassment allegations.
Cincinnati Incident in 2017
In 2017, a gunman entered the University of Cincinnati Hospital and shot an unarmed security guard at the facility’s entrance, resulting in serious but survivable injuries. The shooter, Isaiah Currie, then committed suicide in the hospital lobby.
Chicago Incident in 2018
In 2018, a gunman, identified as Juan Lopez, entered Mercy Hospital and Medical Center and shot and killed an attending physician, a police officer, and a pharmacy resident; one of the victims was his ex-fiancée. Lopez later died in a shootout with police officers responding to the scene.
Colorado Springs Incident in 2019
In 2019, a 72-year-old man named Yuzef Ocheretinsky shot his 74-year-old sister, Victoria Ocheretinsky (a patient at the hospital), in an incident described as a murder-suicide between siblings. The incident occurred in the patient’s room during the middle of the afternoon.
Minnesota Incident in 2021
In 2021, Gregory Ulrich, an ex-patient with a history of mental health challenges, entered Allina Health Medical Clinic in Buffalo, Minnesota. Allegedly angry that he’d been cut off from his opioid medication, he opened fire and injured five people, one fatally. He also attempted to set off two explosive devices, but they failed to detonate.
Tulsa Incident in 2022
In 2022, Michael Louis, armed with a handgun and AR-15 rifle, entered the orthopedic center at Saint Francis Health System’s Natalia Medical Building and shot and killed four people. He blamed one of the victims, a doctor, for his chronic back pain following surgery. Louis then died by suicide.
Dallas incident in 2022
In 2022, a domestic violence incident escalated into a shooting on the maternity floor of the Methodist Dallas Medical Center. Nestor Hernandez, the gunman, had accused his girlfriend of cheating on him and hiding someone in her hospital room moments earlier. He started pistol-whipping her before opening fire and killing a nurse and a social worker (two others were wounded).
Atlanta Incident in 2023
In 2023, Deion Patterson, who’d recently been discharged from the US Coast Guard and had a known history of mental health struggles, opened fire in an 11-floor waiting room inside the Northside Medical Midtown building. He killed one woman and injured four others after becoming enraged. Although he initially got away, escaping by carjacking the driver of a pickup truck, he was arrested eight hours later.
Pennsylvania Incident in 2025
In 2025, Diogenes Archangel-Ortiz, who was grieving the death of his partner, entered the ICU of UPMC Memorial Hospital and took several people hostage, shooting and wounding three of them. He died in an exchange of gunfire with law enforcement; a young police officer also died. Top of FormBottom of Form
Comprehensive Approach to Being Prepared for a Hospital Shooting
Training Protocols
Preventing hospital shootings starts with proper training. Procedural and must-have training should focus on the following:
- Basic emergency response
- Evacuation procedures
- Active shooter in hospital drills
- De-escalation training (more on that below)
Emergency Departments
Emergency departments serve as the first point of contact for patients in crisis, those experiencing a possibly life-or-death medical episode, and those experiencing mental health or substance abuse issues. They may also be the only way to enter a hospital after hours, as locking the main entrance and other doors is standard practice. Preparedness plans should consider the ER’s unique entry point and associated risks. A few things to consider include the following:
- Hiring armed or unarmed security
- Using metal detectors or protective partitions
- Employing round-the-clock or on-call social workers, psychologists, and other mental health professionals
- Enacting policies that limit visitors to daytime hours (many hospitals already do this, although some hospitals allow visitors at any time but may require them to enter the facility through the ER doors)
- Creating diverse protocols for after-hours care, such as requiring patients to ring a doorbell rather than entering unchallenged
- Implementing lockdown procedures for if and when an incident occurs
- Installing CCTV cameras that are monitored in real-time and panic buttons
Active Shooter Response Planning
Comprehensive response plans that include clear reactive procedures, evacuation routes, and designated safe zones should be implemented. Regular simulation drills help staff understand their roles in crisis and life-or-death situations and improve response times while saving lives. Consulting with a local police officer or agency can introduce authenticity and reality to these drills, as law enforcement has tactical experience and may help mimic the visceral stress and urgency experienced in a real situation.
