Foresight and planning by a Florida hospital prevented a random shooting from escalating even further. Patient Cynthia Zingsheim, 92, and health care aide Carrie Rouzer, 36, were shot and killed July 17 for no apparent reason by an armed man who entered Parrish Medical Center in Titusville, Fla.

Law enforcement officials credited the hospital’s active shooter plan, established in 2008, and brave security guards who confronted and held the assailant until police arrived, with averting further casualties. “I cannot stress enough [that] the response of the Parrish Medical Center staff, without a doubt, saved more lives,” Titusville Police Chief John Lau said.     

Joint Commission accreditation standards do not specifically require hospitals to develop an active shooter policy, but its Environment of Care guidelines do require hospitals to identify safety and security risks to determine the specific hazards that they may encounter. Hospitals then must take action to reduce the. If a hospital determines that it may face a threat from an active shooter, it must have a response plan in place.

According to a 2012 study in the Annals of Emergency Medicine, hospitals faced about nine active shooter incidents a year between 2000 and 2005. The rate climbed to 16.7 a year between 2006 and 2011.

How to establish an active shooter plan was the topic of a highly attended general session at the 53rd annual American Society for Healthcare Engineering Conference and Technical Exhibition in Denver in July.

Panelist Constance Packard, executive director of support services, Boston Medical Center/Boston University Medical Campus, outlined a series of best practices her hospital developed, including:

  • Assessing risks and vulnerabilities at least annually.
  • Developing a plan for prevention and response that emphasizes ongoing staff training and establishing a crisis response team.
  • Collaborating with local law enforcement.

Panelist Thomas Smith, president of Healthcare Security Consultants, emphasized steps to prevent an active shooter situation: assess access control plans, identify who belongs in the facility, and train staff to report suspicious or unusual behavior. He encourages hospitals to appoint a threat assessment team.

Parrish Medical Center stepped up its security measures after conducting a vulnerability assessment. It now maintains a law enforcement presence and enhanced security at public entrances, restricts public access to the main entrance and emergency department by requesting identification, and conducts random bag checks. Security officers are now armed with additional protective equipment and gear and are receiving more training. Parrish also is considering installing metal detectors and other equipment.