Should physicians carry guns? — The realities of violence in healthcare facilities

On January 20, 2015, a patient's son shot and killed renowned surgeon and expecting father, Michael J. Davidson, MD, at Brigham and Women's Hospital in Boston. Dr. Davidson worked at the hospital for nine years prior to his untimely death. The assailant's family told the media the gunman killed the cardiothoracic surgeon after Dr. Davidson treated his mother and she passed away. Dr. Davidson's death had many healthcare professionals concerned and some questioned whether healthcare professionals should carry guns.

Unfortunately, Dr. Davidson's death was not an isolated incident. Medical professionals have more to fear than the operating room. Recent data reveals the average number of shooter incidents in the hospital setting have increase from nine active shooter incidents per year from 2000 to 2005 to 16.7 active shooter incidents per year from 2006 to 2011, according to The Journal of American Medical Association. There is cause for concern, but physicians are divided on the best way to protect themselves.

"I take care of patients who are the victims of assaults, stabbings and shootings. Often times rival gang members or those inflicting violence upon the patient come to the hospital seeking to cause further damage," says Akram Alashari, MD, of Grand Strand Regional Medical Center in Myrtle Beach, S.C. "It is important that the physician be able to defend him or herself, especially in the setting when the patients or their family members displace their anger towards their physician."

The Centers for Disease & Control reported the most common form of violence in healthcare is from a disruptive patient or a patient's family member. Healthcare workers reported an estimate 9,200 workplace violence incidents that required time away from the workplace to recover. The majority of these crimes involved a patient or a patient's family member.

While some physicians feel a gun is a pertinent measure in protecting themselves and others, other physicians feel the violence is sensationalized and guns are not prudent to feel safe in the workplace.

"If you look at the number of patients that are seen and the number of encounters we have, it's unusual for violence to occur. I've never felt threatened walking into our inner city hospital," says Kern Singh, MD, of Minimally Invasive Spine Institute at Rush in Chicago, where gang violence is also prevalent. "At the end of the day, when people do something, there is serious mental illness there. Even with security, if someone wants to cause trouble they can."

In 2014, a man unhappy with his mother's treatment entered Good Shepherd Ambulatory Surgical Center in Longview, Texas, and attacked visitors and employees. He stabbed one nurse to death as she tried to protect patients, according to a CNN report. There were four others injured during the attack.

Protocols for violence in healthcare facilities
Shootings can happen anywhere and anytime, and hospitals and other healthcare facilities have certain protocols in place to ensure they are able to best protect themselves. In July 2014, The Joint Commission released an advisory on preparing for active shooter situations. The Joint Commission suggests developing a plan to assist local law enforcement; communication plans; procedures for employee and patient safety; and plan for post-event activities.

The protocols advise healthcare facilities to establish the primary communication method with local law enforcement as well as an emergency hotline with a recorded message for employees when developing the communication plan. The facilities should then devise a process and procedure to lockdown the building to prohibit walk-in traffic after the event occurs. The process and procedure for patient and employee safety includes:

  • Figure out how to account for all patients and employees during the incident
  • Outline how to handle critical patients during the event, especially in the case of evacuation
  • Take loss of service into consideration; it may not be possible to access some operations for up to 10 hours after the event as the facility becomes a crime scene

Hospitals and other healthcare facilities should conduct drills for employees so they are comfortable with their reactions. Depending on the situation, reactions could include running away to notify authorities, hiding in a safe place, barricading patients into a certain area so the shooter can't reach them or fighting if the shooter confronts them. After the incident, healthcare facilities should hold debriefings for surgeons, staff and the media and manage fear among patients, staff and community leaders.

Protocols are a necessity, but sometimes, no protocol can sufficiently prepare a facility for the unimaginable. Violence does and can occur at any time, especially when caring for mentally unstable patients.

"In general, physicians who deal with patients who are mentally stable do not need to carry firearms or other weapons. However, troubled patients may warrant an increased situational awareness," says Joe Alton, MD, author of The Survival Medicine Handbook. "Physicians who routinely deal with the unstable or have been threatened by patients might have to consider some form of personal protection. Alternatively, a security presence provided by the local hospital or law enforcement might serve as a more effective deterrent."

In 2014, there were 14 active shooter incidents that occurred in hospitals throughout the United States, according to The Journal of the American Medical Association. But would surgeons carrying guns deter violence or prevent casualties?

"I have no doubt physicians in the ER are much safer not carrying guns," says Stuart Spitalnic, MD, an emergency medicine physician practicing in Newport, R.I. "If you work in such a place where it is prudent to have armed security, so be it, but either the patients can be taken care of, or you can be concerned for personal safety. Neither will be done effectively if you are trying to do both. I, and I'm sure most in my position, would not want to work in a place where another doctor was carrying."

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