De-Escalation Training
In active shooter situations, de-escalation is often only appropriate when there is no practical means of escape. Nonetheless, this type of training is becoming increasingly crucial to preventing shootings as well as other types of violence and aggression-based behaviors. Those trained in de-escalation utilize emotional intelligence, self-awareness, communication skills, non-threatening language, active listening, and controlled body language to bring unpredictable and dangerous behavior down to a safe and manageable level.
When dealing with an active shooter, someone trained in de-escalation may do the following:
- Maintain their composure
- Avoid sudden movements
- Use a calm speaking voice, simple phrases, and language that does not threaten the perpetrator
- Acknowledge feelings and emotions from a nonjudgmental and humanized place
- Use the perpetrator’s name if known, which can make things feel more sincere
- Offer non-coercive solutions that don’t come across as commands
- Watch for signs of escalating behaviors
- Attempt to delay, allowing police officers or EMS to arrive
- Stand near an exit or barrier, if possible, which enhances safety
Partnerships with Law Enforcement
Fostering strong relationships with police departments and other law enforcement agencies makes it easier to be adequately prepared. A few of the benefits of these partnerships include the following:
- Coordinated response planning
- Sharing intelligence and valuable information
- Joint training exercises
- Insight into how hospitals and medical centers can improve their security and reduce risk
- Faster access to new and novel safety technology
Other Resources Available to Hospitals
Hospitals may have access to additional resources, depending on their location. These external sources may include:
- State or regional healthcare organizations and coalitions
- State or Federal emergency management agencies
- State or Federal preparedness programs
- Local advocacy groups
- Grassroots groups
Employee and Patient Safety and Well-Being
Last but not least, the psychological and physical well-being of staff and patients is a vital element of proper preparedness; after all, people are at the heart of all of this. To center well-being in a preparedness approach, include initiatives that address the following:
- Mental health support
- Staff wellness programs
- Panic alert systems
- Safe spaces during or after emergencies
- Visible safety guidelines
Encouraging staff members to convey their concerns (a “see something, say something” approach) gives employees a voice and makes them direct participants in keeping themselves and their patients safe.
Building a Layered Approach to Hospital Security
Adopting a Multi-Step Process
Choosing the right hospital security systems is a multi-step process that may first include the following:
- Identifying the high-risk areas most vulnerable to shootings (as previously mentioned, this includes the ER and parking lots, but may also encompass mental health clinics and psych wards)
- For hospitals located in increasingly dangerous areas consider metal detectors and at vulnerable entrances or even bulletproof windows if applicable at your hospital
- Analyzing any past incidents to determine what worked and what didn’t
- Working with law enforcement or safety consultants to explore any potential gaps in safety and evacuation plans
- Implementing ALICE Training and Run. Hide. Fight. Strategies.
Perfecting Hiring Practices
Engaging in smart hiring practices is also crucial. This may include:
- Performing thorough background checks on security guards and other personnel
- Verifying licensing
- Weighing the pros and cons of armed security versus unarmed
- Hiring doctors and nurses trained or willing to be trained in de-escalation practices and crisis management
Considering Customization and Scalability
To ensure security customization is fitting for the individual needs of a specific hospital, consider the following:
- Look for services that can scale up when needed, such as during shootings (but also during things like natural disasters)
- Tailor emergency preparedness plans to the layout of the medical facility (considering things like exit doors and possible safe rooms) rather than creating general, one-size-fits-all documents
- Review safety and security features annually to adopt new changes to things like recently built wings, remodeled parking structures, and new patient or staff policies
Embracing Innovative Technology
Embracing groundbreaking technology is among the most essential things hospitals can do to address the threat of active shootings. Breakthroughs in AI and gun detection systems empower companies like Omnilert to stop shootings at the most crucial time: Before they happen.
Overall, this type of technology can do the following:
- Scan camera feeds in real-time in search of firearms
- Use large datasets to determine if an object is a gun or something benign, such as a cellphone or wallet
- Scrutinize potential firearms by looking at things like shape, contour, color, finish, and size
- Analyze body language, how the object is being held, other items present (i.e., tactical gear), and more
- Use human intelligence to verify any flagged gun threat and escalate accordingly
- Automatically activate safety systems, which notify nearby first responders and allow for a faster response
Recent Legislation Regarding Hospital Security
California Assembly Bill 2975
California’s Assembly Bill 2975 was passed in 2024 after a rise in violence, especially gun violence, in medical settings. This bill serves as an amendment to the California Occupational Safety and Health Act of 1973 and is designed to enhance workplace safety through violence prevention. Per the bill, OSHA must adopt standards mandating weapons detection screenings in California hospitals; these policies must be put into effect by March 1, 2027, and include the following:
- Weapon detection devices (outside of metal detectors) at specific entrances, including the main entrance, the ER entrance, and the labor and delivery entrance (if applicable)
- Personnel trained in operating these devices
- Options for patients, staff, and visitors who request and/or require alternative screening methods
- A plan of action for when weapons are detected
- Public signage that notifies the public about these screenings
Ohio House Bill 452
House Bill 452 mandates hospitals to develop workplace violence prevention plans, conduct security risk assessments, and ensure trained personnel are present in emergency and psychiatric departments.
Vermont House Bill 259
Vermont’s House Bill 259 requires hospitals to create security plans in consultation with medical staff and law enforcement, designate trauma-informed care liaisons, and implement incident reporting systems.
Washington House Bill 1162
House Bill 1162 enhances existing workplace violence prevention laws by requiring annual safety plan updates and detailed reviews of incident data.
Continuous Improvement and Evaluation for the Healthcare Industry
The increase in gun violence continues to expose vulnerabilities in public places, with hospitals being among the locations most at risk. Not only are hospitals easy to access, but they’re full of open and predictable layouts and people who may be bedridden and unable to escape. They’re also frequented by those in crisis, experiencing mental health issues, tension, or grief, or under the influence of drugs and alcohol. This makes medical facilities prime places to perfect preparedness through trend analysis, law enforcement feedback, annual evaluation, innovation, and guided improvements.
Established and emerging technologies will undoubtedly make this easier, allowing hospitals to efficiently protect their staff and patients and save lives in more ways than one.
Frequently Asked Questions (FAQs)
What makes hospitals especially vulnerable to active shooter incidents?
Hospitals are high-traffic, emotionally charged environments with open access, limited security at some entrances, and a population that includes vulnerable patients. These factors, combined with predictable routines and occasional visitor volatility, make hospitals uniquely at risk.
Where do most hospital shooting incidents occur?
Most hospital shootings occur in emergency rooms (about 29%), parking lots or hospital grounds (23%), and patient rooms or corridors (19%). ERs are especially vulnerable due to 24/7 access and emotional tension.
How can hospitals improve preparedness for active shooter events?
Hospitals can strengthen their preparedness by implementing regular staff training and simulations, conducting risk assessments, adopting clear emergency protocols, and forming strong partnerships with law enforcement. Integrating technologies like AI-based weapon detection also enhances early intervention capabilities.
What technologies can help prevent hospital shootings?
Innovative technologies like AI-powered visual gun detection, real-time alert systems, panic buttons, and surveillance integrations help hospitals identify threats faster and automate emergency responses before shots are fired.
Are hospitals considered gun-free zones?
Not always. Whether a hospital is a gun-free zone depends on state laws and the facility’s policies. Many hospitals ban firearms on-site, especially in sensitive areas, but enforcement varies.
